The rotating nature of the staff in most emergency rooms means that patients with sickle cell pain crises often see different providers with each visit. Consequently, patients frequently are undermedicated. This scenario often evokes a confrontation between patient and staff. The patient demands more medication since the administered amount is inadequate. The staff becomes defensive, and begin to question whether the patient is simply seeking drugs.
Hostility develops on both sides.
In this context, which is unpleasant for patient and staff, reasonable medical care is not possible. These factors combine to increase the admission rate to the hospital for patients who are treated for vaso-occlusive pain in the ER versus the day hospital. Dr. Lenette Benjamin presented data from Montefiore Hospital in the Bronx at the 21st Annual Meeting of the Comprehensive Sickle Cell Centers in March, 1999. The lower admission rate from the day hospital saved the hospital about one-half million dollars during this time. For communities with substantial numbers of patients with sickle cell disease, a day hospital treatment facility makes sense both from financial and medical points of view.