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

Disclosures:

A. Altomare, None

J. Mecchella, None

K. Kovacs, None

J. Gregory, None

M. M. Andrews, None

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