{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:11:49Z","timestamp":1790813509971,"version":"4.1.0"},"reference-count":30,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,5,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVES:<\/jats:title>\n                  <jats:p>Frequent hospitalizations for sickle cell disease (SCD) vaso-occlusive crises (VOCs) are associated with school absenteeism, emotional distress, and financial hardships. Our goal was to decrease hospital days for VOC admissions by 40% over a 5-year period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>From October 2011 to September 2016, a multidisciplinary quality-improvement project was conducted with a plan-do-study-act methodology. Five key drivers were identified and 9 interventions implemented. Interventions included individualized home pain plans, emergency department and inpatient order sets, an inpatient daily schedule, psychoeducation, and a biofeedback program. High users (\u22654 admissions per year) received an individualized SCD plan and assigned mental health provider. We expanded the high-use group to include at-risk patients (3 admissions per year). Data were analyzed for patients ages 0 to 21 years admitted for VOC. Hospital days were the primary measure; the 30-day readmission rate was the balancing measure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>A total of 216 SCD pediatric patients were managed in 2011 with a 14% increase over 5 years. A total of 122 patients were admitted for VOC. Hospital days decreased by 61% from 59.6 days per month in the preintervention period to 23.2 days per month in the postintervention period (P &amp;lt; .0001). Length of stay decreased from 4.78 (SD = 4.08) to 3.84 days (SD = 2.10; P = .02). Among high users, hospital days decreased from 35.4 to 15.5 days per month. The thirty-day readmission rate decreased from 33.9% to 19.4%. Overall savings in direct hospital costs per year were $555\u2009120.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>A dedicated team effort with simple interventions can have a significant impact on the well-being of a patient population and hospital costs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2018-2218","type":"journal-article","created":{"date-parts":[[2019,4,3]],"date-time":"2019-04-03T12:27:24Z","timestamp":1554294444000},"source":"Crossref","is-referenced-by-count":30,"title":["Improving Care for Sickle Cell Pain Crisis Using a Multidisciplinary Approach"],"prefix":"10.1542","volume":"143","author":[{"given":"Lyn","family":"Balsamo","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Shabanova","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Carbonella","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary V.","family":"Szondy","sequence":"additional","affiliation":[{"name":"Yale New Haven Hospital, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Kalbfeld","sequence":"additional","affiliation":[{"name":"Yale New Haven Hospital, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna-Ann","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Santucci","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Grossman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzana","family":"Pashankar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2019,5,1]]},"reference":[{"issue":"10091","key":"2021121013183206600_B1","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/S0140-6736(17)30193-9","article-title":"Sickle cell disease.","volume":"390","author":"Ware","year":"2017","journal-title":"Lancet"},{"issue":"1","key":"2021121013183206600_B2","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1002\/pbc.22222","article-title":"Vaso-occlusive painful events in sickle cell disease: impact on child well-being.","volume":"54","author":"Brandow","year":"2010","journal-title":"Pediatr Blood Cancer"},{"issue":"3","key":"2021121013183206600_B3","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1002\/pbc.22497","article-title":"Health-related quality of life in children with sickle cell disease: a report from the Comprehensive Sickle Cell Centers Clinical Trial Consortium.","volume":"55","author":"Dampier","year":"2010","journal-title":"Pediatr Blood Cancer"},{"issue":"1","key":"2021121013183206600_B4","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1002\/pbc.21819","article-title":"Associates of school absenteeism in adolescents with sickle cell disease.","volume":"52","author":"Schwartz","year":"2009","journal-title":"Pediatr Blood Cancer"},{"issue":"3","key":"2021121013183206600_B5","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1093\/pubmed\/fdu026","article-title":"A retrospective analysis of the cost of hospitalizations for sickle cell disease with crisis in England, 2010\/11.","volume":"37","author":"Pizzo","year":"2015","journal-title":"J Public Health (Oxf)"},{"issue":"6","key":"2021121013183206600_B6","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1002\/ajh.21408","article-title":"The cost of health care for children and adults with sickle cell disease.","volume":"84","author":"Kauf","year":"2009","journal-title":"Am J Hematol"},{"issue":"4","key":"2021121013183206600_B7","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1002\/pbc.24864","article-title":"Use of a clinical pathway to improve the acute management of vaso-occlusive crisis pain in pediatric sickle cell disease.","volume":"61","author":"Ender","year":"2014","journal-title":"Pediatr Blood Cancer"},{"issue":"11","key":"2021121013183206600_B8","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1016\/j.ijmedinf.2014.08.003","article-title":"Does e-pain plan improve management of sickle cell disease associated vaso-occlusive pain crisis? 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