NM-335
Creating Value: Pediatric APMS Partnered in Sickle Cell Crisis
1Eiszner J, 2Petter J, 1Duncan-Azadi C, 1Broussard A, 1Elwell V, 1Sparks L, 1Baker A, 1Irwin J
1University Of Oklahoma, Oklahoma City, OK, USA; 2Oklahoma University, Oklahoma City, OK, USA
Background:
Broadening the scope of an Anesthesiologist has come into vogue as an American Society of Anesthesiologist’s initiative highlighting the impact of anesthesiologist led care on value and patient satisfaction. Anesthesiologist led pain services provide longitudinal anesthesiologist led care and have great potential to impact satisfaction and provide value through cost reduction. Sickle Cell occurs in 1 in 500 African Americans.1 The disease costs patients an average of $500k/patient on healthcare with over 80% being related to inpatient care.2
Aim:
Our intent was to initiate a quality improvement project to develop a protocol for the longitudinal aspects of sickle cell disease inpatient admissions as a QI effort. This retrospective study is to evaluate its impact on length of stay and re-admission.
Methods:
The available evidence on sickle cell disease in conjunction with Pain and Anesthetic Management was reviewed in a 10 year PubMed review of the literature. This pathway was implemented across all pediatric sickle cell admissions greater than 5 years of age at our institution. After IRB approval by OUHSC, data was collected via EMR Billing Records and the pediatric pain service database. Data comparisons were made by a student t-test.
Results:
A baseline length of stay was obtained from 2 years of patient management prior to this intervention (2014-2015) which consisted of 158 patients. The average length of stay was 4.0 days (Std 3.9) for all sickle cell crises and 6.4 days (Std 4.1) for complex crises (>48hrs). From 2016-9/2016-9/2017 a total of 77 records were obtained. The average sickle crisis length of stay for all comers dropped to 2.8 days (Std 2.0). The length of stay for complex crises fell to 3.9 days (Std 1.1). Both decreases in overall length of stay and complex length of stay were statistically significant with (p<.04) and (p<.02) respectively. The average re-admissions at 1, 7, and 30 days fell significantly by 60%, 51%, and 40% when adjusted for differences in patient volume.
Conclusions:
An anesthesiologist working in concert with allied services towards a common goal of creating value can do so effectively even in fields outside of the perioperative domain.
1. Mvundura et al. Health Care Expenditures for Privately and Publically Insured Children with SSD. Pediatric Blood Cancer 2009
2. Kauf et al. The cost of health care for children and adults with sickle cell disease. Am J Hematol. 2009 Jun;84(6):323-7
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