A new study published in the Annals of Internal Medicine found that patients with sickle cell disease (SCD) experiencing acute pain crises received better care at specialized infusion centers, compared with emergency departments. Researchers reported that patients treated at specialized centers also had faster access to pain medications and lower rates of hospitalization.
Barriers to quality treatment in emergency departments can worsen outcomes for patients with SCD. These include racist misconceptions about Black people having higher pain tolerance, high volumes of patients visiting the emergency department, and a lack of provider training in how to handle acute pain episodes. Additionally, in light of the opioid epidemic, some clinicians might suspect patients with SCD are lying about their pain in order to access opioids; providers may withhold pain medication or avoid giving them the high doses that patients need.
To address these issues, some hospitals have established infusion centers, also known as day hospitals, to meet the specific needs of patients experiencing sickle cell pain crises. The study followed hundreds of patients with SCD for 18 months, tracking visits to infusion centers or emergency departments, time to first treatment, and hospitalization rates. At infusion centers, it took patients an average of 62 minutes to receive the first dose of pain medication, compared with 132 minutes at the emergency departments. Clinicians in the infusion centers were 3.8 times more likely to reassess patients’ pain within half an hour than those in the emergency departments. Patients at infusion centers were also four times as likely to be discharged home rather than hospitalized, perhaps because of the rapid treatment they received, the authors observed.
“Getting care in the right place at the right time, it makes life better for the patients – and better for the providers and better for the payers,” said Sophie Lanzkron, MD, MHS, director of the Sickle Cell Center for Adults at Johns Hopkins Medicine, who led the study.
While the infusion center model is effective, the centers are only open during normal business hours and only available at select hospitals, so there is still a need to improve emergency department care for patients experiencing sickle cell pain crises. “Most places do not have the capacity or patient volume to have independent infusion centers for sickle cell,” said Mohammed Sani Bukari, MD, director of the University of California, San Francisco sickle cell program. “So, if you don’t have the volumes and the capacity – including the manpower and resources – then probably an embedded infusion center is the way to go.”