Cellulitis: Appropriate use and awareness of clinical pathways/Point Of Access Care (POAC) within Waitemata District Health Board
Authors: Rogan A, Wahlers L, Macrae M, Johnston A, Heynike M & Chapman L.
Affiliations: Waitakere and North Shore Hospitals, Waitemata District Health Board, Auckland, New Zealand
Abstract: The incidence of cellulitis in New Zealand is on the increase and is an important public health concern. Clinical pathways are available in WDHB to assess if patients with cellulitis can be appropriately managed in the community via the Primary Options for Acute Care team (POAC). Unnecessary admissions are costly in comparison. Recent local review has shown POAC is underused and failing to meet targets.
We aim to assess whether or not patients at WDHB trusts are treated according to the Gold Standard clinical pathway for cellulitis and POAC use.
Methods: Retrospective audit of 90 patients admitted with cellulitis during 1st-14th November 2015 and an RMO questionnaire detailing awareness of clinical pathways. A data collection proforma was used to collect data including demographics and correct pathway use.
Results: 47 patients met our inclusion criteria. Mean age was 63.6 and 53% were male. 13 of the 47 (28%) met pathway criteria for POAC; 7 having self-presented to ED and 6 as GP referrals. POAC was not used in all 13 cases. 24 of 47 (51%) were unsuitable for POAC. 10 of the 47 (21%) had failed POAC. Average length of stay was 8.4 days. The cellulitis clinical pathway had no documented use in all 47 eligible patients. RMO questionnaire results showed good awareness of clinical pathways but lack of clinical application.
Conclusion: The cellulitis clinical pathway at WDHB is under utilised by RMOs. Potentially a third of cellulitis admissions could have been prevented with correct pathway and POAC use. This would reduce cost significantly and increase bed availability at WDHB. Improved pathway use could help meet local POAC targets.
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