Background: Recent evidence has shown that outpatient follow-up after hospitalization plays an important role in reducing readmission rates for patients with Sickle Cell Disease (SCD). Reducing 28-day readmission rates in patients with SCD has become an established part of our hospital's quality improvement (QI) plan.

Objectives:

To increase the proportion of SCD patients at high risk for readmission who receive outpatient Hematology follow-up within 14 days of discharge from 28% to 90%.

Methods:

SCD patients at high risk for readmission were defined (based on literature) as those with ≥3 hospital admissions for vaso-occlusive episodes (VOE) or ≥1 admission for acute chest syndrome (ACS) within 12 months of the index admission. An interdisciplinary team created a process map to identify barriers and opportunities for improvement. In July 2015, multimodal process steps were introduced using posters, emails, and presentations to direct medical trainees, registered nurses and ward clerks to identify high risk patients, inform the SCD team of admissions, ensure follow-up is booked within 14 days, and confirm with families prior to discharge. A pre- and post-intervention chart review (quarterly, July 2014 through December 2015) was performed on all SCD hospital admissions identified as “crisis” by ICD10 code 57.0, which includes VOE, ACS and splenic sequestration.

Results:

During the 18-month period, there were 223 hospital admissions for 131 patients. Forty-seven percent of admissions were for high-risk patients. Fifty-five percent of patients were taking hydroxyurea at the time of index admission. The 28-day readmission rate was 12.6%, and did not change significantly over the time period. There was no difference in readmission rates between high-risk and standard-risk patients. The mean number of days from discharge to follow-up for patients prior to initiation of the intervention (July 2015) was 40 days, and only 28% of high-risk patients were seen in Hematology clinic within 14 days of discharge. In the first quarter after the introduction of the process steps, this improved to 16 days and 73%, respectively. The improvement, however, was not sustained into the final quarter.

Conclusion:

Our multimodal strategy resulted in improved time to follow-up for SCD patients at high risk for readmission. The lack of maintenance into the final quarter suggests the need for ongoing education to sustain positive changes. Further data collection is required to determine the impact of improved time to follow-up on readmission rates.