Notes From the Community - Soft Tissue Infections - Part 1

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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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Barbara W. -

Throughout this topic discussion there seems to be the assumption that patients are either 1) well enough for discharge with oral antibiotics or 2) sick, requiring admission and IV antibiotics. In my small Canadian ER we hardly ever admit these patients, but we frequently treat them with IV antibiotics through our CCAC outpatient clinic. This is a clinic in the hospital, running 12 hours a day, 7 days a week where patients receive their once daily IV antibiotic dose. If they require more frequent dosing they get a pump to take home, which is replenished once a day. Doc reassessments are done in the ER. Saves lots of admissions, and you do not have to wait for your patient to get worse on oral antibiotics before treating them with IV. Nor do you have to fight with the admitting docs.

Rob O -

Hi Barbara, here is the reply from Bryan Hayes...

Barbara, thanks for this insightful comment. You make some great points about utilization of outpatient clinics. That is certainly an option for some patients (if they truly require IV antibiotics as oppose to oral). There are a few new IV antibiotics available that target gram positive bugs (including MRSA) and are marketed for exactly that purpose. Without getting into the details, health care in the U.S. is pretty complicated, as you probably know. One one side of the coin, it is becoming increasingly challenging to admit patients for cellulitis (or even just observe for 24 hours). Most don't meet predefined criteria for admission or observation set forth by the insurance companies. So, if the patient doesn't meet criteria, the hospital doesn't get reimbursed for the care provided. On the other hand, we don't have enough clinics or reliable patients that will complete the follow up (depending on practice environment). So, there certainly is that middle ground you mentioned, but it's always easy to accomplish in the U.S.

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