Sickle Cell Care Differs in Style, Not Substance

Additionally, other than the use of incentive spirometry, there has been a paucity of data surrounding prevention strategies for acute chest. Dr. Shah’s study showed that hospitalists performed all the basic processes of care similarly to hematologists, as far as IV fluids, incentive spirometry, and DVT prophylaxis are concerned. Therefore, with all the basic best practices performed similarly, why is there such a big difference with acute chest?

This leads me to wonder if that number, 5.6%, represents some difference in documentation. As hospitalists, we certainly are trained with strong emphasis on proper documentation. I wonder if that increased rate of acute chest is an example of true increased incidence, or if it’s just a difference in documentation by hematologist vs. hospitalist.

"Knowledge Gaps"? I’m curious as to how, based on the findings of his study, Dr. Shah came to the conclusion that "there often is a knowledge gap in hospitalist care of sickle cell patients."

The study did not assess knowledge in any fashion for hospitalists. His study clearly pointed out differences in pain management and incidence of acute chest syndrome, but no other significant outcomes were shown, so it’s hard for me to make that leap. Even his study acknowledges the fact that when patients become ill, we always call consults for those patients. His study showed that every patient who was defined as having acute chest by a hospitalist did involve a hematology consult. If anything, Dr. Shah’s study showed that we as hospitalists know our limitations and know when to call for assistance.

In the end, our hope is that we can strike a collaborative balance between our hematologist colleagues at Duke and our hospitalist group that would allow the best care possible for this patient population. There will always be challenges and differences in opinions when multiple physicians are involved, but ultimately, we all hope that we can work together to provide the best outcome for the sickle cell population here at Duke.

Noppon P. Setji, M.D., is a hospitalist at Duke University Medical Center, Durham, N.C . He reports having no conflicts of interest.