Effect of Teledermatology on Length of Hospital Admission, Length of Stay, 30 Day Readmission Rate, and Antibiotic Use in Patients Presenting With Cellulitis vs Pseudocellulitis in an Academic ED Setting

Study Overview
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Brief Summary
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The effect of teledermatology on length of hospital admission, length of stay, 30 day readmission rate, and antibiotic use in patients presenting with cellulitis vs pseudocellulitis in an academic emergency department setting.

Detailed Description
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The Investigator hope to determine if the implementation of teledermatology in the emergency department (ED) at The Ohio State University Wexner Medical Center is beneficial in diagnosing cases of cellulitis and pseudocellulitis conditions. Prior studies have indicated that misdiagnosis may occur in up to 28% of patients in the ED with these conditions. Additionally, dermatological consults have been shown to change diagnosis or management of these conditions in more than 60% of the patients examined. Without the use of teledermatology, however, a dermatological consult would be prohibitively expensive and take time to obtain. The investigator proposes that by utilizing teledermatology in emergency rooms, the investigator can make faster, yet just as accurate, dermatological diagnoses in patients presenting with cellulitis-like symptoms. Subsequently, by reducing the number of misdiagnoses, unnecessary use of antibiotics and hospitalizations will also decrease, lowering health care costs and simultaneously providing patients with faster treatment of the actual dermatologic condition.

Official Title
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The Effect of Teledermatology on Length of Hospital Admission, Length of Stay, 30 Day Readmission Rate, and Antibiotic Use in Patients Presenting With Cellulitis vs Pseudocellulitis in an Academic Emergency Department Setting.

Conditions
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Cellulitis

Intervention / Treatment
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* Other: teledermatology consult
* Other: Routine Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Over 18 Present to the ED with cellulitis-like symptoms, including but not limited to the following: tenderness, redness, swelling, expansive lesion Exclusion Criteria: pregnant prisoner

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Teledermatology consult<br>To determine the benefit of teledermatology to differentiate cellulitis from pseudocellulitis in emergency departments through the analysis of time spent in the emergency department (ED), admission to the inpatient hospital, antibiotic use, time to improvement, and 30-day remission rate. This arm will undergo imaging, a dermatologic assessment will be performed, AND this assessment will be entered into the patients chart. | Other: teledermatology consult<br>* Information from the dermatologic assessment will be entered into the patients chart.<br>|
| Other: Routine Care<br>To determine the benefit of teledermatology to differentiate cellulitis from pseudocellulitis in emergency departments through the analysis of time spent in the emergency department (ED), admission to the inpatient hospital, antibiotic use, time to improvement, and 30-day remission rate. This arm will undergo imaging, a dermatologic assessment will be performed, AND this assessment WILL NOT be entered into the patients chart | Other: Routine Care<br>* The dermatologic assessment will occur but not added to the patients medical record. Dermatology may still be consulted but will be at the prerogative of the treating hospitalist.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Admission to the hospital | To determine the benefit of teledermatology to differentiate cellulitis from pseudocellulitis in emergency departments through the analysis of time spent in the emergency department (ED), admission to the inpatient hospital, antibiotic use, time to improvement, We anticipate a high rate of pseudocellulitis, and this aim will determine if there is a difference in patient admissions among those who receive a dermatologic assessment | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of stay in the hospital | Will assess time spent in the hospital for those that were admitted | 30 days post admission | 
| 30 day readmission rate | Will assess hospitalization/emergency department readmission in the following 30 days | 30 days post admission | 
| Antibiotic use | Will assess the frequency of antibiotic use between groups | 30 days post admission |