Examining “Treat-and-Release” Patterns Among SCD Patients

Patients with sickle cell disease (SCD) often seek treatment for pain crises in emergency departments (ED), where clinicians are typically unprepared to manage these events. Many of these visits end in a discharge from the ED. According to an analysis of population-based surveillance information from the Sickle Cell Data Collection program, these “treat-and-release” visits are less common than previously reported. The findings highlight areas of improvement for the segment of the population with the highest frequency of ED visits.

Susan T. Paulukonis, MD, from the California Rare Disease Surveillance Program and Public Health Institute in Richmond, California, and researchers analyzed ED use for 4,636 patients with SCD (age range = 0-84 years) over a 10-year span from 2005 to 2014.

The majority of patients (88%) had at least one treat-and-release visit, with an average of 2.1 visits per patient (range = 0-185). ED use varied greatly; for example, in 2005:

  • 53% of patients had no treat-and-release ED visits (no ED use)
  • 35% had between 1 and 3 visits (low ED use)
  • 9% had between 4 and 10 visits (medium ED use)
  • 3% had 11 or more visits (high ED use)

The highest-use group accounted for 45 percent of the total number of ED visits during the study period, but only accounted for 3 percent of the study population.

Dr. Paulukonis and co-authors concluded that “further study of the segment of the population with highest ED [use] may highlight areas where changes in health care and health policy could improve and extend the lives of patients with SCD.”

Source: Paulukonis ST, Feuchtbaum LB, Coates TD, et al. Emergency department utilization by Californians with sickle cell disease, 2005–2014. Pediatr Blood Cancer. 2016 December 21. [Epub ahead of print]

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