Reducing Hospitalisations With a Skin and Soft Tissue Infection Clinic

Patients with skin and soft tissue infection are often admitted to hospital despite compelling evidence that many can be managed safely as outpatients. This quality improvement study reports the outcomes of an outpatient skin and soft tissue infection programme implemented at an academic acute-care hospital in Toronto, Canada.

The intervention was an outpatient care pathway for patients with suspected skin and soft tissue infection who may otherwise have required admission to hospital. The programme was implemented within the existing general internal medicine outpatient clinic and primarily involved the addition of part-time advanced practice wound care nurses. The main outcome was the number of hospital inpatient days for skin and soft tissue infection. Data were analysed for 4 years pre-intervention (June 2016-May 2020) and 2 years post-intervention (June 2020-May 2022). Another acute-care hospital in the same network which did not undergo the intervention was included as a control.

During the 2-year post-intervention period there were 465 clinic visits with the programme (mean of 19/month). The median number of inpatient days for skin and soft tissue infection decreased from 224 per month before the intervention to 148 per month after the intervention (a reduction of 34%). There was no reduction in inpatient days for skin and soft tissue infection at the control site or among all diagnoses at the intervention site.

The implementation of an outpatient skin and soft tissue infection programme was associated with a sustained 34% reduction in inpatient days for skin and soft tissue infection. This study demonstrates the benefits of enhancing an existing outpatient internal medicine clinic through the creation of a streamlined care pathway and adding interdisciplinary expertise.