Study: Inpatient Sickle Cell Consult Service Improves Pain Management and Hospital Metrics

In a retrospective analysis of data from 2 years after the implementation of a specialized inpatient sickle cell disease (SCD) consult service at the University of Chicago Medical Center, researchers found the service led to improved pain management, higher engagement with SCD-specific care, and reduced hospital stays for patients with SCD.

SCD is a genetic hematologic disorder that often leads to frequent and prolonged interactions with the health care system for patients, yet few comprehensive SCD care centers are available. Despite the recognized need for specialized care, few institutions offer multidisciplinary services to support patients with SCD. The University of Chicago team aimed to address these disparities by developing an inpatient SCD consult service designed to provide consistent, high-quality pain management and the initiation of disease-modifying therapies such as hydroxyurea. This initiative also aimed to track health care utilization metrics to assess its effectiveness and sustainability.

The service, which began in July 2022, was composed of advanced practice providers working with a combined medicine-pediatrics physician team who created individualized pain management plans (IPPs) for each patient admitted with SCD-related complications. The consult team also provided education to the primary care teams and guided the initiation of disease-modifying treatments. The impact of this service was evaluated by reviewing electronic medical records (EMRs) for patients with SCD admitted to the hospital during the first 2 years of the program. The researchers assessed the number of consult requests, the adoption of IPPs, the average length of stay (LOS), and the number of hospitalizations.

During a 2-year period, the consult service increased its consult requests by 115%, from 214 to 462, and the percentage of SCD admissions with a consult order placed rose from 44% to 81%. The use of IPPs for managing SCD-related pain also increased by 74%, with 80% of patients now carrying an IPP during admission. The average LOS for patients decreased by 17.9%, from 7.8 days before the service was implemented to 6.6 days by the second year.

The researchers note that the analysis was conducted as part of a quality improvement initiative, so it did not undergo formal review by an institutional review board. Challenges such as staffing and funding also remain a concern, which could hinder the long-term sustainability of the consult service.

“Despite the challenges in delivering health care to patients living with SCD, creative approaches involving multidisciplinary teams may provide a tenable solution,” the study authors concluded. “By utilizing a small group of providers dedicated to improving outcomes for patients with SCD, this program has provided a framework for delivering standardized care.”

Reference

Thomas R, Bundy A, Giannini J, et al. Pain management in patients with sickle cell disease through an inpatient sickle cell disease consult service. Paper presented at: American Society of Hematology Annual Meeting; December 7-10, 2024; San Diego, CA. Accessed November 26, 2024. https://www.hematology.org/meetings/annual-meeting