Transfer of care and overstay in the management of cellulitis in the emergency short stay unit: A retrospective cohort study

Objective: This study aimed to quantify the rate of transfer of care or overstay from cellulitis management in the emergency short stay unit (ESSU) and to identify risk factors during initial assessment associated with transfer of care or overstay. Methods: A retrospective cohort study was conducted including cellulitis patients diagnosed with and admitted to the ESSU at a metropolitan adult tertiary referral centre. Data abstracted included patient demographics, comorbidities, initial investigations and initial vital signs. Transfer of care or overstay were defined as inpatient admission or a stay in ESSU >28 h, respectively. Results: Of the 451 included patients, 157 (34.8%) met the criteria for transfer of care or overstay. These criteria included admission to hospital inpatient units (115 patients, 73.2%) and patients who overstayed the ESSU time period (42 patients, 26.8%). Variables independently associated with transfer of care or overstay were obesity (adjusted odds ratio [OR] 4.33; 95% confidence interval [CI] 1.38-15.59), i.v. drug use (adjusted OR 2.15; 95% CI 1.03-4.51), white blood cell count (adjusted OR 1.09; 95% CI 1.02-1.16 per 1 x 10(9)/L increase) and C-reactive protein (adjusted OR 1.004; 95% CI 1.00-1.01 per 1 mg/L increase). Conclusions: Transfer of care or overstay after admission to ESSU was high among patients with cellulitis. Variables independently associated with transfer of care or overstay were obesity, i.v. drug use, elevated white blood cell count and elevated C-reactive protein. Awareness of these variables can inform appropriate guidelines for ESSU admission, potentially improving patient flow and reducing length of stay in the ED and hospital.