How day units can improve sickle cell crisis pain management

For me, one of the worst parts of having sickle cell disease, aside from the horrific, debilitating pain of a crisis, is navigating the emergency department here in the U.K, where I live.

I appreciate that it’s a high-pressure work environment that brings heavy responsibility, and it must be very difficult for practitioners to stay on top of everyone in their care. But almost all of my experiences have been negative.

Just thinking about the emergency department terrifies me. I’m always scared I’ll encounter a medical professional who doesn’t take kindly to sickle cell patients and refuses to administer pain relief according to the schedule prescribed by my hematologist.

This fear means that when acute crisis pain strikes, I’m reluctant to go to the hospital. I’ll often suffer at home instead of seeking the medical intervention that a sickle cell crisis requires. Based on my conversations with my sickle cell network, my experience is not the exception. Many patients try to resolve acute crises at home out of fear of being mistreated in the emergency department.

So when my hospital announced they were establishing a day unit for sickle cell patients, to say I was extremely happy would be an understatement.

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The day unit is a nurse-led service where sickle cell patients are assessed and treated according to the severity of their crisis pain. The aim is for us to receive rapid pain relief as outpatients. Yes, outpatients!

Because the emergency department is often unable to deliver pain relief rapidly and on schedule, a crisis can last much longer than it needs to. Patients often require admission at the end of the day because our crisis hasn’t been resolved. But with the day unit, we should be able to go home at the end of the day.

Additionally, we’ll be treated by healthcare professionals with a deep understanding of hematology, which often isn’t the case in the emergency department. Hopefully, this means we can avoid any negative connotations or judgments from practitioners who don’t understand our disease.

I know of many other hospitals in the U.K., particularly in London, that have established a day unit for sickle cell patients. It not only provides an alternative to the emergency department, but I believe it will also save hospital resources and money in the long run, as it reduces the likelihood of admissions, which are costly for the National Health Service (NHS). The service also allows for fewer disruptions and a better quality of life for sickle cell patients. It’s a win-win.

Given the NHS’ current financial constraints and resourcing pressures, I think all hospitals serving sickle cell patients should consider implementing the day unit service. I wouldn’t limit it to the U.K., though; the service could benefit hospitals and patients globally.

However, day units do have some limitations. If, at the end of the day, there are no ward beds available and a patient remains in acute crisis, they will likely need to be moved to the emergency department until a suitable bed is available. Also, if a patient is experiencing a severe crisis or complications such as acute chest syndrome, they will need to go to the emergency department for treatment.

At the hospital where I receive treatment, the day unit service is very small — only permitting one patient at a time. Since the hospital has numerous sickle cell patients under its care, I hope the staff expand this service and make it more accessible so that multiple patients can be served concurrently.

Note: Sickle Cell Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Sickle Cell Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to sickle cell disease.