title: Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care.
abstract: BACKGROUND
  Cellulitis is responsible for over 400,000 bed days per year in the English National Health Service (NHS) at the cost of £96 million.
  
  
  OBJECTIVE
  An audit following transfer of care of lower limb cellulitis managed in secondary care from general physicians to dermatologists.
  
  
  METHODS
  Review of patient details and work diaries from the first 40 months of implementation of the new model of care.
  
  
  RESULTS
  Of 635 patients referred with lower limb cellulitis 33% had other diagnoses which did not require admission. Four hundred and seven of 425 patients with cellulitis were managed entirely as outpatients, many at home. Twenty-eight per cent of patients with cellulitis had an underlying skin disease identified and treated, which is likely to have reduced the risk of recurrent cellulitis, leg ulceration and lymphoedema. Only 18 of 635 patients referred with lower limb cellulitis required hospital admission for conventional treatment.
  
  
  CONCLUSIONS
  This new way of managing suspected lower limb cellulitis offered substantial savings for the NHS, and benefits of early and accurate diagnosis with correct home treatment for patients.
authors.affiliation: Dermatology Department, Norfolk and Norwich University Hospital, Norwich, UK. nick.levell@nnuh.nhs.uk
authors.forename: N J
authors.initials: NJ
authors.lastname: Levell
authors.forename: C G
authors.initials: CG
authors.lastname: Wingfield
authors.forename: J J
authors.initials: JJ
authors.lastname: Garioch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D003880:Dermatology / Q000458:organization & administration* / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents