Improving the health and wellbeing of patients with cellulitis
Melanie Thomas, Clinical Director Lymphoedema Wales, Swansea Bay University Health Board
Introduction
Cellulitis, a bacterial skin infection, can lead to emergency admissions and sepsis if not promptly treated. Hospital admissions and GP events for cellulitis are rising, with 1.7% of emergency admissions in 2021-2022 attributed to cellulitis.
In Wales, cellulitis causes over 32,000 bed-days and 200,000 GP events annually, costing over £28 million. Enhancing care quality through evidence-based, patient-centred approaches and reducing waste and harm is crucial. The aim was to reduce cellulitis recurrence by 10% annually among 7,000 NHS Wales patients through education and effective treatment.
Methods
- Identified need for improvement and planned change implementation.
- Communicated with key stakeholders.
- Focused on collecting reliable, evidence-based data for monitoring change.
- Created three posts for National Cellulitis Improvement Programme (NCIP).
Goals:
- Early identification and correct assessment of cellulitis patients.
- Evidence-based treatment and equitable service delivery.
- Efficient resource use and capturing patient values through Patient Reported Outcome Measures (PROMS) and Patient Reported Experience Measures (PREMS).
- Acknowledge and respect cultural and diversity needs.
- Provide evidence-based education.
Aims:
- Reduce repeated cellulitis incidence.
- Decrease NHS costs of cellulitis recurrence.
- Support education in Primary and Secondary Care.
- Develop a cellulitis PROM.
Outcomes
- Since April 2020, 28,000 individuals received a leaflet to reduce cellulitis risk and nearly 7,000 completed NCIP
- PROMs indicate significant improvements in outcomes and quality of life.
- NCIP reduced recurrent cellulitis episodes from 5,337 to 163, admissions from 2,955 to 31, and length of stay from 22,870 days to 164 days, saving over £15 million.
- Every admitted cellulitis patient receives educational materials and clinical consultation options.
- Initial goal to reduce recurrence rates by 10% greatly exceeded.
- NCIP conducted 230 educational sessions, training 1,500 HCPs in Wales about cellulitis.
Learnings
- Launching across all health boards was challenging due to varied governance.
- Clear SOPs and Benefit Profiles were crucial.
- Dedicated reports to Execs accelerated NCIP into Primary Care.
- Data, especially PROMs, was essential to demonstrate value.
- Should have considered a national digital programme for data capture.
What next?
- NCIP integrated into six health boards; Powys set to implement Primary Care aspect soon.
- Collaboration with GPs and Antimicrobial Pharmacists to include patients with multiple antibiotic prescriptions or long-term prophylactic antibiotics.
- Wales sets a global precedent in cellulitis care with a replicable NCIP model.
