632. Discharges on Intravenous Antibiotics: Timeline and Use of Service-specific Data to Inform Change
Session: Oral Abstract Session: Outpatient Antimicrobial Therapy
Friday, October 4, 2013: 8:30 AM
Room: The Moscone Center: 300

Background: Outpatient Parenteral Antimicrobial Therapy (OPAT) discharges (d/c) require early involvement of Infectious Disease (ID) and d/c coordinators to ensure a safe d/c plan. Arranging home therapy or facility transfer is a dynamic process, evolving within the 24-48 hours prior to d/c, and is influenced by microbiology culture status, disposition-specific antibiotic choices, and insurance coverage. Our aim was to standardize the d/c process, track all discharges on intravenous antibiotics (IV abx), and develop institutional quality reports.

Methods: Discharges on IV abx were identified through ID consult requests and early-warning triggers (collaboration of antimicrobial stewardship, microbiology, pharmacy personnel, and d/c coordinators). Using the OPAT Program database, electronic health record queries, and chart review, we assessed the timing of ID consultation and placement of OPAT d/c recommendations/orders, stratified by patient disposition, ID diagnosis, and d/c service. We also assessed 30-day readmissions.

Results: There were 379 discharges on IV abx between May 2012 and February 2013 (333 unique patients). Median age was 58 years; 58% were male.  Hospital medicine and orthopedics were the primary d/c services. The average length of stay was 10.2 days. 211 (56%) were home d/c and 168 (44%) were facility d/c (including infusion suites and hemodialysis centers). The mean time between admission and ID consult was 3.3 days. The mean times between ID consult and d/c, and OPAT d/c recommendations/orders and d/c were 7.0 days and 1.7 days, respectively. These intervals varied by patient disposition, ID diagnosis, and d/c service (see figure for select examples). The 30-day readmission rate was 18% (range 11-40%); 45 (65%) occurred in patients who had been d/c to home vs. 24 (35%) to facilities. Of 116 patients who were readmitted at least once during the study interval, 41 (35%) were hemodialysis patients.

Conclusion: Coordinating OPAT discharges is complex and variable. Providing service-specific feedback may prompt earlier ID involvement and enhance peri-discharge planning. Despite advances, ID diagnoses requiring OPAT still have long lengths of stay and merit review as an independent, high-risk discharge subgroup.


Antonia Altomare, DO1,2,3, John Mecchella, DO1,2,3, Katherine Kovacs, MS, APRN1, Janice Gregory, RN, BSN1 and Mary-Margaret Andrews, MD1,2, (1)Dartmouth-Hitchcock Medical Center, Lebanon, NH, (2)Geisel School of Medicine at Dartmouth, Hanover, NH, (3)The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH


A. Altomare, None

J. Mecchella, None

K. Kovacs, None

J. Gregory, None

M. M. Andrews, None

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