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Transfer of care and overstay in the management of cellulitis in the emergency short stay unit: A retrospective cohort study
Author(s) -
Abetz Jeremy W,
Adams Nicholas G,
Newnham Harvey,
Smit De Villiers,
Mitra Biswadev
Publication year - 2017
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12731
Subject(s) - medicine , cellulitis , retrospective cohort study , odds ratio , confidence interval , intensive care unit , emergency department , emergency medicine , white blood cell , surgery , psychiatry
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 >28 h, 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 × 10 9 /L increase) and C‐reactive protein (adjusted OR 1.004; 95% CI 1.00–1.01 per 1 mg/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.