J Healthc Qual. 2022;44(1):50-58. doi: 10.1097/JHQ.0000000000000292.
Vaso-occlusive pain leads to high acute care utilization among patients with sickle cell disease (SCD). Data suggest that clinical pathways (CPWs) reduce variation in the management of vaso-occlusive pain and improve clinical outcomes.
We implemented and evaluated a CPW for vaso-occlusive pain at our institution using a before and after study design. The primary objective was to decrease acute care utilization among patients with SCD, which was assessed by the primary outcome measures of hospital length of stay (LOS), 30-day readmission rate, and total hospitalizations annually per patient. Secondary outcome measures were packed red blood cell transfusions, and acute chest syndrome incidence. Patient-controlled analgesia use and promethazine use were assessed to estimate CPW use.
Three hundred fourty-four admissions in 112 patients were analyzed, of which 193 admissions occurred pre-CPW and 151 admissions occurred post-CPW implementation. Post-CPW implementation, we observed a significant decrease in hospital admissions annually per patient, an increase in patient-controlled analgesia use, and a decrease in intravenous promethazine use. We observed trends toward decreased 30-day readmission rate and increased acute chest syndrome incidence, which were not statistically significant. No effect was found on hospital LOS.
Clinical pathway implementation at our institution reduced variation in management and decreased hospital admissions for vaso-occlusive pain.
镰状细胞病（SCD）患者的血管阻塞性疼痛会导致高急性护理利用率。数据表明，临床路径（CPW）可减少血管阻塞性疼痛管理中的变异性，并改善临床结果。
我们使用前后研究设计，在我院实施并评估了血管阻塞性疼痛的 CPW。主要目标是通过评估主要结局指标住院时间（LOS）、30 天再入院率和每位患者每年的总住院次数，来减少 SCD 患者的急性护理利用率。次要结局指标为红细胞悬液输注和急性胸痛综合征发生率。评估患者自控镇痛（PCA）和苯海拉明的使用情况来估计 CPW 的使用情况。
共分析了 112 例患者的 344 次住院情况，其中 193 次住院发生在 CPW 实施前，151 次住院发生在 CPW 实施后。CPW 实施后，我们观察到每位患者每年的住院次数显著减少，PCA 使用增加，静脉用苯海拉明使用减少。我们观察到 30 天再入院率降低和急性胸痛综合征发生率增加的趋势，但无统计学意义。CPW 对住院 LOS 没有影响。
我院实施 CPW 减少了血管阻塞性疼痛管理中的变异性，并降低了因血管阻塞性疼痛的住院次数。
