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Program for Cellulitis and Sepsis Safety

Logical Images is committed to patient safety through diagnostic accuracy. A quality improvement (QI) initiative focused on diagnostic accuracy and appropriate patient management is already impacting care. Calculate your savings.

30% of Patients Are Wrongly Admitted to Hospitals for Cellulitis

There is frequent overdiagnosis of patients with presumed cellulitis or soft tissue infection, leading to unnecessary and expensive hospitalizations and IV antibiotic therapy. Unnecessary admissions put patients at increased risk for hospital-acquired infections such as Clostridium difficile, medication reactions, and other adverse events. On the other hand, patients presenting with red skin who truly have cellulitis may be “missed,” leading to bacterial sepsis. 

The goal of this safety program is to drive accuracy in diagnosis of “true” cellulitis versus diseases in the differential diagnosis.

There are no confirmatory tests or studies that specifically rule in or rule out cellulitis. Augmenting clinicians’ knowledge and improving clinical reasoning skills around this diagnostic area are critical. A 3-part programmatic quality initiative to address the problem of cellulitis misdiagnosis in hospitals and urgent care is underway in the Rochester, NY, area.

cellulitis_sepsis.jpg

A 48-year-old patient presenting with bilateral leg redness and swelling. Patient had been admitted to the hospital 3 times over 6 months for the diagnosis of “cellulitis.”


Calculate ROI for Reducing Cellulitis Diagnostic Error:

 

Savings Calculator

Adjust number of hospital admissions for cellulitis:


Adjust average payment per hospitalization:
$12,000


 

*Model assumes that 20% of cellulitis admissions in error are correctable, based on prior studies1,2,3 (see references at bottom).

cellulitis_annual_cost.png

The annual costs for cellulitis diagnostic error in the U.S. are staggering: 557,000 inpatient admissions for cellulitis × 20% error rate = 114,000 unnecessary admissions. The average DRG is $12,000 resulting in $1,336,800,000 / year cost in the U.S.


Program for Cellulitis and Sepsis Accuracy Includes:

  • Online CME physician training in the problem area of cellulitis/SSTI, accredited by the medical liability insurer Coverys.
  • A protocol accessible through the e-record to complement training and augment the diagnostic process of suspected soft tissue infections.
  • Community-wide communications directed at patients and providers.
  • The use of VisualDx diagnostic clinical decision support.

The QI initiative includes innovation and discovery of new methods in clinician education and care, paving the way for more comprehensive health services research in this focused clinical problem-solving domain. This program is also synergistic with the current community effort to reduce C difficile infections in our hospitals and the New York State emphasis on diagnosing sepsis.


Participants

  • Rochester Regional Hospitals – Rochester General Hospital, Strong Memorial Hospital, Highland Hospital, and Unity Health System; additional regional/rural hospitals to be determined based on admission rates associated with cellulitis
  • Regional Payors – Excellus BCBS
  • Logical Images

QI Strategy

  • Training
    • Site seminars/rounds on topic (diagnosing cellulitis, similar conditions/false positives, how to use clinical decision support)
    • CME (accredited online course)
  • A diagnostic “triage protocol”
  • VisualDx decision support
  • Community-wide education

Scientific Advisors

Loren Miller MD PhD, UCLA; Noah Craft MD PhD, Logical Images; Sandra Schneider MD, Manish Shah MD MPH, Emergency Medicine URMC; Rick Stearns MD, Rochester General Hospital; Lowell A. Goldsmith MD MPH, Dean Emeritus University of Rochester College of Medicine


  1. David CV, Chira S, Eells SJ, et al. Diagnostic accuracy in patients admitted to hospitals with cellulitis. Dermatol Online J. 2011;17(3):1. [PubMed].
  2. Ellis Simonsen SM, van Orman ER, Hatch BE, Jones SS, Gren LH, Hegmann KT, Lyon JL. Cellulitis incidence in a defined population. Epidemiol Infect. 2006;134(2):293-299. [PubMed].
  3. Levell NJ, Wingfield CG, Garioch JJ. Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care. Br J Dermatol. 2011;164(6):1326-1328. [PubMed].