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

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Tachycardia may indicate a severe skin infection requiring admission. Updating emergency department observation unit protocols to fit local patient needs can improve care for skin and soft tissue infections.

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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.