sickle cell disease; sickle cell anemia; family medicine; sickle cell crisis; hematology; patient-controlled analgesia; hospitalization; length of stay
Emergency Medicine | Family Medicine | Hematology | Hemic and Lymphatic Diseases | Internal Medicine | Primary Care
Sickle cell crisis hospitalizations are emotionally and financially burdensome to patients and healthcare systems, and processes to decrease the frequency or length of stay of these crises should be examined.
This is a multicenter retrospective hospital record review of sickle cell crisis hospitalizations as defined by ICD-10 codes (D57.1-4), from January 2016 through December 2019, examining inpatient medication administration records and length of stay among admitted adults aged 18–65 years. Patient controlled analgesia orders using morphine, hydromorphone, fentanyl and/or merperidine at any point of an admission (n=188) were compared to admissions without any patient-controlled analgesia orders (n=2,159). The primary end point was hospital length of stay in days. A secondary analysis examining patients with or without greater than four admissions was also conducted.
The 1,675 patients who met criteria comprised 2,347 sickle cell hospitalizations during the four years examined. Of those admissions, 188 had at least one patient-controlled analgesic documented in their chart and had an average length of stay of 4.54 days (SD 3.34). The 2,159 admissions without any patient-controlled analgesia had an average length of stay of 5.74 days (SD 4.64). The difference of 1.2 days between the groups was statistically significant (p≤0.0001) using a Wilcoxon signed-rank test.
Among patients with sickle cell crises who required inpatient hospitalizations, the use of patient-controlled analgesia demonstrated a statistically significant reduction of 1.2 days in their total length of stay. These findings support potentially changing hospital protocols to increase patient-controlled analgesia utilization.
Figure 1 replaced with a label correction. The label was redundant with the figure legend and referred to reference color in graph as red instead of orange. 10/27/2021: Corresponding author email updated.
Prestia, Brett M.; Ramzan, Talha; Waldron, Catherine; Malik, Ameer; Pallay, Robert M.; Murbach, Candace R.; Flynn, Mike; Shaw, Eric PhD; Kutlar, Abdullah; and Lowe, Daniel
"Utilization of Patient-Controlled Analgesia Reduces Length of Stay of Sickle Cell Crisis Hospitalizations,"
HCA Healthcare Journal of Medicine: Vol. 2:
4, Article 12.
Available at: https://scholarlycommons.hcahealthcare.com/hcahealthcarejournal/vol2/iss4/12