Background: At our childrens hospital outpatient parenteral antimicrobial therapy (OPAT) has been overused and associated with home care costs of $1000/week (excluding drug costs). In 2014, our inpatient stewardship program added a mandatory review of discharges with OPAT that did not have ID consultation. Our objective was to evaluate the impact of OPAT stewardship.
Methods: We identified patients discharged with OPAT from Primary Childrens Hospital from 5/2013-4/2015 (pre-intervention 5/2013-4/2014 vs intervention 5/2014-4/2015). The primary outcome was the monthly rate of hospital discharges with OPAT. Secondary outcomes included clinical indications for OPAT and 30-day readmissions or emergency department (ED) visits for OPAT complications. We used interrupted time series methods to compare time trends in OPAT utilization before and after initiating OPAT stewardship. Additionally, we evaluated the impact of OPAT stewardship by calculating the difference between the observed and expected number of OPAT discharges (based on projection of pre-intervention trends) and applying an estimated cost of $143/day to the median duration of treatment.
Results: There were 777 OPAT discharges during the study period (424 pre-intervention, 353 intervention). Prior to OPAT stewardship, 47% of OPAT discharges had ID consultation; during the intervention, 87% had stewardship review or ID consultation. The average rate of OPAT discharges declined by 20%, from 23.5/1000 hospital discharges during the pre-intervention period to 17.8/1000 discharges (Figure, P<0.001). We observed a reduction in 30-day readmissions/ED visits for catheter complications from 2.5 to 2.1/1000 discharges (11% of OPAT discharges in both periods). Declines in OPAT utilization were greatest for musculoskeletal and respiratory infections (Table). OPAT stewardship led to avoidance of 19 OPAT discharges per month (median duration 10 days) and an estimated reduction of $325,716/year in home care costs.
Conclusion: The addition of OPAT review to an inpatient stewardship program was feasible, reduced OPAT utilization and it resulted in substantial cost savings and reduced complications. Pediatric stewardship programs should consider OPAT review as a priority target.
E. Thorell, None
E. Knackstedt, None
A. Pavia, None
S. K. Sanderson, None
L. Esquibel, None
A. L. Hersh, Merck: Grant Investigator , Research grant
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