Day hospital versus inpatient management of uncomplicated vaso-occlusive crises in children with sickle cell disease.
BACKGROUND
Day hospital (DH) management for patients with sickle cell disease (SCD) experiencing uncomplicated vaso-occlusive pain crises has been utilized as an alternative care delivery system to inpatient hospitalization. The objective of this study was to determine whether DH management results in shorter length of stay compared to inpatient care.


METHODS
We conducted a retrospective cohort study with 35 DH admissions and 35 inpatient admissions for children with SCD presenting with uncomplicated vaso-occlusive crises (VOCs). A DH admission was defined as a minimum of two consecutive days of aggressive pain management as an outpatient, including intravenous hydration and analgesics, supported by home treatment over night with oral analgesic and anti-inflammatory agents. We gathered data on demographics, pain scores, length of stay, admission charges, and needs for persistent care.


RESULTS
DH care resulted in a 39% reduction of the average length of stay compared to inpatient admissions. Multivariate linear regression demonstrated that the location of patient care for VOCs was a significant predictor of length of stay (P < 0.0006) after controlling for patient characteristics, severity of illness, and disease history.


CONCLUSIONS
We conclude that a dedicated DH facility has the potential to provide efficient and timely management of uncomplicated VOCs through reduction of length of stay. This delivery care system may be particularly relevant for children who are significantly impacted by inpatient hospitalization.
Raphael
Jean L
JL
Baylor College of Medicine, Pediatrics, Texas Children's Cancer Center, Houston, Texas, USA. raphael@bcm.edu
Kamdar
Aditi
A
Wang
Tao
T
Liu
Hao
H
Mahoney
Donald H
DH
Mueller
Brigitta U
BU
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications / Q000191:economics*; D002648:Child; D015331:Cohort Studies; D003631:Day Care, Medical / Q000191:economics / Q000592:standards*; D005260:Female; D017048:Health Care Costs; D006776:Hospitals, Pediatric / Q000191:economics / Q000592:standards*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D010359:Patient Readmission; D011787:Quality of Health Care; D012189:Retrospective Studies; D014652:Vascular Diseases / Q000191:economics* / Q000209:etiology