Improving care for children with sickle cell disease/acute chest syndrome.
BACKGROUND
Acute chest syndrome (ACS) is a leading cause of hospitalization and death of children with sickle cell disease (SCD). An evidence-based ACS/SCD guideline was established to standardize care throughout the institution in February 2008. However, by the summer of 2009 use of the guideline was inconsistent, and did not seem to have an impact on length of stay. As a result, an implementation program was developed.


OBJECTIVE
This quality-improvement project evaluated the influence of the development and implementation of a clinical practice guideline for children with SCD with ACS or at risk for ACS on clinical outcomes.


METHODS
Clinical outcomes of 139 patients with SCD were evaluated before and after the development of the implementation program. Outcomes included average length of stay, number of exchange transfusions, average cost per SCD admission, and documentation of the clinical respiratory score and pulmonary interventions.


RESULTS
Average length of stay decreased from 5.8 days before implementation of the guideline to 4.1 days after implementation (P = .033). No patients required an exchange transfusion. Average cost per SCD admission decreased from $30 359 before guideline implementation to $22 368. Documentation of the clinical respiratory score increased from 31.0% before implementation to 75.5%, which is an improvement of 44.5% (P < .001). Documentation of incentive spirometry and positive expiratory pressure increased from 23.3% before implementation to 50.4%, which is an improvement of 27.1% (P < .001).


CONCLUSIONS
Implementation of a guideline for children with SCD with ACS or at risk for ACS improved outcomes for patients with SCD.
Evidence Based Outcomes Center, Texas Children’s Hospital, Houston, Texas 77030, USA. eacrabtr@texaschildrens.org
Elizabeth A
EA
Crabtree
M Michele
MM
Mariscalco
Joy
J
Hesselgrave
Suzanne F
SF
Iniguez
Tanya J
TJ
Hilliard
Julie P
JP
Katkin
Kathy
K
McCarthy
Mireya Paulina
MP
Velasquez
Gladstone
G
Airewele
Marilyn J
MJ
Hockenberry
D056586:Acute Chest Syndrome / Q000209:etiology / Q000628:therapy*; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D005791:Patient Care / Q000379:methods / Q000592:standards*; D010865:Pilot Projects; D017410:Practice Guidelines as Topic / Q000592:standards*; D058996:Quality Improvement / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies