QS304 - Outpatient Management Of Acute Sigmoid Diverticulitis: Provider Education And A Clinical Pathway Reduced Antibiotic Use Without Compromise In Patient Outcomes

Image or Table (Do Not add text here):

Purpose/Background: Sigmoid diverticulitis is a common gastrointestinal disease evaluated in hospital emergency departments (ED). Historically, the inflammation of diverticulitis has been attributed to bacterial infection and has been treated with antibiotics (ABX). European studies have demonstrated acute uncomplicated sigmoid diverticulitis (AUSD) may be treated without ABX in select patients. However, routine use of ABX is still prevalent for this disease in the USA. We implemented a quality improvement initiative to reduce unnecessary usage of ABX for patients with AUSD discharging from the ED. We evaluated the effect of the quality improvement measures on ABX usage and clinical outcomes for patients with AUSD.

Methods/Interventions: We implemented a diverticulitis clinical pathway in the electronic health record (EHR) and delivered education for ED providers in 6/2023. The pathway identified eligible patients with AUSD based on established clinical guidelines and prompted providers to use non-ABX approaches to care. A retrospective chart review was performed on patients ≥18 years presenting with CT-confirmed AUSD between 6/2022—6/2024 to evaluate ABX prescribing in the ED and 90-day follow-up outcomes. We compared PRE- and POST-intervention groups. Patients were excluded based on clinical guidelines.

Results/Outcomes: Of 318 patients with CT-confirmed AUSD, 189 patients met the inclusion criteria and were included for analysis. There were 81 and 108 patients in PRE and POST groups, respectively. There were no differences in age, gender, race, and pre-existing comorbidities. Initial ED temperature, pulse, BP, and WBC were similar between the two groups. There was a significant reduction in use of ABX in the POST group 81(100%) vs 66(61%), p< 0.001 including oral ABX 80 (99%) vs 64(59%), p< 0.001. There was no difference in the use of IV ABX 9(11%) vs 8(7%), p=0.53. All patients were discharged from the ED. No differences were seen in the subsequent ABX use 14(17%) vs 14(13%), p=0.54, return to ED 9(11%) vs 5(5%), p=0.15, hospitalization 3(4%) vs 3(3%), p=1.0, drainage procedure 0(0%) vs 2(2%), p=0.61, and emergency surgery (0% vs 0%) within 90 days between the PRE and POST groups. Of 108 patients in the POST group, 66 patients received ABX and 42 patients did not. No differences were seen in gender, race, comorbidities, WBC, initial pulse, and temperature. In the POST group, patients who received ABX were older 61 vs 56 years, p=0.07 and were more likely to get subsequent ABX 12(18%) vs 2(5%), p=0.08 within 90 days. There were no differences in diverticulitis-related return to ED, hospitalization, drainage procedure, and emergency surgery within 90 days between the two groups.

Conclusion/Discussion: Before the qualitive improvement initiative, clinical guidelines for AUSD that recommended omitting ABX had been poorly adopted. The implementation of the EHR-based diverticulitis pathway and clinician education were associated with decreased use of ABX for AUSD without compromising patient outcomes.