Emergency Department (ED), ED Observation, Day Hospital, and Hospital Admissions for Adults with Sickle Cell Disease.
Emergency Department (ED), ED Observation, Day Hospital, and Hospital Admissions for Adults with Sickle Cell Disease.
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DOI：
10.5811/westjem.2017.9.35422
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Tanabe P
中科院分区：
文献类型：
--
作者：
Cline DM;Silva S;Freiermuth CE;Thornton V;Tanabe P
对于镰状细胞性贫血患者，使用替代场所管理无并发症的血管闭塞危象（VOC），如日间医院（DH）或艾德观察室，可能会显著降低入院率，从而降低30天再入院率。在实施镰状细胞病（SCD）VOC患者管理最佳实践的两个机构质量改进项目背景下，我们前瞻性比较了在我们的两个研究中心就诊的两个不同SCD患者队列的1）急诊科（艾德）; 2）艾德观察室; 3）DH和4）住院的急性护理接触。使用来自每个机构的代表性患者样本，我们还将SCD患者在患者家庭机构20英里内的外部医院的就诊或入院情况制成表格。在30个月内，427例患者（研究中心1 297例，研究中心2 130例）开始了4，740次机构访视，共计6，627次不同的急性护理接触，包括接触组合。就诊范围从最低0例（研究中心1 500例患者中的203例[40.6%];研究中心2 195例患者中的65例[33.3%]）到研究中心2 1例患者的最高152例（5次/月）急性护理就诊不等。研究中心2的患者更有可能在研究期间住院（88.4% vs. 74.4%，p=0.0011）并接受艾德访视（96.9% vs. 85.5%，p=0.0002）。研究中心1更频繁地使用DH（研究中心1的297例患者中有1.207次就诊，研究中心2的130例患者中有199次就诊），仅在研究中心1使用艾德观察。35%的患者访问了他们家学术中心以外的医院。在对两个镰状细胞队列的30个月评估中，个体患者之间的医疗保健利用率差异很大。一个队列有更多的住院和艾德遭遇，而另一个队列有更多的日间医院遭遇，并使用镰状细胞病观察VOC协议。三分之一的抽样患者在其护理提供者的机构之外前往医院接受急诊护理。
Use of alternative venues to manage uncomplicated vaso-occlusive crisis (VOC), such as a day hospital (DH) or ED observation unit, for patients with sickle cell anemia, may significantly reduce admission rates, which may subsequently reduce 30-day readmission rates. In the context of a two-institution quality improvement project to implement best practices for management of patients with sickle cell disease (SCD) VOC, we prospectively compared acute care encounters for utilization of 1) emergency department (ED); 2) ED observation unit; 3) DH, and 4) hospital admission, of two different patient cohorts with SCD presenting to our two study sites. Using a representative sample of patients from each institution, we also tabulated SCD patient visits or admissions to outside hospitals within 20 miles of the patients’ home institutions. Over 30 months 427 patients (297 at Site 1 and 130 at Site 2) initiated 4,740 institutional visits, totaling 6,627 different acute care encounters, including combinations of encounters. The range of encounters varied from a low of 0 (203 of 500 patients [40.6%] at Site 1; 65 of 195 patients [33.3%] at Site 2), and a high of 152 (5/month) acute care encounters for one patient at Site 2. Patients at Site 2 were more likely to be admitted to the hospital during the study period (88.4% vs. 74.4%, p=0.0011) and have an ED visit (96.9% vs. 85.5%, p=0.0002). DH was used more frequently at Site 1 (1.207 encounters for 297 patients at Site 1, vs. 199 encounters for 130 patients at Site 2), and ED observation was used at Site 1 only. Thirty-five percent of patients visited hospitals outside their home academic center. In this 30-month assessment of two sickle cell cohorts, healthcare utilization varied dramatically between individual patients. One cohort had more hospital admissions and ED encounters, while the other cohort had more day hospital encounters and used a sickle cell disease observation VOC protocol. One-third of patients sampled visited hospitals for acute care outside of their care providers’ institutions.
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影响因子：
1.2
作者：
Nietert, PJ;Abboud, MR;Silverstein, MD
通讯作者：
Silverstein, MD
影响因子：
3.1
作者：
Thornton, Victoria L.;Holl, Jane L.;Tanabe, Paula
通讯作者：
Tanabe, Paula
影响因子：
0.5
作者：
Freiermuth, Caroline E.;Silva, Susan;Tanabe, Paula
通讯作者：
Tanabe, Paula
影响因子：
6.5
作者：
Ware, MA;Hambleton, I;Serjeant, GR
通讯作者：
Serjeant, GR
影响因子：
3.2
作者：
Raphael, Jean L.;Kamdar, Aditi;Mueller, Brigitta U.
通讯作者：
Mueller, Brigitta U.