Background:

Cellulitis is a common reason for admission to the hospital. The disease is often over–diagnosed due to difficultly in differentiating it from chronic venous stasis and stasis dermatitis. The natural history and etiology of cellulitis is also often misunderstood. This can result in inappropriate antimicrobial use, increased length of stay, and high rates of readmission. Readmission rates are especially high for recurrent cellulitis associated with chronic edema. We hypothesized that implementation of a specialized cellulitis consult service comprised of an infectious diseases physician and a hospitalist could reduce hospital length of stay, antibiotic utilization, and overall hospital costs.

Methods:

Over a 5–month period in 2011, we provided consultation services to the hospitalist group on 3 weekdays for patients admitted with non–purulent cellulitis or a cutaneous abscess. Approximately 50% of patients with cellulitis or an abscess were enrolled in this semi–randomized fashion. We excluded patients that were destined for intensive care or resident–run floors, patients that had been hospitalized for over 24 h, and patients that had chronic wounds, osteomyelitis, or diabetic foot infections. Subjects were enrolled through consultation by hospitalists and daily admission log screening. The service communicated their recommendations to the attending physician and co–management was encouraged. There were two groups of controls: (1) “historical controls”—patients admitted to the hospitalist service with cellulitis over the 6–month period prior to the intervention; and (2) “concurrent controls”—patients admitted with cellulitis to the hospitalist service on days when the consult service was unavailable. The same exclusion criteria were used. The project was reviewed by the Institutional Review Board.

Results:

Patients seen by the consult service had a significantly lower 30–day readmission rate (2% vs 10.3%) when compared to historical controls with similar severity of illness indexes (Table 1). We observed a significant reduction in length of stay (and therefore cost) compared to concurrent controls (4.58 days/$9,554 to 2.74 days/$6,241), although not compared to historical controls (2.88 days/$6,074 to 2.74 days/$6,241) (Table 1). The severity of illness index for all three groups was not significantly different. The consult service did not significantly increase total hospitalization cost and was well received by the providers.

Conclusions:

The specialized consult service for patients admitted with skin and soft tissue infections clearly reduced the 30–day readmission rates for recurrence or worsening of the infection. The length of stay and total hospitalization costs were also reduced. The service does not appear to increase costs and is well received by providers.

Table 1