Peter M Yarbrough1, Polina V Kukhareva2, Emily Sydnor Spivak3, Christy Hopkins4, Kensaku Kawamoto2. 1. Department of Internal Medicine, Division of General Medicine, University of Utah Medical Center, Salt Lake City, Utah. 2. Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah. 3. Department of Internal Medicine, Division of Infectious Diseases, University of Utah Medical Center, Salt Lake City, Utah. 4. Division of Emergency Medicine, University of Utah Medical Center, Salt Lake City, Utah.
Abstract
BACKGROUND: Cellulitis is a common infection with wide variation of clinical care. OBJECTIVE: To implement an evidence-based care pathway and evaluate changes in process metrics, clinical outcomes, and cost for cellulitis. DESIGN: A retrospective observational pre-/postintervention study was performed. SETTING: University of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah. PATIENTS: All patients 18 years or older admitted to the emergency department observation unit or hospital with a primary diagnosis of cellulitis. INTERVENTION: Development of an evidence-based care pathway for cellulitis embedded into the electronic medical record with education for all emergency and internal medicine physicians. MEASUREMENTS: Primary outcome of broad-spectrum antibiotic use. Secondary outcomes of computed tomography/magnetic resonance imaging orders, length of stay (LOS), 30-day readmission, and pharmacy, lab, imaging, and total facility costs. RESULTS: A total of 677 visits occurred, including 370 visits where order sets were used. Among all patients, there was a 59% decrease in the odds of ordering broad-spectrum antibiotics (P < 0.001), 23% decrease in pharmacy cost (P = 0.002), and 13% decrease in total facility cost (P = 0.006). Compared to patients for whom order sets were not used, patients for whom order sets were used had a 75%, 13%, and 25% greater decrease in the odds of ordering broad-spectrum antibiotics (P < 0.001), clinical LOS (P = 0.041), and pharmacy costs (P = 0.074), respectively. CONCLUSION: The evidence-based care pathway for cellulitis improved care at an academic medical center by reducing broad-spectrum antibiotic use, pharmacy costs, and total facility costs without an adverse change in LOS or 30-day readmissions.
BACKGROUND:Cellulitis is a common infection with wide variation of clinical care. OBJECTIVE: To implement an evidence-based care pathway and evaluate changes in process metrics, clinical outcomes, and cost for cellulitis. DESIGN: A retrospective observational pre-/postintervention study was performed. SETTING: University of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah. PATIENTS: All patients 18 years or older admitted to the emergency department observation unit or hospital with a primary diagnosis of cellulitis. INTERVENTION: Development of an evidence-based care pathway for cellulitis embedded into the electronic medical record with education for all emergency and internal medicine physicians. MEASUREMENTS: Primary outcome of broad-spectrum antibiotic use. Secondary outcomes of computed tomography/magnetic resonance imaging orders, length of stay (LOS), 30-day readmission, and pharmacy, lab, imaging, and total facility costs. RESULTS: A total of 677 visits occurred, including 370 visits where order sets were used. Among all patients, there was a 59% decrease in the odds of ordering broad-spectrum antibiotics (P < 0.001), 23% decrease in pharmacy cost (P = 0.002), and 13% decrease in total facility cost (P = 0.006). Compared to patients for whom order sets were not used, patients for whom order sets were used had a 75%, 13%, and 25% greater decrease in the odds of ordering broad-spectrum antibiotics (P < 0.001), clinical LOS (P = 0.041), and pharmacy costs (P = 0.074), respectively. CONCLUSION: The evidence-based care pathway for cellulitis improved care at an academic medical center by reducing broad-spectrum antibiotic use, pharmacy costs, and total facility costs without an adverse change in LOS or 30-day readmissions.
Authors: Polina V Kukhareva; Charlene Weir; Guilherme Del Fiol; Gregory A Aarons; Teresa Y Taft; Chelsey R Schlechter; Thomas J Reese; Rebecca L Curran; Claude Nanjo; Damian Borbolla; Catherine J Staes; Keaton L Morgan; Heidi S Kramer; Carole H Stipelman; Julie H Shakib; Michael C Flynn; Kensaku Kawamoto Journal: J Biomed Inform Date: 2022-02-12 Impact factor: 6.317
Authors: Rahul S Kamath; Deepthi Sudhakar; Julianna G Gardner; Vagish Hemmige; Hossam Safar; Daniel M Musher Journal: Open Forum Infect Dis Date: 2018-01-12 Impact factor: 3.835