Audit of a Novel Nurse-Led Program for Nonantibiotic Management of Acute Uncomplicated Diverticulitis
Bibliographic record
Abstract
BACKGROUND: Nonantibiotic outpatient treatment of acute uncomplicated diverticulitis is safe; however, uptake remains low. OBJECTIVE: To assess the success of nonantibiotic management of uncomplicated diverticulitis through a nurse-led outpatient program. DESIGN: Retrospective audit from June 2022 to March 2024. SETTINGS: Nurse-led outpatient program for nonantibiotic management of acute uncomplicated diverticulitis at a university-affiliated hospital. PATIENTS: Immunocompetent adults with CT-proven acute uncomplicated diverticulitis and C-reactive protein <150 mg/L. Eligible patients not referred to the program but treated in the emergency department during the same period were also reviewed. INTERVENTIONS: This program included education, diet modification, analgesia, clinic visit, and telephone follow-ups by a nurse. MAIN OUTCOME MEASURES: The primary outcome was the success of the program, defined as the proportion not requiring an emergency department visit, admissions within 60 days of diagnosis, or need for antibiotics. RESULTS: Of 236 patients referred to the program, 84 met inclusion criteria, of whom 43 patients (51.2%) were started on antibiotics before referral but were treated by the program. Forty-one patients (48.8%) completed the nonantibiotic protocol (48.8%; n = 41), which had a 97.6% success rate. Concurrently, 219 eligible patients were treated in the emergency department but not referred to the program. There was no difference in the number of emergency department visits between the 2 groups (program: n = 7 [8.3%] vs emergency department: n = 27 [12.3%]) within 60 days of diagnosis. Two patients (2.3%) treated in the program required admission, whereas 7 patients (3.2%) in the emergency department group were admitted. Overall, antibiotics were started before referral in 51.2% of patients in the program compared to 92.2% in the emergency department ( p < 0.005). LIMITATIONS: Modest sample size, single institutional data, and retrospective design. CONCLUSIONS: Implementation of nonantibiotic treatment for mild acute uncomplicated diverticulitis can be successful using an outpatient nurse-led program with referrals from the emergency department and community. See Video Abstract . AUDITORA DE UN NUEVO PROGRAMA DIRIGIDO POR ENFERMERAS PARA EL TRATAMIENTO SIN ANTIBITICOS DE LA DIVERTICULITIS AGUDA NO COMPLICADA: ANTECEDENTES:El tratamiento ambulatorio sin antibióticos de la diverticulitis aguda no complicada es seguro; sin embargo, la aceptación sigue siendo baja.OBJETIVO:Evaluar el éxito del manejo sin antibióticos de la diverticulitis no complicada a través de un programa ambulatorio dirigido por enfermeras clínicas.DISEÑO:Auditoría retrospectiva de junio 2022 a marzo 2024.AJUSTE:Programa ambulatorio dirigido por enfermeras clínicas para el tratamiento sin antibióticos de la diverticulitis aguda no complicada en hospital afiliado a una universidad.PACIENTES:Adultos inmunocompetentes con diverticulitis aguda no complicada comprobada por TC y proteína C reactiva <150 mg/L. También se revisaron a pacientes elegibles no derivados al programa, pero tratados en el Departamento de Emergencias durante el mismo período de tiempo.INTERVENCIONES:Este programa incluyó educación, modificación a la dieta, analgesia, visita clínica y seguimiento telefónico por parte de una enfermera clínica.PRINCIPALES MEDIDAS DE RESULTADOS:El resultado primario fue el éxito del programa, definido como la proporción de pacientes que no requirieron una visita al Departamento de Emergencias, admisiones dentro de los 60 días posteriores al diagnóstico o necesidad de antibióticos.RESULTADOS:De 236 pacientes derivados al programa, 84 cumplieron con los criterios de inclusión, de los cuales 43 (51,2%) iniciaron con antibióticos antes de ser derivados, pero tratados por el programa. Cuarenta y uno (48,8%) completaron el protocolo sin antibióticos (48,8%, n = 41), con un 97,6% de éxito. Al mismo tiempo, 219 pacientes elegibles fueron tratados en el Departamento de Emergencias, pero no derivados al programa. No hubo diferencia en el número de visitas al Departamento de Emergencias entre los dos grupos [programa: n = 7 (8,3%) frente al Departamento de Emergencias: n = 27 (12,3%)] dentro de los 60 días posteriores al diagnóstico. Dos pacientes (2,3%) tratados en el programa requirieron admisión, mientras que 7 (3,2%) pacientes del grupo del Departamento de Emergencias fueron ingresados. En general, se inició el tratamiento con antibióticos antes de ser derivados en el 51,2 % de los pacientes del programa, en comparación con el 92,2 % en el Departamento de Emergencias (p < 0,005).LIMITACIONES:Tamaño modesto de la muestra, datos de una sola institución y diseño retrospectivo.CONCLUSIONES:La implementación del tratamiento sin antibióticos para la diverticulitis aguda leve sin complicaciones, puede ser exitosa utilizando un programa dirigido por enfermeras clínicas ambulatorias por referencias del Departamento de Emergencias y la comunidad. (Traducción-Dr. Fidel Ruiz Healy ).
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".