YNHH President Richard D'Aquila (standing, left) congratulated members of the clinical redesign team that reduced length of stay among pediatric patients with sickle cell disease. The team included (standing, l-r): Crystal Clemons, consultant; Matthew Grossman, MD; Ginny Szondy, care manager; and Kasia Bogusiewicz, clinical social worker. Seated, (l-r) are: Judith Carbonella, APRN; Scott Sussman, MD; and Farzana Pashankar, MD.
Children with sickle cell disease often experience frequent hospitalizations with longer lengths of stay, multiple emergency department visits and under-utilized outpatient services.
According to data, the average length of stay at Yale New Haven Children's Hospital for these patients was 4.3 days, while the national median length of stay was 3.6. In April 2015, a multidisciplinary team of physicians and representatives from Social Work, Psychiatry and nursing developed practice changes to reduce length of stay, increase use of patient-controlled analgesia (PCA) and reduce ED admissions.
Internal Consulting Group's Crystal Clemons, project manager, said that to reduce length of stay, the team focused on managing expectations by revamping the patient schedule and behavioral plans. Staff members now review expectations with the patient and family upon admission, and expectations are reinforced by physicians, nurses and social workers.
Another factor impacting length of stay is PCA use. PCA orders were revised to include an algorithm for initiating use and an "exit strategy" for patient management. To reduce ED admissions, the team worked with pediatric ED staff to develop an order to aid in the treatment and potential release of sickle cell crisis patients. The order rapidly initiates treatment of patients with sickle cell crisis and helps promote early, appropriate management of pain crises.
Plans are under way to provide more aggressive interventions with intensive care management for patients. Data from July through September show improvement in pediatric ED discharges and PCA use. The team continues to monitor length of stay.