Sickle cell anemia day hospital: an approach for the management of uncomplicated XXXX crises.

@entity1 @entity341 @entity3458 @entity158 @entity580
@entity158 crisis episodes are poorly treated in @entity3458 , both in timeliness and appropriateness of care. Delayed treatment in Emergency Departments, unrelieved @entity158 , frequent admissions, and prolonged hospitalizations are common. We established a @entity580 ( @entity580 ) to determine if an alternative care delivery system could improve @entity158 relief and reduce unnecessary hospital admissions for @entity1 with uncomplicated @entity158 crises. Trained @entity580 staff delivered prompt titration for @entity158 relief based on each @entity1 's analgesic history and qualitative and quantitative assessments. Response to therapy and comorbidities commanded disposition. During the first 5 years of @entity580 operation there were 2554 visits; 60% of the @entity1 had severe @entity158 . During an average visit of 4.5 hours, 84% of the @entity1 were titrated to relief; 90% had @entity158 relief within 2 to 4 hours. Overall, 81% of the @entity1 were discharged home (70% initially and 90% to 94% in the last 3 years). During the first 5 years of the @entity580 , there were 2612 @entity341 ( @entity341 ) visits that averaged 13 hours each. The combined @entity341 and @entity580 admissions during this time represented a 40% decrease in the baseline @entity341 admission rate of 92%, (1 year pre- @entity580 ). @entity1 with uncomplicated @entity158 crisis were admitted 5 times less often from the @entity580 (8.3%) than from the @entity341 (42.7%). The length of stay (LOS) for inpatients followed by the @entity580 staff decreased by 1.5 days, while the LOS for @entity1 followed by non- @entity580 staff remained unchanged. Reduction of admissions and LOS represented a savings of approximately  1.7 million. We conclude that a dedicated facility provides the kingpin for effective and rapid @entity158 crisis management, reduces hospitalizations, and facilitates integration of the approach into other areas of care. (Blood. 2000;95:1130-1136)
