Although they make up a small fraction of the patients at Froedtert Hospital, the sickle cell patients are one of the most difficult groups to treat.
With high readmission rates and high utilization of the emergency room, the group of patients was a challenge for the hospital. Until last year.
Wisconsin's Only Adult Sickle Cell Clinic
Dr. Joshua Field, a hematologist at the Blood Center of Wisconsin, opened the state’s only adult Sickle Cell Clinic at Froedtert Hospital in September 2011. Within one year, 30-day readmissions have been reduced 30 percent, emergency department visits are down 23 percent and inpatient admissions have been reduced 35 percent.
The clinic has saved Froedtert $1 million annually. And, more importantly, it has changed patients’ lives.
"This is more than a clinic, it is a program that has helped us redesign how we care for these individuals," said Kathy Bagemihl, vice president of ambulatory services. "When we first opened, one person said they had never been able to go on vacation before because they were afraid they would have a crisis. Dr. Field has been able to manage that for patients so they can be more functional, productive members of the community." Sickle cell disease is a genetic disease that primarily affects African Americans. It creates red blood cells that have an abnormal "sickle" shape instead of a normal disc shape. Sickle cells carry less oxygen and can interrupt healthy blood flow, eventually leading to tissue and organ damage.
"At some point, most sickle cell patients experience painful episodes in their legs, arms, chest or back, most often felt in their bones."
Because some sickle cell patients have severe pain, the Sickle Cell Clinic has a full-time infusion nurse on staff Monday through Friday so patients can have treatments for pain in the clinic, instead of emergency rooms – a first for many of them, Field said.
Preventative Care to Reduce Financial Loss
"Obviously this is more cost-effective, but it also provides a great deal more consistency of care," Field said. "Patients come in for an infusion and are treated by a nurse who has seen them through every infusion for the last six months. We have a lot of trust from our patients and that helps us take care of them better."
The clinic is staffed by Field, two nurse practitioners, an infusion nurse, nurse coordinator, medical assistant and clinic manager.
If patients do end up in the emergency department or are admitted to the hospital, Field is notified and keeps tabs on them so there is no communication breakdown, he said. The clinic started with 78 patients. Today, there are 230.
Because Field has found a way to provide preventive care to a population that historically had used the emergency room as their doctor’s office, the financial loss has been greatly reduced.
"There are still individuals who will need to be admitted, but the majority of care can be provided on an outpatient basis," Bagemihl said. "This is one example of how we are working to meet community needs and a demonstration of our commitment to do what is right for the patient and do it in a less costly way."