Audit of a Novel Nurse-Led Program for Non-Antibiotic Management of Acute Uncomplicated Diverticulitis.

Abstract

Background: Non-antibiotic outpatient treatment of acute uncomplicated diverticulitis is safe; however, uptake remains low.

Objective: To assess the success of non-antibiotic management of uncomplicated diverticulitis through a nurse clinician-led outpatient program.

Design: Retrospective audit from June 2022-March 2024.

Settings: Nurse clinician-led outpatient program for non-antibiotic 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 time period were also reviewed.

Interventions: This program included education, diet modification, analgesia, clinic visit, and telephone follow-ups by a nurse-clinician.

Main outcome measures: Primary outcome was 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 which 43 (51.2%) were started on antibiotics before referral but were treated by the program. Forty-one (48.8%) completed the non-antibiotic protocol (48.8%, n = 41), with 97.6% success. 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, while 7 (3.2%) patients 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 non-antibiotic treatment for mild acute uncomplicated diverticulitis can be successful using an outpatient nurse-clinician led program with referrals from the Emergency Department and community. See Video Abstract.