A feasibility assessment of an ambulatory care pathway for cellulitis at a tertiary referral centre in the Republic of Ireland

Abstract

Abstract Introduction There is a need for the development of more ambulatory care pathways to reduce the number of bed-days utilized by ambulatory care sensitive conditions in hospitals in Ireland. Healthcare policy and strategy has changed to reflect this. Our aim was to determine if an ambulatory care pathway for the management of cellulitis would be feasible in our tertiary referral centre. Methods We searched hospital coding data to identify all admissions with cellulitis from 1/1/2018 to 31/12/2018 in our tertiary referral centre. We estimated the cost of cellulitis admissions using guidelines from the Healthcare Pricing Office in Ireland. We used guidance from the Department of Public Expenditure and Reform to calculate the cost of staff in a proposed ambulatory care model. Results We identified 249 episodes of care with cellulitis in 2018. 89.6% (223/249) were emergency episodes of care. A total of 2372 bed-days was utilized by emergency episodes of care at a cost of €1,126,369–1,129,823. The median cost of an emergency episode of care due to cellulitis was €2291 (IQR 2291–5594) with a mean cost per bed-day of €475–476. Overall, there was neither sepsis nor a surgical intervention coded in 85.2% (190/223) of emergency episodes of care. We identified a cohort of 23.8% (53/223) of emergency episodes of care that had a length of stay of 1–3 days which could potentially have been managed using an ambulatory care pathway. Conclusion Even if only a small proportion of cases were ambulated there are significant savings in terms of bed-days and costs to be made. An ambulatory care pathway for cellulitis should be established in our tertiary referral centre and this methodology could be used to inform resourcing of pathways elsewhere.