Background: Outpatient parenteral antimicrobial therapy (OPAT) is a low-cost alternative to acute inpatient care for patients requiring intravenous antibiotics. However, up to 35% of OPAT patients are readmitted or experience therapy-related adverse events. Guidelines recommend close monitoring by a multidisciplinary team but little is known about other measures to improve the hospital to outpatient transition for these patients.
Methods: In January 2014, we implemented an inpatient to OPAT care transition pathway to ensure safe discharges and prevent readmission of our OPAT patients. A collaborative group involving Infectious Diseases (ID) consultants, case managers, mid-level OPAT coordinators and ID clinic staff was required for effective execution of the intervention. Data on demographics, comorbidities, diagnosis, microbiology, antimicrobials, care transition, outpatient monitoring, readmission and complications were collected in a RedCap OPAT Safety database between 01/2014 and 12/2014.
Results: In the first 12 months post-implementation we collected data on 145 OPAT patients. The median age was 57 (IQR=45-66) with male predominance (61%). Most received OPAT from a home infusion company (97/145;67%). Leading diagnosis for OPAT were bone/joint infections (53/145;37%), bacteremia (43/145;30%) and urinary tract infections (15/145;10%). The majority (128/145;88%) had documented positive cultures, with Staphylococcus aureus as the most commonly isolated organism (40% MRSA). The overall 30-day readmission rate was 21% (31/145) with 65% (20/31) of those attributed to OPAT-related complications including worsening infection. Leading indications for OPAT-related readmission are shown in Figure 1.
Conclusion: Implementation of an inpatient to OPAT care transition pathway resulted in 30-day readmission rates comparable to other studies of OPAT patients. The relationship between OPAT care coordination and readmissions remains unclear as the leading cause for readmission in our cohort was worsening infection. Further studies are needed targeting the impact of care transition programs in the OPAT population.
C. C. Saveli,
M. P. Mancuso, None
L. Pisney, None
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