title: Differences in pain management between hematologists and hospitalists caring for patients with sickle cell disease hospitalized for vasoocclusive crisis.
abstract: OBJECTIVE
  Sickle cell disease (SCD) is a chronic disease characterized by multiple vaso-occlusive complications and is increasingly cared for by hospitalists. The purpose of this study is to examine differences in pain management between hematologists and hospitalists.
  
  
  METHODS
  We performed a single-institution, retrospective review of pain management patterns and outcomes in adult SCD patients hospitalized for vaso-occlusive crisis.
  
  
  RESULTS
  Over 26 months, we found a total of 298 patients (120 cared for by the hematologists and 178 by hospitalists), with a mean age of 32 (range 19-58). Patients cared for by hospitalists had a lower total number of hours on a patient controlled analgesia (PCA) device (171 vs. 212 hours, P=0.11). Hospitalists also were significantly more likely to utilize demand only PCA (42% vs. 23%, P=0.002) and had a significantly lower rate of using both continuous and demand PCA (54% vs. 67%, P=0.04). In addition, patients cared for by hospitalists had a significantly shorter hospitalization (8.4 days) compared to hematologists (10 days, P=0.04) with a non-significant difference in 7 and 30 day readmission rates (7.2% vs. 6.7% and 40% vs. 35% respectively).
  
  
  CONCLUSIONS
  We found patients cared for by hospitalists more frequently utilized home oral pain medication during admission, had shorter lengths of hospitalization, and did not have a significant increase in readmission rates.
authors.affiliation: *Department of Pediatric Hematology/Oncology †Division of Hematology ‡Department of Pediatrics §Division of Oncology ∥Department of Hospital Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Nirmish
authors.initials: N
authors.lastname: Shah
authors.forename: Margo
authors.initials: M
authors.lastname: Rollins
authors.forename: Daniel
authors.initials: D
authors.lastname: Landi
authors.forename: Radhika
authors.initials: R
authors.lastname: Shah
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bae
authors.forename: Laura M
authors.initials: LM
authors.lastname: De Castro
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D000755:Anemia, Sickle Cell / Q000150:complications / Q000628:therapy*; D006405:Hematology; D020445:Hospitalists; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010359:Patient Readmission; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D055815:Young Adult