A patient with sickle cell disease who has frequent hospital readmissions within 1 week of discharge may have a poor prognosis. It is important to determine the cause for the readmission in order to prevent future readmissions. The authors are from Thomas Jefferson University in Philadelphia.


It is important to determine if the painful episode on readmission is the same as for the previous admission, or if it is due to a different problem.


Factors affecting readmission with continuation of a painful episode:

(1) premature discharge (leaving against medical advice, needing to get back to work, needing to care for a family member, etc.)

(2) suboptimal management, especially in prescribing pain medicines

(3) maladaptive behavior (poor adherence with therapy, selling medications, etc.)

(4) problems in continuity in care (followup provider often not the same as the one giving hospital care)


Other factors that may cause readmission:

(1) opiate withdrawal syndrome

(2) complications of therapy


Factors affecting readmission for a new painful episode:

(1) disease progression reflecting cumulative damage to different organs

(2) onset of a new process (pneumonia, etc.)


To read more or access our algorithms and calculators, please log in or register.