Algorithm helps reduce unneeded hospital stays for sickle cell children
A nationwide effort has sought to move the age for admissions from 2 to 1
An algorithm that grew out of a collaboration between different specialties at the Medical University of South Carolina (MUSC) may help reduce unnecessary hospital admissions for children with sickle cell disease (SCD), according to a new study.
“This algorithm safely allows our care of these patients to align with national thoughts and practice, while also considering quality of life for our patients and their families,” Shayla Bergmann, MD, pediatric hematologist/oncologist at MUSC Children’s Health and co-author of the study, said in a university news story.
Bergmann said the algorithm “lessens the burden of hospital stays and complications, and it lowers time missed from work for parents and caregivers.” The study, “Implementation of a Low-risk Algorithm for Outpatient Management of Febrile Pediatric Patients With Sickle Cell Disease,” was published in the Journal of Pediatric Hematology/Oncology.
SCD is a genetic disorder marked by abnormalities in red blood cells. Among its complications, the disease can cause dysfunction in the spleen, which houses immune cells needed to fend off infections. Spleen dysfunction can make young children with sickle cell more vulnerable to serious infections.
“Your spleen does a lot of things. One of the most important is to help to prevent infections,” said Jason Erno, MD, who joined the project as a medical student and is now a resident in internal medicine at the University of Virginia. “These kids are susceptible to more severe infections than your average kid, which is why it can be so scary when they get sick.”
Historically, children with SCD younger than 2 who have a high fever have been immediately admitted to the hospital. But this approach means many get hospitalized even though they don’t necessarily need to be, which puts a strain on families and on healthcare resources.
Reducing rate of hospital admissions in sickle cell
To reduce unnecessary hospitalizations, an effort nationwide has been to move the age for immediate admission from 2 to 1. At MUSC, clinicians implemented an algorithm where specialists in pediatric emergency medicine would consult with pediatric hematologists/oncologists before admissions, with the goal being to avoid hospitalizations for low-risk patients who can be safely cared for at home.
“We were thrilled to partner with our [emergency department] colleagues and with the MUSC Value Institute to create a treatment pathway to streamline care for our patients with sickle cell disease and safely reduce the burden of repeated hospitalizations for their families,” said Michelle Hudspeth, MD, senior author of the study and division chief for pediatric hematology/oncology at MUSC Children’s Health. “We sought to … see if we could safely reduce the age of required admission for fever with a clearly standardized protocol that included predefined risk factors.”
The researchers compared the rates of hospitalizations in the year before and after the algorithm was implemented. They found that, before it was implemented, 55.2% of children with SCD who came to the emergency department with a high fever were admitted to the hospital. After it was implemented, the rate fell to 43.6%, a more than 10% difference. Rates of re-admissions to the emergency department were similar before and after the algorithm was implemented.
The reduction in admission rates seen after the algorithm was implemented wasn’t statistically significant, meaning it’s mathematically plausible that the change could be due to random chance. Still, researchers said a reduction of this magnitude “was likely meaningful to reduce health care burdens for patients and families.”
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