High Readmission Rates Among Patients with Skin and Soft Tissue Infections

Michael D. Nailor, PharmD, BCPS-AQ ID, clinical associate professor at the University of Connecticut School of Pharmacy, clinical specialist in infectious diseases at Hartford Hospital, and director of Infectious Disease Residency program at Hartford Hospital, explains that resources for skin and soft tissue infections need to be directed at emergency departments.

Interview Transcript (slightly modified for readability)

“Just before I start I’d like to thank my co-investigators, Kristin Linder, [PharmD], and David Nicolau, [PharmD, FCCP, FIDSA], for their help on this project.

We looked at 357 patients that came to the emergency department with skin infections at Hartford Hospital, and we excluded patients [who] had necrotizing fasciitis or osteomyelitis, because obviously those patients had different therapy modalities. We wanted to look at a number of different things, one of which was how many patients get treated in the emergency department and are sent home, what happens to them after they get sent home, and what happens to the patients who get admitted to the hospital, [what is] the outcome for them in both going home as well as being readmitted back to the hospital.

What we found in those patients is that about 70% actually are treated in the emergency departments and go home, with the other 30% being admitted to the hospital. Then, if you look at the patients [who] come back to the hospital, it’s about 25% in both groups; so about 22% of the patients [who] get admitted go home on some sort of therapy and then bounce back to the hospital and about 28% [of those] who got treated in the emergency department [and] went home came back to the hospital later. If you look at those groups of patients, about 60% come back with skin and soft tissue infections, and the other 40% come back for other reasons, all within 30 days.

What that tells us is that there [are] a lot of patients coming to the hospital with skin [infections], but most aren’t actually getting admitted. When we develop resources for treating skin infections, we need to really direct resources at the emergency departments and not just at the inpatient setting. Then, we need follow-up for our patients [who] are going home, because with 25% or so of patients coming back to the hospital and about half of those being readmitted, we’re missing something on the outpatient side. We don’t know what those things are yet; they might not be getting long enough therapies, they might not be taking their therapies, they might have access to therapy issues.

Certainly with non- skin and soft tissue-related readmissions, there are other things going on with their comorbidities that might be leading them back. In fact, one of the things we saw in the patients [who] got readmitted to the hospital, 30% got discharged to a skilled nursing facility. These are sick patients with chronic diseases that really need more resources not just in the hospital, but outside the hospital as well.”