scholarly journals Daily Opioid Use Is Common in Adults with Sickle Cell Disease Presenting to an Acute Care Unit for Treatment of Vaso-Occlusive Pain

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4587-4587
Author(s):  
Fuad El Rassi ◽  
Neli Stoyanova ◽  
Eldrida Randall ◽  
Morgan L. McLemore ◽  
Claudia R. Morris
Keyword(s):  
Clinical Trial ◽  
Acute Care ◽  
Sickle Cell ◽  
Clinical Characteristics ◽  
Pain Therapy ◽  
Admission Rate ◽  
Cell Disease ◽  
Opioid Use ◽  
Chronic Opioid Use ◽  
Acute Care Unit

Abstract Background: Pain is the hallmark of sickle cell disease (SCD), and the most common reason for emergency department (ED) visits and hospitalizations in adults and children with SCD. The Emory University Sickle Cell Center at Grady Memorial Hospital has been providing specialized services for adult SCD patients for 30 years. In addition to daily sickle cell specialized clinics, the center is set up with a 24/7 acute care unit (ACU) that is staffed by specialized SCD providers and manages vaso-occlusive episodes (VOE). The patients are started on intravenous narcotics, fluids and antibiotics within 30 minutes of presenting to the ACU. After eight hours of management, the patient is then either discharged home if the VOE is controlled or admitted to the hospital for continued management. Annually, around 3000 ACU visits are recorded with 17% hospital admission rate (over the last 5 years). Little information is known about the clinical characteristics of adults with SCD and chronic opioid use in the setting of VOE pain. Methods: Clinical data from adult SCD patient visits for VOE presenting to the ACU was prospectively collected over a 4-month period (March 1, 2015- July 1 2015) as part of a screening process of an ongoing clinical trial. Results: 214 patients were evaluated for VOE requiring parenteral opioids, with an admission rate of 18%. Mean age was 31+/-14 years, 53% were male and the majority (80%) had hemoglobin (Hb) SS. See Table 1 for clinical characteristics. Over 80% of patients treated in the ACU were ultimately discharged home. Interestingly, the rate of chronic opioid use was around 50% in both admitted and discharged patients from the ACU. Conclusions: The admission rate for VOE in adults with SCD is low at our center through the utilization of the ACU. 51% of patients requiring admission for continued pain therapy were on daily opioids and most of these patients had Hb-SS. 50% of the patients discharged from the ACU were also on daily opioids which represents a significant finding when trying to recruit opioid-na•ve patients on clinical trials to manage VOE. Additionally, this high percentage of daily opioid users reflects a group of patients with possibly more severe disease, who are at risk of tolerance, hyperanalgesia and difficulty in managing VOE in the outpatient setting. This information is valuable for clinical trial design, as chronicopioid use is often an exclusion criterion for enrollment into novel pain therapy trials in SCD. More research is needed on this important topic. Table 1. Clinical Characteristics of Adults with SCD and VOE presenting to Grady Acute Care Center Characteristics Total(N=214) Admitted(N=38) Discharged (N=176) Patient Visits (%) 100% 18% 82% Male n (%) 114 (53%) 19 (50%) 95 (54%) Female n (%) 100 (47%) 19 (50%) 81 (46%) Age ± SD 31±14 29±10 31±9 Hb SS 170 (80%) 34 (89%) 136 (77%) Hb SC 37 (17%) 4 (11%) 33 (19%) Hb S beta+ thalassemia 7 (3%) 0 7 (4%) Chronic Opioids n (%) 108 (51%) 19 (50%) 89 (51%) Disclosures No relevant conflicts of interest to declare.

scholarly journals Trends in Hospital Utilization for Acute Illness in a Large Population-Based Cohort of Children and Adolescents with Sickle Cell Disease (SCD): 2010–2017

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3528-3528
Author(s):  
Kristina Lai ◽  
Sonia Anand ◽  
Maa-Ohui Quarmyne ◽  
Carlton Dampier ◽  
Peter A. Lane ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Acute Care ◽  
Sickle Cell ◽  
Large Population ◽  
Admission Rate ◽  
Acute Illness ◽  
Hospital Utilization ◽  
Acute Chest Syndrome ◽  
Cell Disease ◽  
Admission Rates

Abstract Disease severity and healthcare utilization varies widely among persons with sickle cell disease (SCD). Hydroxyurea (HU) has been demonstrated to reduce rates of pain and acute chest syndrome, the leading causes of inpatient utilization in patients with Hb SS and S β°-thalassemia in clinical trials. We recently reported that HU was clinically effective in reducing rates of pain and acute chest syndrome in patients who initiate treatment. Use of hydroxyurea in SS/S β°-thalassemia has increased markedly since 2010. Thus we sought to detemine trends of hospital utilization for acute illness during an 8 yr in which HU utilization increased markedly (2010-2017). Data from years 2010-201 were obtained from the SCD database and patient records at Children's Healthcare of Atlanta (CHOA). Utilization data were restricted to acute care admissions. Admissions for elective procedures, non-SCD related discharge diagnoses, rare SCD genotypes, and patients who had undergone bone marrow transplant were excluded. Patients were compared based on number of hospitalizations, age, sex, SCD genotype (SS/S β°-thalassemia vs Hb SC/S β+thalassemia), and discharge diagnosis. A total of 3,116 patients had at least one encounter between 2010 and 2017; 2,947 patients met inclusion criteria. From 2010-2017 the total number of active patients per year increased from 1,546 patients to 1,789 patients (+16%), while the total number acute care admissions increased from 1,295 admissions to 1,609 admissions (+24%). There were no significant differences in the proportion of patients with genotypes SS/S β° thalassemia genotypes (67.0% vs 63.9%, p=0.06). Overall patients with SS/S β° thalassemia had higher admission rates compared to SC/S β+ thalassemia patients (0.94 vs 0.57 admissions per patient per year). During the study period. overall admission rates in SCD (acute illness hospitalizations/patient/yr) increased from a low of 0.74 in 2011 to a high of 0.90 in 2017. The proportion of admissions attributed to SS/S β°-thalassemia patients decreased (79.2% in 2010 vs 72.3% in 2017, p<0.0001). However, admission rate in SC/S β+ thalassemia increased (0.53 to 0.69 admissions per patient per year). Overall, over 60% of patients were not admitted in any given year, and the proportion of patients with 0-1 admissions in a given year remained unchanged. However, the proportion of super high hospital utilizers (SHHU), patients with 8 or more admissions in a given year, increased by 185%. In 2001 this group made up 0.6% of all patients and accounted for 7.3% of admissions; in 2017 SHHU had increased 1.8% of patients and 24.3% of admissions. There was no difference in genotype or sex between SHHU and non-SHHU patients. SHHU were older (>90% of patients over age 8 years), and had greater percentages of admissions for pain and acute chest syndrome then non-SHHU. In conclusion, during a period in which HU utilization in SS/S β°-thalassemia increased significantly, hospital utilization for acute illness in SS/S β° thalassemia decreased as expected. However, during the same period there was an unexpected increase in overall hospital utilization for acute illness in SCD. This increase in hospital utilization was the result of 1) a marked increase in SHHU and 2) an overall increased utilization in SC/S β+ thalassemia. Disclosures Dampier: Pfizer: Research Funding.

scholarly journals Managing Sickle Cell Disease Patients with Acute Pain Crisis in the Most Appropriate Setting

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2169-2169
Author(s):  
Michel Gowhari ◽  
Tiesa Hughes-Dillard ◽  
Catherine Ryan ◽  
Alexia Johnson
Keyword(s):  
Sickle Cell Disease ◽  
Acute Care ◽  
Sickle Cell ◽  
Acute Pain ◽  
Admission Rate ◽  
Cell Disease ◽  
Observation Unit ◽  
Improvement Project ◽  
Hospital Admission Rate ◽  
Pain Crisis

Introduction: Pain is the top concern of individuals with sickle cell disease (SCD). Acute painful vaso-occlusive episodes in SCD are the leading cause of emergency department (ED) encounters and frequent hospital admissions. Well-documented disparities include significant delay and under treatment of SCD patients with acute pain crisis in the ED. An acute care observation unit (ACOU) staffed with SCD specialists can help to address these disparities. SCD patients treated in a dedicated ACOU have a 40% lower admission rate than patients treated in the ED. An expedited transfer and treatment program at our dedicated sickle ACOU at the University of Illinois Hospital (UIH) was implemented with the goal of improving overall care and decreasing the hospital admission rate for SCD patients. Method: This is an outcome study of individuals with SCD >16 years of age who presented with an acute painful episode to UIH. A quality improvement project used the Plan-Do-Study-Act translation method. The following key areas were identified for intervention: 1) established criteria for direct ACOU admission, 2) expedited transfer to the ACOU from the ED, 3) addition of a third provider to expand hours, and 4) establishing a consistent but individualized pain treatment plan across the ED and ACOU. The number of admissions to hospital of patients with SCD was examined from September 2018 through August 2019. Applying the Donabedian triad of Structure, Process, and Outcomes, we demonstrated improved outcome and decrease hospitalization. Results: There were 877 admissions to the ACOU from January to July of 2019, which is an increase of 37% compared to the same period in 2018. Of the 877 admissions, 793 were discharged home (90.4%) as compared to 88.6 % in 2018. The average time to first dose of opioids in the ACOU in 2019 was 55 minutes with and average decrease in the pain score of 2.62 during an average length of stay of 4:18 hours. Conclusions: Expedited care and treatment with a focus on improving quality and improving access resulted in increased volume of patients treated and decreased rate of admission to the hospital. Allocating resources to a dedicated sickle acute care observation unit can significantly decrease inpatient hospitalizations. Table. Disclosures No relevant conflicts of interest to declare.

Temperature and Humidity Effects on Acute Vaso-Occlusive Pain Episodes in Sickle Cell Disease

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 992-992
Author(s):  
Fuad El Rassi ◽  
Eldrida Randall ◽  
Sidney F. Stein ◽  
Hanna Jean Khoury ◽  
James R. Eckman ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Hospital Admission ◽  
Acute Care ◽  
Sickle Cell ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Emergency Department Visits ◽  
Cell Disease ◽  
Temperature And Humidity ◽  
The City

Abstract Background: Sickle cell patients suffer from painful vaso-occlusive episodes (VOE) that interrupt patients' lives and productivity and lead to emergency department visits and hospitalizations and, on occasion, death. The VOE in sickle cell disease (SCD) accounts for 90% of hospital admissions for patients with SCD and constitute a financial burden on both patients and hospitals. Efforts to prevent pain crises have failed to establish a causal relationship in about 40% of reported cases. The remaining 60% of known causes of VOE are related to dehydration, febrile illness, and infections. The Emory University Sickle Cell Center at Grady Memorial hospital has been providing specialized services for SCD patients for 30 years. The center includes a 24/7 acute care unit (ACU) that is staffed by SCD providers who specialize in the management of VOE. The patients are started on intravenous narcotics and fluids within 30 minutes of presenting to the ACC. After eight hours of management, the patient is then either discharged home if the VOE is controlled or admitted to the hospital for continued management. Annually, around 3000 ACU visits are recorded with a 17% hospital admission rate. When patients are questioned on the reason for their presentation, “weather change” is frequently reported as the trigger of the VOE. A review of the literature reveals scant data to support the hypothesis that weather-related changes trigger sickle cell pain crises. Methods: In a retrospective evaluation of patient visits over the last 4 years, we identified temperature and humidity measurements for that period of time and attempted to correlate them with the frequency of ACU visits. We used the “weatherspark” website that records weather changes for the city of Atlanta because > 90% of our patients reside in the city. Results: The four-year review of weather data and ACU visits did not show a direct correlation between graphs of temperature and humidity, and the number of ACU visits. The annual number of visits to the ACU was 2930, 2467, 3195 and 3370 for the years 2011, 2012, 2013 and 2014 respectively. The average admission rate was 16.6% overall, and the admission rate in the years 2011, 2012, 2013 and 2014 was 12.4%, 14.9%, 19.6% and 19.6% respectively. The attached figure has an example of the year 2013 charts for temperature, humidity, sickle cell acute care visits and hospital admission graphs. Conclusion: The retrospective analysis does not reflect a direct correlation between the temperature and humidity graphs and the number of ACU visits and hospital admissions. Given the volume of data analyzed, it is unlikely that there is any correlation between temperature and humidity variations and either acute care visits or admissions. Atlanta, GA- ACU visits, Hospital admissions, Temperature and Humidity Charts for 2013: DATA from weatherspark.com Figure 1. Figure 1. Figure 2. Figure 2. Figure 3. Figure 3. Disclosures No relevant conflicts of interest to declare.

scholarly journals Characteristics of Sickle Cell Clinic Visits and Hospital Admissions in a Large Urban Academic Hospital

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5857-5857
Author(s):  
Levani Odikadze ◽  
Morgan L. McLemore ◽  
Neli Stoyanova ◽  
Fuad A El Rassi
Keyword(s):  
Sickle Cell Disease ◽  
Emergency Room ◽  
Acute Care ◽  
Sickle Cell ◽  
Hospital Admissions ◽  
Disease Patient ◽  
Admission Rate ◽  
Cell Disease ◽  
The Mean ◽  
Clinic Visits

Introduction: Although high rates of emergency department (ED) visits by sickle cell disease patient population is a significant health-care system burden, there are limited studies available that explore outpatient/ED visit patterns. The purpose of this study was to evaluate the pattern of medical care utilization including clinic visits and hospital admission in adults with sickle cell disease in a large urban academic center with a dedicated 24 hour/7 day a week sickle cell emergency room. Methods: Patients seen in the Acute Care at Grady Memorial Hospital Comprehensive Sickle Cell Center (GMHSCC) over a three years from January 2015 to December 2017 where analyzed. The Acute Care center at GRMHSCC is a unique 24 hour 7 day a week dedicated emergency room for sickle cell patients. Patient demographics, specialized sickle cell clinic visits and hospital admissions were analyzed descriptively. Independent samples t-test was used for comparison of hospitalization and acute care visits between males/females and phenotype groups. Results: The total of 1,277 patients were included in analysis representing 12,129 acute care visits. 683 (53.5%) females and 593 males (46.5%). Mean age was 32.9 years. Genotypes where similar to known expected distributions, 878 patients had Hb SS (68.8%), 301 had SC (23.6%), 23 had SB0TH (1.8%) and 74 had SB+TH (5.8%). The mean number of acute care visits over 3 years for SS phenotype was 9.71, SC phenotype 9.74, SB+Th phenotype 5.73 and SB0TH phenotype 10.48. Overall admission rate was 16%. There was a significant statistical difference between the mean number of admissions among SS and SC phenotype patients (p=0.009). Rate of hospitalization per clinic visit for SS phenotype was 18.19% , for SC phenotype 10.78% , SB+TH phenotype was 15.58% and SB0TH phenotype 9.55%; Conclusions and future objectives: We have demonstrated that a dedicated Sickle Cell emergency room is able to achieve a significantly lower admission rate than standard Emergency rooms. Preliminary analysis shows that the distribution of acute care visits is distributed across the genotypes at the known distribution. In addition there is no difference in mean number of sickle cell acute visits between patients with SS and SC phenotype. This is interesting as Hgb SC is considered a less severe form of the disease. There was a statistically significant higher admission rate for SS patients compared to SC patients. Future analyses will look at additional parameters associated with acute care visits and admission. Disclosures No relevant conflicts of interest to declare.

scholarly journals Chronic opioid use in patients with sickle cell disease

Hematology ◽  
2021 ◽  
Vol 26 (1) ◽  
pp. 415-416
Author(s):  
George Mo ◽  
Tim Jang ◽  
Connor Stewart ◽  
Leen Khoury ◽  
Natalie Ferguson ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Cell Disease ◽  
Opioid Use ◽  
Chronic Opioid Use

Opioid management strategy decreases admissions in high-utilizing adults with sickle cell disease

2017 ◽  
Vol 13 (3) ◽  
pp. 143 ◽  
Author(s):  
Amy Mager, PA-C, MPAS ◽  
Kristin Pelot, MSSW ◽  
Kathryn Koch, APNP ◽  
Lawrence Miller, PsyD ◽  
Collin Hubler, BS ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Management Strategy ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Psychological Disorder ◽  
Successful Implementation ◽  
Cell Disease ◽  
Opioid Use ◽  
Percent Decrease

Background: A subset of adults with sickle cell disease (SCD) heavily utilizes the emergency department (ED) and hospital. The objective of our study was to determine the efficacy of a multidisciplinary strategy to address unmet needs in highly utilizing adults with SCD.Methods: In a prospective study, adults with SCD with ≥10 admissions per year were assessed by a multidisciplinary team for gaps in medical, social, and psychological care. Thereafter, the team decided upon the subject's predominant domain that drove admissions and instituted an interventional plan. All plans included an opioid management strategy. Preintervention and postintervention admission rate, as well as opioid use, was compared.Results: Twelve subjects were enrolled. Median rate of ED and hospital admissions preintervention was 25 per year. The predominant domains identified were social needs (n = 6), psychological disorder (n = 1), and substance use disorder (n = 5). Multifaceted interventional plans were developed to address a wide range of gaps in care, but an opioid management strategy was the only intervention successfully completed. Even so, when the preintervention versus postintervention admission rate was compared, regardless of the domain, there was a 40 percent decline in hospital admissions (p = 0.03). Consistent with the successful implementation of an opioid management plan, the decrease in admissions was accompanied by a 37 percent decrease in intravenous opioid use (p = 0.02) and 10 percent decrease in oral opioid use (p = 0.04).Conclusion: An opioid management strategy, as part of a larger effort to improve care for high-utilizing adults with SCD, decreased rate of admissions and opioid use.

scholarly journals Opioid doses and acute care utilization outcomes for adults with sickle cell disease: ED versus acute care unit

2018 ◽  
Vol 36 (1) ◽  
pp. 88-92 ◽  
Author(s):  
Robert E. Molokie ◽  
Chariz Montminy ◽  
Corissa Dionisio ◽  
Muhammad Ahmen Farooqui ◽  
Michel Gowhari ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Acute Care ◽  
Sickle Cell ◽  
Care Utilization ◽  
Cell Disease ◽  
Acute Care Utilization ◽  
Acute Care Unit

scholarly journals Hospitalization Events among Children and Adolescents with Sickle Cell Disease in Basra, Iraq

Anemia ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Zeina A. Salman ◽  
Meaad K. Hassan
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Readmission Rate ◽  
Length Of Hospital Stay ◽  
Acute Chest Syndrome ◽  
Cell Disease ◽  
Opioid Use ◽  
Asthma Symptoms ◽  
The Mean ◽  
High Readmission Rate

Objectives. Despite improvements in the management of sickle cell disease (SCD), many patients still experience disease-related complications requiring hospitalizations. The objectives of this study were to identify causes of hospitalization among these patients and factors associated with the length of hospital stay (LOS) and readmission.Methods. Data from 160 patients (<14 years old) with SCD who were admitted to the Basra Maternity and Children’s Hospital from the first of January 2012 through July 2012 were analyzed.Results. The main causes of hospitalization were acute painful crises (73.84%), infections (9.28%), acute chest syndrome (8.02%), and acute splenic sequestration crisis (6.32%). The mean LOS was4.34±2.85days. The LOS for patients on hydroxyurea (3.41±2.64days) was shorter than that for patients who were not (4.59±2.86days),P<0.05. The readmission rate (23.1%) was significantly higher among patients with frequent hospitalizations in the previous year (OR 9.352, 95% CI 2.011–43.49), asthma symptoms (OR 4.225, 95% CI 1.125–15.862), and opioid use (OR 6.588, 95% CI 1.104–30.336). Patients on hydroxyurea were less likely to be readmitted (OR 0.082, 95% CI 0.10–0.663).Conclusions. There is a relatively high readmission rate among patients with SCD in Basra. The use of hydroxyurea significantly decreases the LOS and readmission rate.

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