Evidence-based care pathway for cellulitis improves process, clinical, and cost outcomes.

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.