SHM Converge Scientific Abstract ePoster Gallery-Improving Care of Hospitalized Patients With Sickle Cell Disease

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This study examined hospitalized patients with acute sickle cell disease (SCD)-related illness, who initially had worse outcomes than other hospital medicine patients, including longer length of stay, much higher 7-day and 30-day readmission rates, and more against-medical-advice (AMA) discharges.<br /><br />To improve care, the team introduced an electronic medical record (EMR)-embedded clinical decision support algorithm designed to standardize evidence-based management. The pathway emphasized early evaluation for complications, early consultation with hematology and social work, prompt and aggressive pain control with frequent reassessment, de-escalation strategies for pain treatment, and deliberate discharge planning.<br /><br />The intervention was evaluated using a pre-post comparison of all relevant encounters identified through validated ICD-10 codes during the year before and after implementation. The key findings were:<br /><br />- 7-day readmission rates decreased significantly after implementation.<br />- AMA discharges also decreased significantly.<br />- Social work consults increased significantly.<br />- Hematology consults showed a trend toward increase.<br />- Length of stay and 30-day readmission rates did not significantly improve.<br />- The algorithm was used in only about one-quarter of eligible encounters.<br /><br />The authors concluded that standardized care algorithms can improve meaningful outcomes even with imperfect adoption. However, their data were limited to one institution, and the sample size was too small to assess the impact of specific subgroups or determine which parts of the algorithm were most effective.<br /><br />Future work should focus on increasing algorithm adoption, evaluating which pathway components drive the best outcomes, and strengthening post-discharge and multidisciplinary support during transitions of care.

Asset Subtitle

Sarah Scarpato

Meta Tag

Author List Angela Keniston, Anunta Virapongse, Eric Grimm, Kathryn Hassell, Kevin Sullivan, Sarah Scarpato

Category Innovations

Concept Clinical Decision Support

Concept Acute Sickle Cell Disease-Related Illness

Concept Sickle Cell Disease Inpatient Care Pathway

Concept Clinical Algorithms

Concept Standardized Care

Distinguished Non-Finalist

Presenter Organization University of Colorado Hospital

Presenting Author Sarah Scarpato

Track Quality Improvement

Keywords

sickle cell disease

hospitalized patients

clinical decision support

electronic medical record

readmission rates

against-medical-advice discharges

standardized care pathway

hematology consult

social work consult

pain management

Clinical Decision Support

Acute Sickle Cell Disease-Related Illness

Sickle Cell Disease Inpatient Care Pathway

Clinical Algorithms

Standardized Care