TY - JOUR
T1 - Transfer of care and overstay in the management of cellulitis in the emergency short stay unit
T2 - A retrospective cohort study
AU - Abetz, Jeremy W.
AU - Adams, Nicholas G.
AU - Newnham, Harvey
AU - Smit, De Villiers
AU - Mitra, Biswadev
PY - 2017/4
Y1 - 2017/4
N2 - Objective: This study aimed to quantify the rate of transfer of care or overstay from cellulitis management in the emergency short stay unit (ESSU) and to identify risk factors during initial assessment associated with transfer of care or overstay. Methods: A retrospective cohort study was conducted including cellulitis patients diagnosed with and admitted to the ESSU at a metropolitan adult tertiary referral centre. Data abstracted included patient demographics, comorbidities, initial investigations and initial vital signs. Transfer of care or overstay were defined as inpatient admission or a stay in ESSU >28h, respectively. Results: Of the 451 included patients, 157 (34.8%) met the criteria for transfer of care or overstay. These criteria included admission to hospital inpatient units (115 patients, 73.2%) and patients who overstayed the ESSU time period (42 patients, 26.8%). Variables independently associated with transfer of care or overstay were obesity (adjusted odds ratio [OR] 4.33; 95% confidence interval [CI] 1.38-15.59), i.v. drug use (adjusted OR 2.15; 95% CI 1.03-4.51), white blood cell count (adjusted OR 1.09; 95% CI 1.02-1.16 per 1×109/L increase) and C-reactive protein (adjusted OR 1.004; 95% CI 1.00-1.01 per 1mg/L increase). Conclusions: Transfer of care or overstay after admission to ESSU was high among patients with cellulitis. Variables independently associated with transfer of care or overstay were obesity, i.v. drug use, elevated white blood cell count and elevated C-reactive protein. Awareness of these variables can inform appropriate guidelines for ESSU admission, potentially improving patient flow and reducing length of stay in the ED and hospital.
AB - Objective: This study aimed to quantify the rate of transfer of care or overstay from cellulitis management in the emergency short stay unit (ESSU) and to identify risk factors during initial assessment associated with transfer of care or overstay. Methods: A retrospective cohort study was conducted including cellulitis patients diagnosed with and admitted to the ESSU at a metropolitan adult tertiary referral centre. Data abstracted included patient demographics, comorbidities, initial investigations and initial vital signs. Transfer of care or overstay were defined as inpatient admission or a stay in ESSU >28h, respectively. Results: Of the 451 included patients, 157 (34.8%) met the criteria for transfer of care or overstay. These criteria included admission to hospital inpatient units (115 patients, 73.2%) and patients who overstayed the ESSU time period (42 patients, 26.8%). Variables independently associated with transfer of care or overstay were obesity (adjusted odds ratio [OR] 4.33; 95% confidence interval [CI] 1.38-15.59), i.v. drug use (adjusted OR 2.15; 95% CI 1.03-4.51), white blood cell count (adjusted OR 1.09; 95% CI 1.02-1.16 per 1×109/L increase) and C-reactive protein (adjusted OR 1.004; 95% CI 1.00-1.01 per 1mg/L increase). Conclusions: Transfer of care or overstay after admission to ESSU was high among patients with cellulitis. Variables independently associated with transfer of care or overstay were obesity, i.v. drug use, elevated white blood cell count and elevated C-reactive protein. Awareness of these variables can inform appropriate guidelines for ESSU admission, potentially improving patient flow and reducing length of stay in the ED and hospital.
KW - Cellulitis
KW - Emergency service
KW - Hospital
UR - http://www.scopus.com/inward/record.url?scp=85010607068&partnerID=8YFLogxK
U2 - 10.1111/1742-6723.12731
DO - 10.1111/1742-6723.12731
M3 - Article
AN - SCOPUS:85010607068
VL - 29
SP - 143
EP - 148
JO - EMA - Emergency Medicine Australasia
JF - EMA - Emergency Medicine Australasia
SN - 1742-6731
IS - 2
ER -