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Hospital to help sickle cell patients

Section: Health

Kate Moran

To help steer patients with sickle cell disease away from local emergency rooms, a Tulane University hematologist plans to open a day hospital to care for patients during their periodic bouts of pain.

Dr. Rebecca Kruse-Jarres will launch the five-bed hospital next month inside Tulane Medical Center. She has assembled a team that includes a nurse, nurse practitioner, social worker and pain specialist to work alongside her and develop trusted relationships with adult sickle cell patients.

Sickle cell disease is an inherited condition that causes the body to produce defective red blood cells that collapse into crescent shapes. Such cells tend to bunch up and occlude blood vessels, preventing oxygen from reaching limbs or vital organs.

There is no cure for the disease, which affects approximately 100,000 people in the United States, most of whose ancestors come from Africa. Still, Kruse-Jarres said patients can monitor their health with proper medication and clinic appointments every three to six months. Many patients experience episodes of acute pain between those clinic visits, however.

Afflicted patients most often seek relief in hospital emergency rooms, which have been choked in almost perpetual gridlock since Hurricane Katrina destroyed other health-care resources, from primary-care clinics to psychiatric hospitals. Sickle cell patients often have to abide the pain for hours as ER doctors treat patients with more critical conditions.

When it opens in November, the day hospital will allow sickle cell patients to bypass the emergency room altogether. Kruse-Jarres said her team of caregivers will provide rapid care that costs less than an emergency room visit. The population of sickle cell patients is also small enough -- there are maybe 200 in the city -- that her team of caregivers will most likely know them by name.

"If you have a day hospital, a place patients can go to be treated right away by a team that knows sickle cell disease and that probably knows them too, you can deliver much better care," she said.

Robin James, a Gentilly resident with sickle cell anemia, said she used to breeze through the emergency room at Tulane Medical Center before the storm. As crowds have swelled since Katrina, she has idled in the emergency room for four or five hours without being seen by a doctor. Sometimes she leaves and comes back, and other times she drives out to Tulane-Lakeside in Metairie to avoid the lines.

"I'm one who waits till the last minute to go to the hospital because of the emergency room situation," James said. "If you drink a lot of fluids at home, sometimes that can bring you out of it. If it gets too bad, you have no choice but to go to the hospital. A lot of times you're dehydrated, and your blood count may have dropped."

She said the new hospital for sickle cell patients at Tulane would be a "great big help."

Kruse-Jarres secured a $420,000 grant from Baptist Community Ministries, the state's largest private foundation, to sustain the sickle cell hospital for three years. She said most sickle cell patients have some form of insurance, including Medicaid or Medicare, or are eligible to enroll.

Lynn Bick, director of ambulatory nursing at Tulane Medical Center, said the day hospital will do more than help keep patients out of the emergency room. Kruse-Jarres and her team of nurses and social workers will counsel the patients on how to stave off the pain episodes with proper care at home and advise them to visit the day hospital right away when the episodes begin.

"With the counseling and the support, we will be able to better care for patients and make them accountable for their care, too," Bick said. "People who are accountable for their care know how to recognize when they need early intervention. If the patient wakes up in the middle of the night and feels a pain crisis coming, he or she will know to call first thing in the morning."

While Kruse-Jarres estimated there are roughly 200 adult sickle cell patients in the New Orleans area, no one knows for sure how many are here. Infants are tested for the disease at birth, and the state tracks the number of diagnoses per year. However, the state does not monitor how long those patients live or whether they move out of Louisiana.

Fifty-four newborns were diagnosed with sickle cell disease in the greater New Orleans area between 2004 and 2006, according to the Department of Health and Hospitals. The statewide total for that same period was 256. All but one of the newborns found to have the disease were "non-white."

Tulane Medical Center will hold a grand opening for the day hospital on Saturday, but it will not open to patients until sometime next month. The hospital will be open Monday through Friday, and patients will be able to call (504)¤988-1250 to schedule a visit.

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