title: Evidence-based care pathway for cellulitis improves process, clinical, and cost outcomes.
abstract: BACKGROUND
  Cellulitis is a common infection with wide variation of clinical care.
  
  
  OBJECTIVE
  To implement an evidence-based care pathway and evaluate changes in process metrics, clinical outcomes, and cost for cellulitis.
  
  
  METHODS
  A retrospective observational pre-/postintervention study was performed.
  
  
  METHODS
  University of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah.
  
  
  METHODS
  All patients 18 years or older admitted to the emergency department observation unit or hospital with a primary diagnosis of cellulitis.
  
  
  METHODS
  Development of an evidence-based care pathway for cellulitis embedded into the electronic medical record with education for all emergency and internal medicine physicians.
  
  
  METHODS
  Primary outcome of broad-spectrum antibiotic use. Secondary outcomes of computed tomography/magnetic resonance imaging orders, length of stay (LOS), 30-day readmission, and pharmacy, lab, imaging, and total facility costs.
  
  
  RESULTS
  A total of 677 visits occurred, including 370 visits where order sets were used. Among all patients, there was a 59% decrease in the odds of ordering broad-spectrum antibiotics (P < 0.001), 23% decrease in pharmacy cost (P = 0.002), and 13% decrease in total facility cost (P = 0.006). Compared to patients for whom order sets were not used, patients for whom order sets were used had a 75%, 13%, and 25% greater decrease in the odds of ordering broad-spectrum antibiotics (P < 0.001), clinical LOS (P = 0.041), and pharmacy costs (P = 0.074), respectively.
  
  
  CONCLUSIONS
  The evidence-based care pathway for cellulitis improved care at an academic medical center by reducing broad-spectrum antibiotic use, pharmacy costs, and total facility costs without an adverse change in LOS or 30-day readmissions.
authors.affiliation: Department of Internal Medicine, Division of General Medicine, University of Utah Medical Center, Salt Lake City, Utah.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Yarbrough
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah.
authors.forename: Polina V
authors.initials: PV
authors.lastname: Kukhareva
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Utah Medical Center, Salt Lake City, Utah.
authors.forename: Emily Sydnor
authors.initials: ES
authors.lastname: Spivak
authors.affiliation: Division of Emergency Medicine, University of Utah Medical Center, Salt Lake City, Utah.
authors.forename: Christy
authors.initials: C
authors.lastname: Hopkins
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Kawamoto
mesh_terms: D000046:Academic Medical Centers / Q000191:economics*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D002481:Cellulitis / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000592:standards; D019317:Evidence-Based Medicine / Q000191:economics* / Q000592:standards; D005260:Female; D017721:Hospital Costs / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000592:standards; D017064:Process Assessment, Health Care / Q000191:economics* / Q000592:standards; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents