Background: Outpatient parenteral antibiotic therapy (OPAT) is an integral part of infectious disease (ID) management. The IDSA OPAT guidelines stress the importance of monitoring outcomes and safety assessment, yet there is no prescribed method to execute this process. There is limited published data on effective OPAT monitoring strategies in the US healthcare system.
Methods: To monitor and measure outcomes of patients on OPAT, our multi-disciplinary re-design team built a tracking system and database into the existing electronic medical record (EMR). A data entry form, called an “episode of care (EOC)”, is completed in the EMR by the ID physician at the time of consultation (see figure). Data include: consultant’s name, discharge location, antibiotic type, duration of treatment, lab monitoring recommendations, and outpatient (OP) follow-up visit date. This information automatically populates three items: the hospital interagency referral, a dashboard for active monitoring by outpatient providers, and a database for quality metric analysis. Outcomes measured include emergency room (ER) visits 30-days post discharge, 30-day re-admission rates, clinic no -show rates, and adverse events. Patients discharged on IV antibiotics with no EOC (i.e. no ID oversight) were also identified.
Results: In a 6-month period after the initiation of the new tracking system at our institution, 515 patients were discharged from the hospital on OPAT with an EOC. An additional 197 were discharged on IV antibiotics and no EOC. Of the patients with an EOC 25.5% had an ED visit within 30 days of discharge, and 19% had a 30-day re-admission from time of discharge. There were 20 adverse events related to antibiotic therapy documented (9 lab abnormalities, 6 antibiotic side-effects, 3 line complications, 1 episode of clostridium difficile, and 1 incorrect/missed antibiotic). Nineteen patients had a no-show to their first ID follow-up appointment.
Conclusion: We demonstrate the feasibility of integrating a tracking system for patients on OPAT into a pre-existing EMR and creating a database for assessment of outcomes. We also identify a significant number of patients discharged without ID oversight, revealing missed opportunities for ID input in these cases.
M. Malinis, None