Using a Shared Infusion Clinic for Outpatient Management of Sickle Cell Vaso‐Occlusive Crisis as a Strategy of Decreasing Emergency Department Visits

Patients with sickle cell disease (SCD) experience high rates of emergency department (ED) visits and hospitalizations, primarily owing to vaso‐occlusive crises (VOC). In Edmonton, patients followed by the Centre for Bleeding and Rare Blood Disorders (CFBD) have access to the Medical Outpatient Unit (MOU) to receive care from a personalized pain plan for their VOC episodes as an alternative to ED presentation. In this study, we performed a retrospective analysis to evaluate the use of the MOU, thereby diverting patients from presenting to acute care. A chart review was completed of patients 18 years or older with SCD who utilized the MOU from November 2019 to December 2022. Any repeat encounters within 7 days were assumed to be part of the same VOC event. Twenty‐six patients with SCD presented to MOU during the time of this study. There was a total of 136 encounters (median 2, maximum 25) accounting for 96 separate episodes of VOC (median 2, maximum 19). The most common interventions included administration of IV fluids in 129 encounters (95%) and use of pain medications in 64 encounters (47%). Patients only required assessment by nursing in the majority (80%) of encounters and were discharged home safely from MOU in 99% of encounters, with only two encounters resulting in patients requiring assessment in ED. Seventy of 96 episodes of VOC treated in MOU did not have an associated presentation to ED within 30 days (73%). The total ED presentations of this cohort decreased from 59 in 2016–2018 to 38 during this study. The use of the MOU was effective strategy for providing outpatient assessment and treatment of VOC, and there was an associated decrease in ED visits in this cohort.