A Quality Improvement Initiative to Decrease Hospital Admission for Skin and Soft Tissue Infections From an...

Area of Science:

• Emergency Medicine
• Infectious Diseases
• Clinical Research

Background:

• Skin and soft tissue infections (SSTIs) are common reasons for emergency department (ED) visits.
• Determining appropriate disposition for patients with SSTIs managed in an ED observation unit (EDOU) is crucial for efficient resource allocation and patient care.
• Existing protocols may not fully account for factors influencing admission decisions for SSTI patients in the EDOU.

Purpose of the Study:

• To identify factors associated with the need for full hospital admission ( > 2 days) for patients with SSTI managed in an EDOU.
• To inform the development and refinement of a new protocol for managing SSTI patients within the EDOU.

Main Methods:

• Retrospective cohort study of adult patients treated for SSTI in an EDOU between 2017 and 2018.
• Data collected included demographics, vital signs, SSTI characteristics, procedures, consultations, length of stay, and disposition.
• Statistical analysis involved univariable and multivariable logistic regression to identify predictors of admission.

Main Results:

• Of 408 patients, 100 (24.5%) required admission. Factors associated with higher odds of admission included tachycardia (OR, 1.85).
• Factors associated with lower odds of admission included SSTI on the torso (OR, 0.23), planned expert consultation (OR, 0.32), and undergoing a procedure like incision and drainage (OR, 0.42).
• Following protocol update, the admission rate for SSTI patients decreased to 22.4%.

Conclusions:

• Tachycardia in the ED may signal a more complicated SSTI requiring hospital admission.
• Adapting EDOU protocols to the specific characteristics of the local patient population can enhance patient selection and management for SSTIs.