OBJECTIVES To assess whether there is: a) a clinical difference between patients with cellulitis treated according to the recommendations of a clinical cellulitis guideline, and those treated otherwise and b) a difference in the cost of antibiotic treatment of the two groups.
METHODS Emergency Department (ED) patients diagnosed with cellulitis at a community hospital were graded using a 4-point scale, and physicians were encouraged to treat based on an established practice guideline. Patients were contacted 5 days after their ED visit, and again at 10 days if they had not improved by 5 days. Physician 'compliance' was defined as having followed three or more of the five elements of the guideline.
RESULTS Of the 272 patients, 147 (54.1%) were classified as Grade I, 53 (19.5%) Grade II, 33(12.1%) Grade III, and 6 (2.2%) Grade IV. In 12.1% the grade was not assigned. 43.5% were treated in compliance with the guidelines, of which 83.3% reported improvement at 5 days, compared to 87.7% of those treated otherwise. At 10 days, 98.8% of the patients treated in compliance with the protocol had improved compared to 94.7% of those treated otherwise. Average antibiotic cost/patient was: Grade 1: $8.48, Grade II: $16.65, Grade II: $96.53 in the 'compliance' group, and $35.68, $51.28, and $150.18 respectively in the 'non-compliance' group.
CONCLUSIONS Patients treated in accordance with the cellulitis guideline had similar outcomes to those treated otherwise, at significantly lower cost. Efforts to encourage compliance with the guideline are indicated.
Samuel G Campbell MB BCh, CCFP(EM), Dip PEC(SA), CHE
Dr. Campbell is an Associate Professor of Emergency Medicine at the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia. Dr. Campbell's current research interests are in the emergency management of infectious disease, and patient safety.
Campbell, Samuel; Burton-MacLeod, Rebecca; and Howlett, Todd
"A cellulitis guideline at a community hospital – we can reduce costs by standardizing care,"
Journal of Emergency Primary Health Care:
1, Article 2.
Available at: http://ro.ecu.edu.au/jephc/vol7/iss1/2