Situation:
59 year-old male presented to ED with rapidly expanding redness in lower left leg. Patient has a history of cellulitis, having presented to this ED 3x in the past two (2) years. Patient reports prophylactic oral antibiotics prescribed by primary care as a ‘just in case’ treatment does not appear to be working. ED Provider recommended admission and referred to hospitalist.
Case Summary:
Typical treatment is a 4 day inpatient stay pending cultures. Cost is $12,000. StatPoint conducts 9 home visits for $4,500. Savings $7,500, ROI = 1.7x. (And an RPM implementation could save +$2,000 or more).
Monitoring provider intercepted bed orders and placed referral to StatPoint for home treatment:
- Meet patient at home and perform evaluation and med rec
- Place midline and begin broad spectrum antibiotics
- Visit twice daily x2 days for well checks
- Visit daily x2 days until resolution.
StatPoint RN found patient also diabetic; recent change in medication by primary care could be associated. Monitoring provider consulted with primary care.
Patient showed continued signs of improvement through the 5 day treatment course. Cultures showed group A Streptococcus infection; antibiotics adjusted on Day 4, and patient presented no signs of reaction upon the change. A follow up appointment with an Infectious Disease provider was scheduled in 7 days.
Discussion:
Suspected infection in otherwise stable patients is a daily event in most EDs. Primary care providers are not equipped to manage evolving situations, and the needed diagnostic information is generally not available in a timely manner. This leads to patients being advised to ‘go to the ER. While the ultimate goal is to intercept this patient before they get to the ER, it’s inevitable that this will continue to happen long into the future. Educating providers will be a key factor in adjusting these practice patterns in the future.
