Introduction

Welcome to the APSA Quality and Safety committee Skin and Soft Tissue Infections (SSTI) Toolkit. This page is intended to help anyone who is interested in Quality Improvement (QI) pertaining to the management of Skin and Soft Tissue Infections.

Available toolkit projects are listed below. Many of the approaches described are evidence-based - some are not. These approaches have not been approved by APSA.

Skin & Soft Tissue Infections Quality Initiatives

Simple abscesses are a common reason for hospital admissions and many can be drained in the emergency room. Nationwide Children’s Hospital found that more than 25% of patients with simple abscesses were being admitted to the hospital and undergoing drainage in the operating room. At the time of their assessment, no clinical pathway was available. The pediatric surgery department, working in conjunction with the emergency, infectious disease and anesthesiology departments, developed a clinical treatment pathway to find ways to increase drainage in the emergency department in an effort to reduce hospitalizations.

Protocol:

• NCH- Evidence-Based Guideline SSTI

Resources:

• NCH - SSTI Emergency Department I&D Key Driver Diagram
• NCH PPT - Increasing Emergency Room Incision and Drainage Procedures for Simple Abscesses to Reduce Hospitalizations

Stakeholders: pediatric surgery, emergency department, infectious disease depatment, anesthesiology

Challenges and Solutions:

• Individual case reviews were implemented to do a lack in progress in decreasing the number of admissions to the hospital. An emergency room physician queried providers on reason for surgical consultation when abscesses met criteria for ED drainage. A pediatric surgery fellow queried residents and fellows on the reason for opting for drainage in the operating room rather than in the emergency room.
• Availability of ED anesthesia providers occurred during peak ED usage times, which resulted in increased admissions. Once identified, efforts were made to increase the number of providers capable of providing these services during those periods.

Links to published data (used to develop the protocol):

Submitted by: Brian D. Kenney, MD, MPH

Publically Available SSTI Clinical Pathways

Several insititutions

have pubilically available SSTI Clinical Pathways which are included for your review, as they may serve as an impetus for a QI initiative at your local institution.

Protocol:

• Children’s Hospital of Philadelphia: CHOP - Emergency Department Clinical Pathway for Evaluation-Treatment of Children with Suspected Cellulitis-Abscess
• Connecticut Children’s: CC Clinical Pathway - SSTI
• John’s Hopkins All Children’s Hospital: JHACH Pediatric SSTI Clinical Pathway
• Seattle Children’s Hospital: SCH Cellulitis and Abscess Clinical Pathway v3.0
• Texas Children’s Hospital: TCH SSTI Evidence-Based Guideline

Recent Research

For recent research pertaining to the to the management of Skin and Soft Tissue Infections, please refer to references: [1][2][3]

References