Do patients with acute diverticulitis need to be in the hospital? - Implementation of an @Home treatment pathway to reduce admissions

Abstract

Abstract Aims Acute complicated diverticulitis is often treated as an in-patient, despite few needing intervention. Virtual wards are designed to treat patients at home. The aim was to develop an NHS@Home service for acute diverticulitis to reduce hospital admissions. Methods A retrospective review of patients with diverticulitis examined daily WCC & CRP, analgesia and IV antibiotic requirements, NEWS2 & pain scores. This was used to develop an @Home treatment protocol. In this, patients with CT-confirmed diverticulitis +/- localized perforation <3cm, NEWS2 <2, Pain score <5, and CRP <200 were given one dose of IV antibiotics, then oral antibiotics at home with thrice-a-day observations and daily bloods. Discharge was nurse-led on day 2 or 3 with criteria for re-admission. Results Of 42 admissions, mean WCC was 12.7, mean CRP was 171 if perforated, and 85 if not. All NEWS2 scores were <2 and mean pain score was 3. 65% of patients (28/42) had no perforation on CT. Most patients (60.5%) did not require opioid analgesia, mean IV antibiotic treatment duration was 2.5 days and mean LOS was 3.75 days. Only 6/42 patients (14.28%) had a collection. In all patients, WCC was static or reduced during admission but CRP increased in a third. 35 patients were treated on the Diverticulitis@Home Pathway in the first 4 months with one readmission. The pathway was used to standardize colonic imaging according to guidelines. As a result, 60% (36/61) of endoluminal imaging previously ordered by clinicians was canceled. Conclusion An @home diverticulitis pathway is safe, effective and saves bed days.