Program Expansion of a Day Hospital Dedicated to Manage Sickle Cell Pain

Background: Vaso-occlusive crisis (VOC) is the hallmark complication of sickle cell disease (SCD). The majority of SCD-related healthcare costs in the United States, estimated at $2.4 billion annually, is attributed to frequent emergency room (ER) visits and hospitalizations due to recurrent VOC (1-3). A day hospital (DH) dedicated to manage uncomplicated VOC reduces admission rates, decreases length of stay (LOS) for inpatient admissions, and saves hospital costs (4 , 5). Most DH programs have hours of operation from 9 am to 5 pm, and programs with extended hours are limited. The impact of extended hours of DH programs on patient care is less clear.

Methods: The Comprehensive Sickle Cell Center at the University of Illinois at Chicago (UIC) started a DH program to manage uncomplicated VOC in 2009 that was open from 8 am-5 pm Monday through Friday. To improve patient access and decrease the burden on the ER, the hours of operation were increased to 8 am-11 pm in February, 2014. Data on VOC-related patient visits to the DH and ER and admissions to the inpatient floors for calendar years 2012- 2016 were collected from the electronic medical record and evaluated. Descriptive statistics, the Cochrane trend test and Jonckheere-Terpstra trend test were used for data analysis.

Results: The number of the DH visits increased from 208 visits in to 1058 visits in 2016. The proportion of the DH visits compared to the ER visits during the same time period showed a trend of significant increase (p<0.0001; Figure 1A). The numbers of unique patients served in the DH (66 in 2012 to 164 in 2016) also had a greater progressive increase compared to in the ER (115 in 2012 to 185 in 2016) (p=0.0012; Figure 1B). With increasing utilization of the DH, the inpatient admission rate from the DH over the 5-year span decreased (24% in 2012 to 14% in 2016; p<0.0001) (Figure 2A). The LOS for inpatient admissions from either the ER or DH due to a VOC also significantly decreased after program expansion (p<0.0001) (Figure 2B).

Summary: Here we show that expanding the operation hours of a DH program increased its utilization by SCD patients by almost 5-fold. This was accompanied by a decreased hospital admission rate from the DH and a decrease in LOS for inpatient admissions, which may represent significant cost savings. A major advertising campaign to promote the UIC Comprehensive Sickle Cell center during the same time period may also contribute to the increasing patient visits in both DH and ER, but the incremental increase in the DH utilization over the ED most likely reflects the impact of expanded hours in the DH. Further expansion of the DH program may offer more benefits to patients with SCD.

Reference:

1. K. L. Hassell, Am J Prev Med38, S512 (Apr, 2010).

2. S. Lanzkron, C. P. Carroll, C. Haywood, Jr., Am J Hematol85, 797 (Oct, 2010).

3. T. L. Kauf, T. D. Coates, L. Huazhi, N. Mody-Patel, A. G. Hartzema, Am J Hematol84, 323 (Jun, 2009).

4. L. J. Benjamin, G. I. Swinson, R. L. Nagel, Blood95, 1130 (Feb 15, 2000).

5. A. H. Adewoye, V. Nolan, L. McMahon, Q. Ma, M. H. Steinberg, Haematologica92, 854 (Jun, 2007).

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