DENVER – Next-day infectious diseases consultation for cellulitis reduced the number of emergency department visits and hospital admissions by 19% and 25%, respectively, a single-center study demonstrated.
This approach "is advantageous for patients if they don’t need to be admitted, and there is potential cost savings, because a lot of cost occurs during hospital admissions, especially in the first couple of days," lead study author Dr. Jennifer F. Gittzus said in an interview during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. "Patients with cellulitis are generally very happy if they don’t have to be admitted. They prefer being treated in the outpatient setting."
Dr. Jennifer F. Gittzus
Repeat emergency department (ED) visits for cellulitis are common, and inpatient admissions for cellulitis are often poorly reimbursed, noted Dr. Gittzus, of the Infectious Disease and International Travel Clinic at Concord (N.H.) Hospital. She and her colleagues hypothesized that a referral model that included next day infectious diseases (ID) consultation and ID management of outpatient intravenous (IV) antibiotics could decrease ED visits for cellulitis and perhaps also decrease admissions and/or length of stay. To find out, the researchers compared ED visits and hospital admission for cellulitis year 2010 (the year prior to this referral service being available), with those that occurred in 2011 and 2012.
Dr. Gittzus reported that between 2010 and 2012, ED visits for cellulitis fell from 948 to 748, for a reduction of 19%, while outpatient cellulitis episodes (defined as one episode potentially encompassing several days of therapy) rose from 23 to 271, an increase of more than 1,000%. Over the same time period, the number of inpatient hospital admissions for cellulitis dropped from 320 to 241, a reduction of 25%. As a consequence, daptomycin use increased at Concord Hospital from 86 days of therapy in 2010 to 571 days of therapy in 2012, "but this occurred mostly in the [ED] and outpatient settings," Dr. Gittzus emphasized.
Overall, the cost for outpatient management of cellulitis was a fraction of the cost of a hospital admission for cellulitis. For example, in 2010, the average daily inpatient charges and average daily outpatient charges were $3,818.79 and $574.42, respectively, while in 2012 those same charges stood at $5,229.96 and $1,633.40.
"We were surprised at how well this referral services was used by the emergency department," Dr. Gittzus said. "We’re actually expanding this [approach] to other diagnoses that benefit from IV antibiotics but don’t necessarily need acute hospital admission."
Dr. Gittzus said that she had no relevant conflicts of interest to disclose.