462. Emergency Department Visits of Patients on Community-based Parenteral Anti-infective Therapy at Home
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Community-based parenteral anti-infective therapy (CoPAT) is an accepted option for patients who require parenteral antibiotic therapy after discharge from hospital. Emergency department (ED) visits related to this treatment may highlight health care system deficiencies and help identify opportunities for improvement. The aim of this study was to describe ED visits in patients receiving CoPAT at home.
Methods: At the Cleveland Clinic, all patients requiring CoPAT are evaluated before discharge and managed by infectious disease (ID) physicians. Patients discharged on CoPAT in 2008 with home nurse visits through Cleveland Clinic Home Care (CCHC) were included in this study. Baseline characteristics were obtained from our CoPAT registry. ED visits were identified from the Cleveland Clinic’s integrated electronic health system by following events till 30 days after completion of the CoPAT course unless readmitted sooner.
Results: Of 2948 patients discharged on CoPAT, 463 patients (mean age 55 yrs, 58% male) received 540 CoPAT courses at home through CCHC. The median duration of CoPAT was 16 days. There were 142 ED visits from 120 CoPAT courses (22%), or 6.7 per 1000 patient days. The reasons for ED visits were worsening infection (24%), vascular access problems (23%), antimicrobial adverse effects (1%), and unrelated reasons (49%). Twenty-one (62%) of 34 visits for worsening infection occurred while the pts were still on therapy. Forty-six percent of visits resulted in readmission. Twenty-eight (82%) of 34 patients visiting the ED for worsening infection were readmitted, compared to two (6%) of 32 for vascular access problems (OR 62.69, CI 13.34 to 480).
Conclusion: More than a fifth of all CoPAT courses at home had at least one ED visit during or within 30 days after completing treatment. Visits for worsening infection and vascular access problems accounted for almost half the ED visits. ED visits for worsening infection were far more likely to result in readmission than those for vascular access problems.
Steven Gordon, MD, FIDSA1, Anil Jain, MD2, Steven Landers, MD, MPH2, Divya Patel, DO3, Susan Rehm, MD2, Nabin Shrestha, MD4 and  N. K. Shrestha, None..
D. Patel, None..
S. M. Gordon, None..
S. Landers, None..
A. K. Jain, None..
S. J. Rehm, None., (1)Infectious Disease, Cleveland Clinic, Cleveland, OH, (2)Cleveland Clinic, Cleveland, OH, (3)Internal Medicine, Cleveland Clinic, Cleveland, OH, (4)Cleveland Clinic Foundation, Cleveland, OH


S. Gordon, None

A. Jain, None

S. Landers, None

D. Patel, None

S. Rehm, None

N. Shrestha, None