1089. Emergency Department Utilization during Self-Administered Outpatient Parenteral Antimicrobial Therapy
Session: Poster Abstract Session: Clinical Practice Issues
Friday, October 6, 2017
Room: Poster Hall CD
Background:

Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) has been established as a clinically safe and effective alternative to inpatient or outpatient extended-course intravenous antibiotics while reducing healthcare resource utilization. However, previous research has not confirmed that transferring patients from the hospital to home for treatment does not cause a compensatory increase in emergency department (ED) visits. We sought to validate S-OPAT clinical safety and healthcare costs associated with S-OPAT by confirming that S-OPAT does not increase ED utilization during treatment.

Methods:

We conducted a before-after study of ED utilization among S-OPAT patients. We compared ED visits, hospital admissions resulting from ED visits, hospital admissions due to OPAT-related causes, and hospital charges associated with all ED visits 60 days before and after initiation of S-OPAT. A 60-day time frame was selected to effectively encompass the maximum treatment duration (8 weeks) for S-OPAT. Paired t-tests were used to compare the change in ED utilization before and after initiation of S-OPAT.

Results:

Among our cohort of 944 S-OPAT patients, 430 patients visited the ED 60 days before or after starting treatment. Of the patients with ED visits, 69 were admitted to the hospital for OPAT-related causes and 228 incurred hospital charges from their visit. Initiation of S-OPAT was associated with a statistically significant reduction in total ED visits, all-cause hospital admission, OPAT-related hospital admission, and hospital charges (see Table 1).

Conclusion:

Our review of ED utilization among S-OPAT patients demonstrates a reduction in multiple parameters of ED utilization with the initiation of S-OPAT treatment. Our findings confirm that S-OPAT does not yield an increase, but rather a decrease, in ED visits with the transfer of patients from hospital to home.

Table 1

60 days before S-OPAT

60 days after starting S-OPAT

Paired t-test p- value

ED visits (encounters per patient)

N=430

3.4 ± 2.9

2.9 ± 2.6

<0.001

Hospital admissions (inpatient days per patient)

N=430

14.8 ± 16.5

6.2 ± 13.2

<0.001

Hospital admissions: S-OPAT-related (inpatient days per patient)

N=69

9.6 ± 9.5

4.0 ± 6.8

<0.001

Hospital charges (dollars per patient)

N=228

$81,034 ± 59,552

$36,105 ± 59,972

<0.001

Anisha Ganguly, B.S., B.A., UT Southwestern Medical Center, Dallas, TX, Larry Brown, MS, MPH, Clinical Epidemiology, Parkland Memorial Hospital, Dallas, TX, Deepak Agrawal, MD, MPH, Gastroenterology, UT Southwestern Medical Center, Dallas, TX and Kavita Bhavan, MD, MHS, Infectious Diseases, UT Southwestern Medical Center, Dallas, TX

Disclosures:

A. Ganguly, None

L. Brown, None

D. Agrawal, None

K. Bhavan, None

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