• Jena L Welch-Coltrane, Anthony A Wachnik, AdamsMeredith C BMCBDepartment of Anesthesiology, Section of Pain Medicine, Wake Forest School of Medicine, North Carolina, USA., Cherie R Avants, Howard A Blumstein, Amber K Brooks, Andrew M Farland, Joshua B Johnson, Manoj Pariyadath, Erik C Summers, and Robert W Hurley.
• Department of Anesthesiology, Section of Pain Medicine, Wake Forest School of Medicine, North Carolina, USA.
• Pain Med. 2021 Aug 6; 22 (8): 174317521743-1752.

ObjectivePatients with sickle cell disease (SCD) face inconsistent effective analgesic management, leading to high inpatient healthcare utilization and significant financial burden for healthcare institutions. Current evidence does not provide guidance for inpatient management of acute pain in adults with sickle cell disease. We conducted a retrospective analysis of a longitudinal cohort quality improvement project to characterize the role of individualized care plans on improving patient care and reducing financial burden in high healthcare-utilizing patients with SCD-related pain.MethodsIndividualized care plans were developed for patients with hospital admissions resulting from pain associated with sickle cell disease. A 2-year prospective longitudinal cohort quality improvement project was performed and retrospectively analyzed. Primary outcome measure was duration of hospitalization. Secondary outcome measures included: pain intensity; 7, 30, and 90-day readmission rates; cost per day; total admissions; total cost per year; analgesic regimen at index admission; and discharge disposition.ResultsDuration of hospitalization, the primary outcome, significantly decreased by 1.23 days with no worsening of pain intensity scores. Seven-day readmission decreased by 34%. Use of intravenous hydromorphone significantly decreased by 25%. The potential cost saving was $1,398,827 as a result of this quality initiative.ConclusionsImplementation of individualized care plans reduced both admission rate and financial burden of high utilizing patients. Importantly, pain outcomes were not diminished. Results suggest that individualized care plans are a promising strategy for managing acute pain crisis in adult sickle cell patients from both care-focused and utilization outcomes.© The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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