Evaluation of 30-day Readmission Rates in Patients Receiving Self-Administered Outpatient Parenteral Antimicrobial Therapy (OPAT) at a County Institution

Background: Outpatient parenteral antimicrobial therapy (OPAT) services are commonly administered in one of three settings – infusion clinics, visiting nurse model, and self-administration.

Parkland Hospital is a 758-bed teaching hospital serving an indigent patient population in Dallas, Texas. The OPAT clinic at Parkland Hospital consists of 2 infectious Disease (ID) physicians, one ID clinical pharmacist, and nursing staff.  Patients discharged on OPAT are educated regarding self-administration of antibiotics and monitored in OPAT clinic weekly until completion of their therapy.  During OPAT visits, PICC line dressing changes are made, necessary labs are drawn, modifications to therapy are made as needed, and patients are evaluated for resolution of infection.  Our original data from 2010 upon the establishment of the OPAT clinic had reported a decrease in readmission rates to 29% (N-249). IDSA recommends outcomes measurement as a part of continuous performance improvement initiative to evaluate quality and safety for an OPAT program. Our objective is to determine 30-day readmission rates for patients discharged on OPAT for 2/2011-8/2012.

Methods: Data was retrospectively collected from the hospital’s electronic database to examine 30-day readmission for patients discharged to receive OPAT in an 18-month period from February 1, 2011 to August 1, 2012

Results: The mean duration of therapy (N – 303) was 26 days. The leading diagnosis for OPAT was osteomyelitis (69%) followed by bacteremia/endovascular infections (13%) and genitourinary infections (8%). Commonly prescribed antimicrobials were Ceftriaxone, Daptomycin, and Ertapenem.  From 1/2011 – 8/2012 the readmission rate was 12%. The main causes of OPAT-related readmissions were treatment failure, adverse drug reactions, and PICC line dysfunction.

Conclusion: OPAT has several pharmacoeconomic advantages associated with cost benefit, cost avoidance, and reduction in risk for nosocomial infections. To our knowledge this is the first exclusively self-administered OPAT program in the country. A detailed analysis was done to evaluate the cause of readmissions for these patients and based on our outcomes data we have been able to show safety, efficacy, and cost savings of an OPAT program.