Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; and.
Yale New Haven Hospital, New Haven, Connecticut.
Pediatrics. 2019 May;143(5). doi: 10.1542/peds.2018-2218. Epub 2019 Apr 3.
Frequent hospitalizations for sickle cell disease (SCD) vaso-occlusive crises (VOCs) are associated with school absenteeism, emotional distress, and financial hardships. Our goal was to decrease hospital days for VOC admissions by 40% over a 5-year period.
From October 2011 to September 2016, a multidisciplinary quality-improvement project was conducted with a plan-do-study-act methodology. Five key drivers were identified and 9 interventions implemented. Interventions included individualized home pain plans, emergency department and inpatient order sets, an inpatient daily schedule, psychoeducation, and a biofeedback program. High users (≥4 admissions per year) received an individualized SCD plan and assigned mental health provider. We expanded the high-use group to include at-risk patients (3 admissions per year). Data were analyzed for patients ages 0 to 21 years admitted for VOC. Hospital days were the primary measure; the 30-day readmission rate was the balancing measure.
A total of 216 SCD pediatric patients were managed in 2011 with a 14% increase over 5 years. A total of 122 patients were admitted for VOC. Hospital days decreased by 61% from 59.6 days per month in the preintervention period to 23.2 days per month in the postintervention period ( < .0001). Length of stay decreased from 4.78 (SD = 4.08) to 3.84 days (SD = 2.10; = .02). Among high users, hospital days decreased from 35.4 to 15.5 days per month. The thirty-day readmission rate decreased from 33.9% to 19.4%. Overall savings in direct hospital costs per year were $555 120.
A dedicated team effort with simple interventions can have a significant impact on the well-being of a patient population and hospital costs.
镰状细胞病（SCD）血管阻塞危象（VOC）频繁住院与学生缺课、情绪困扰和经济困难有关。我们的目标是在 5 年内将 VOC 入院的住院天数减少 40%。
从 2011 年 10 月至 2016 年 9 月，采用计划-实施-研究-行动方法进行了多学科质量改进项目。确定了五个关键驱动因素并实施了 9 项干预措施。干预措施包括个体化家庭疼痛计划、急诊和住院医嘱集、住院日常安排、心理教育和生物反馈计划。高使用者（每年≥4 次住院）接受个体化 SCD 计划和指定的心理健康提供者。我们将高使用组扩大到包括高危患者（每年 3 次住院）。分析了年龄在 0 至 21 岁之间因 VOC 住院的患者数据。住院天数是主要衡量标准；30 天再入院率是平衡衡量标准。
2011 年共管理了 216 名 SCD 儿科患者，5 年内增加了 14%。共有 122 名患者因 VOC 住院。与干预前的每月 59.6 天相比，住院天数减少了 61%，降至每月 23.2 天（<0.0001）。住院时间从 4.78（SD=4.08）缩短至 3.84 天（SD=2.10；=0.02）。在高使用者中，住院天数从每月 35.4 天减少到 15.5 天。30 天再入院率从 33.9%降至 19.4%。每年直接住院费用的总体节省为 555120 美元。
一支专门的团队通过简单的干预措施，可以对患者群体的健康和医院成本产生重大影响。
