463. Infectious Diseases (ID) Consultation Decreases the Readmission Rate of Patients Receiving Outpatient Parenteral Antibiotic Therapy (OPAT)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: ID consultation to determine OPAT regimen impacts patient selection and decreases cost. At the South Texas Vet Health Care System, OPAT did not require ID consultation. Rates of readmission and complications were elevated. There was minimal communication between OPAT team members and treating physician. Our aim was to decrease the rate of unplanned admission by improving patient selection, follow-up and teamwork during OPAT.
Methods: We retrospectively collected 7 months of data. The OPAT team identified system failures using process flow and cause-and-effect diagrams. We implemented mandatory review of all OPAT cases by an ID physician. Team members communicated regularly, and the ID physician provided outpatient consultation. Data were prospectively collected for 5 months after intervention and compared using Statistical Process Control charts, Chi square and t test.
Results: 47 and 37 patients received OPAT in the pre- and post-intervention period, respectively (Medical: 30 vs 26; Surgical: 17 vs 11, mean age 63 in both). OPAT indications (pre vs post-intervention) were bacteremia (23% vs 32%), osteoarticular (38% vs 32%), intra abdominal (9% vs 0%), urinary tract (9% vs 13%), pulmonary (12% vs 0%) and other infections (9% vs 31%). Cultures were monobacterial (55% vs 67%), polybacterial( 17% vs 11%), or negative (28% vs 22%) in the pre and post-intervention period, respectively.
Readmission rates decreased from 32% to 14% during therapy (p:0.049) and from 43% to 22% at 3 months (p:0.043). Completion of OPAT increased from 55% to 81%. (p:0.04)
Conclusion: Involvement of an ID physician in patient selection and follow-up during OPAT leads to a decreased readmission rate and increased completion rate.
Jose Cadena, MD1, Kelly Echeverria, PharmD2, Wayne Fischer, BS, MS, PhD3, Tony Ho, MD1, Amruta Parekh, MD, MPH1, Jan E. Patterson, MD, FIDSA, FSHEA4 and  J. A. Cadena, None..
K. Echeverria, None..
T. Ho, None..
A. Parekh, None..
W. Fischer, None. 
J. E. Patterson,
Basilea Role(s): Consultant, Grant Investigator, Received: Research Grant, Consulting Fee.
Pfizer Role(s): Grant Investigator, Speaker's Bureau, Received: Research Grant, Speaker Honorarium.
Schering-Plough Cooperation Role(s): Grant Investigator, Received: Grant Recipient.
Merck Role(s): Consultant, Speaker's Bureau, Received: Speaker Honorarium, Consulting Fee., (1)Dept. of Med, Infectious Diseases and Ctr for Patient Safety and Health Policy,Univ. of Texas Health Science Ctr at San Antonio., San Antonio, TX, (2)South Texas Vet. Health Care System, San Antonio, TX, (3)3. Perioperative Enterprise, University of Texas M. D. Anderson Cancer Ctr,, Houston, TX, (4)University of Texas Health Sciences Center, San Antonio, TX