scholarly journals 126. evaluation of Addition of Outpatient Parenteral Antimicrobial Therapy and Orthopedic ID Resources to Transitions-of-care Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S192-S193
Author(s):  
Brett Young ◽  
Scott Bergman ◽  
Trevor C Van Schooneveld ◽  
Nicolas W Cortes-Penfield ◽  
Bryan Alexander
Keyword(s):  
Infectious Disease ◽  
Clinical Outcomes ◽  
Antimicrobial Therapy ◽  
Hospital Readmission ◽  
Academic Medical Center ◽  
Transitions Of Care ◽  
Day Hospital ◽  
Consult Service ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
The Impact

Abstract Background Our large academic medical center initiated both an Outpatient Parenteral Antimicrobial Therapy (OPAT) program supported by an infectious disease trained pharmacist, along with an Orthopedic Infectious Disease (OID) consult service to assist in caring for these specialized populations. We measured the impact of these services. Methods Patients discharged on parenteral antimicrobial therapy were divided into two groups. The pre-OPAT cohort included all patient receiving OPAT from 4/1/18 - 10/31/18; the post-OPAT cohort included all patients who received OPAT from 4/1/19 - 10/31/19 with OPAT consult (Fig 1). The OID consult service began in September 2018 prior to initiation of the OPAT program. The primary outcome was 30-day hospital readmission. Secondary outcomes included: length of stay (LOS), 90-day readmission, clinical outcomes, and identification of predictors of hospital readmission. Clinical outcomes included: time from final OR visit to discharge for OID patients and optimal treatment (cefazolin, oxacillin, or nafcillin) for MSSA. Results Introduction of these programs was associated with a reduction in all-cause 30-day readmission from 39.3% to 22.9%, and a reduction in 30-day readmission for patients on-treatment from 24.6% to 15.6% (p< 0.01 for both). No difference was seen in hospital LOS (8 days in each cohort). In a subgroup analysis (Fig 2), OID patients in the post-OPAT cohort saw a median reduction of 2 days (7 days to 5 days, p=0.002) in time from final OR visit to discharge. Use of optimal treatments for MSSA increased in the post-OPAT cohort compared to pre-OPAT (65.2% to 80.9%; p=0.06). The 90-day hospital readmission rate were higher in the post-OPAT cohort among patients who lived in metro-area zip codes (p=0.03). Having an established primary care physician was associated with lower 90-day hospital readmission in both the pre-and post-OPAT cohorts (p=0.05 and 0.01, respectively). Conclusion Thirty-day readmission rates among patients discharged on OPAT significantly lowered following initiation of a combination of both a pharmacist-led OPAT program and OID consult service. OPAT and OID programs accrue additional efficiencies and clinical benefits to both patients and hospitals, which can be further evaluated and used to justify such service additions. Disclosures All Authors: No reported disclosures

Characterization of Drug-Related Problems Occurring in Patients Receiving Outpatient Antimicrobial Therapy

2017 ◽  
Vol 30 (6) ◽  
pp. 600-605 ◽  
Author(s):  
Cory M. Hale ◽  
Jeffrey M. Steele ◽  
Robert W. Seabury ◽  
Christopher D. Miller
Keyword(s):  
Antimicrobial Therapy ◽  
Hospital Readmission ◽  
Care Management ◽  
Hospital Readmissions ◽  
Antimicrobial Treatment ◽  
Transitions Of Care ◽  
Drug Related Problems ◽  
Patient Harm ◽  
Outpatient Parenteral Antimicrobial Therapy

Background: Despite the numerous benefits of outpatient parenteral antimicrobial therapy (OPAT), appreciable risks of drug-related problems (DRPs) exist. No studies to date comprehensively assess DRPs in this population. Objectives: Objectives of this study were to (1) characterize the frequency and types of DRPs experienced by patients discharged on OPAT and (2) determine the fraction of adverse drug reactions (ADRs) resulting in hospital readmission or emergency department (ED) presentation and changes in therapy. Methods: This was a retrospective chart analysis evaluating consecutive adult patients discharged on OPAT between May 2015 and October 2015. Patients were assessed for the presence of DRPs until the cessation of antimicrobial treatment, including oral step-down therapy. The outcome of each ADR was recorded, including those resulting in hospital readmissions, presentation to the ED, or changes in antimicrobials. Results: Among 144 patients discharged on OPAT, 199 DRPs occurred in 91 (63.2%) patients. Harm and potential impaired efficacy occurred in 76.9% and 23.1%, respectively. The ADRs comprised 59% of DRPs, occurring in 44.4% of patients. The second most common DRP type was drug interactions (DIs), accounting for 22.6% of DRPs. Rifampin, fluoroquinolones, and daptomycin had the highest frequencies of preventable DRPs in the form of DIs, whereas cephalosporins had the fewest DRPs. Approximately 26% of ADRs caused changes in therapy and 9% resulted in hospital readmission or ED utilization. Conclusion: DRPs with the potential to cause patient harm or impair treatment efficacy often occur with OPAT, most commonly ADRs and DIs. Enhanced monitoring and transitions of care management may reduce the incidence of these DRPs.

scholarly journals Maximising the opportunity of a self‑administration outpatient parenteral antimicrobial therapy pathway

2021 ◽  
Vol 15 (1) ◽  
pp. 15-23
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Therapy ◽  
Patient Questionnaire ◽  
University Hospitals ◽  
Self Administration ◽  
Patient Response ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Nurse Empowerment ◽  
The University ◽  
The Impact

Background: The University Hospitals of Leicester NHS Trust outpatient parenteral antimicrobial therapy (OPAT) service has expanded rapidly with more nurse-led direction. Aims: A retrospective study between 1 July 2014 and 31 December 2019 was undertaken to assess the impact of OPAT expansion on beds released for further utilisation, clinical outcomes, adverse vascular access device (VAD) outcome, and self- and family-administered parenteral antimicrobial therapy. Method: Data were extracted from the OPAT Patient Management System and from a patient questionnaire survey. Findings: 1084 completed patient episodes were recorded in 958 patients, rising from 39 episodes in 2014 to 265 in 2019. The number of beds released for further utilisation correspondingly rose from 828 in 2014 to 8462 in 2019. The proportion of patients/family members trained to self-administer rose from 25% to 75%, with clinical cure/improvement of infection remaining high at between 84.6% and 92.8% of patients annually. Serious adverse VAD events remained low throughout. The patient response was generally positive. Conclusion: Nurse empowerment within OPAT can lead to significant improvements and patient benefits, while maintaining clinical outcomes.

Discharge Delays and Costs Associated With Outpatient Parenteral Antimicrobial Therapy for High-Priced Antibiotics

2019 ◽  
Vol 71 (7) ◽  
pp. e88-e93 ◽  
Author(s):  
Monica L Bianchini ◽  
Rachel M Kenney ◽  
Robyn Lentz ◽  
Marcus Zervos ◽  
Manu Malhotra ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Private Insurance ◽  
Hospital Costs ◽  
Care Facility ◽  
Transitions Of Care ◽  
Beta Lactam ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Subacute Care ◽  
Cost Effective Treatment ◽  
The Impact

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is a widely used, safe, and cost-effective treatment. Most public and private insurance providers require prior authorization (PA) for OPAT, yet the impact of the inpatient PA process is not known. Our aim was to characterize discharge barriers and PA delays associated with high-priced OPAT antibiotics. Methods This was an institutional review board–approved study of adult patients discharged with daptomycin, ceftaroline, ertapenem, and novel beta-lactam-beta-lactamase inhibitor combinations from January 2017 to December 2017. Patients with an OPAT PA delay were compared with patients without a delay. The primary endpoint was total direct hospital costs from the start of treatment. Results Two-hundred patients were included: 141 (71%) no OPAT delay vs 59 (30%) OPAT delay. More patients with a PA delay were discharged to a subacute care facility compared with an outpatient setting: 37 (63%) vs 52 (37%), P = .001. Discharge delays and median total direct hospital costs were higher for patients with OPAT delays: 31 (53%) vs 21 (15%), P < .001 and $19 576 (interquartile range [IQR], 10 056–37 038) vs $7770 (IQR, 3031–13 974), P < .001. In multiple variable regression, discharge to a subacute care facility was associated with an increased odds of discharge delay, age >64 years was associated with a decreased odds of discharge delay. Conclusions OPAT with high-priced antibiotics requires significant care coordination. PA delays are common and contribute to discharge delays. OPAT transitions of care represent an opportunity to improve patient care and address access barriers.

Maximising the opportunity of a self-administration outpatient parenteral antimicrobial therapy pathway

2021 ◽  
Vol 30 (2) ◽  
pp. S4-S10
Author(s):  
Jake Bodycot ◽  
Linda Mashonganyika ◽  
Nicola Kucziw ◽  
Chanelle Ingham ◽  
Samira Bhukera ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Therapy ◽  
Patient Questionnaire ◽  
University Hospitals ◽  
Self Administration ◽  
Patient Response ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Nurse Empowerment ◽  
The University ◽  
The Impact

Background: The University Hospitals of Leicester NHS Trust outpatient parenteral antimicrobial therapy (OPAT) service has expanded rapidly with more nurse-led direction. Aims: A retrospective study between 1 July 2014 and 31 December 2019 was undertaken to assess the impact of OPAT expansion on beds released for further utilisation, clinical outcomes, adverse vascular access device (VAD) outcome, and self- and family-administered parenteral antimicrobial therapy. Method: Data were extracted from the OPAT Patient Management System and from a patient questionnaire survey. Findings: 1084 completed patient episodes were recorded in 958 patients, rising from 39 episodes in 2014 to 265 in 2019. The number of beds released for further utilisation correspondingly rose from 828 in 2014 to 8462 in 2019. The proportion of patients/family members trained to self-administer rose from 25% to 75%, with clinical cure/improvement of infection remaining high at between 84.6% and 92.8% of patients annually. Serious adverse VAD events remained low throughout. The patient response was generally positive. Conclusion: Nurse empowerment within OPAT can lead to significant improvements and patient benefits, while maintaining clinical outcomes.

scholarly journals 608. Impact of Implementing Pharmacist Review and Monitoring of Outpatient Parenteral Antimicrobial Therapy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S365-S365
Author(s):  
Emily R Kirkpatrick ◽  
Elizabeth O Hand ◽  
Darrel W Hughes ◽  
Jasmin K Badwal ◽  
Kristi A Traugott
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Therapy ◽  
Intervention Group ◽  
Care Program ◽  
Standard Of Care ◽  
Transitions Of Care ◽  
Control Group ◽  
Laboratory Monitoring ◽  
Outpatient Parenteral Antimicrobial Therapy

Abstract Background Given current efforts to increase the safety of outpatient parenteral antimicrobial therapy (OPAT) programs nationwide, this project sought to determine whether pharmacist managed OPAT review and monitoring improves adherence to standard of care laboratory monitoring recommendations. Methods A single-center, retrospective review of patients > 18 years of age who received OPAT from University Health System was conducted. Patients who received OPAT between October 2018 and December 2018 served as the historical control group. After a pharmacist transitions of care program was implemented, patients who received OPAT between October 2019 and December 2019 were included in the intervention group. Patients were excluded if they received less than 7 days of OPAT, completed therapy prior to discharge, or died while inpatient. The primary endpoint was adherence to laboratory monitoring recommendations > 75% of the duration of planned OPAT. Only patients followed by the OPAT clinic were included in this analysis. Recommendations provided in the 2018 Infectious Diseases Society of America OPAT guidelines were used to define appropriate lab monitoring. Secondary endpoints included 30-day readmissions. Results A total of 409 patients were included in this study: 198 patients in the pre-implementation group and 211 patients in the post-implementation group. In patients with OPAT clinic follow-up, the post-implementation group was significantly more likely to receive monitoring adherent to standard of care laboratory monitoring recommendations > 75% of the duration of planned OPAT: 42/161 (26.1%) vs. 98/176 (55.7%), OR 3.6 (95% CI 2.2-5.6, p = 0.0001). There was no difference in 30-day readmission rates between groups in the overall population. Patients in the post-implementation group with OPAT clinic follow up had lower 30-day infectious disease-attributed readmissions: 18/161 (11.2%) vs. 14/176 (8.0%), p = 0.31. Conclusion Implementation of a transitions of care pharmacist significantly improved adherence to laboratory monitoring recommendations for patients receiving OPAT and numerically reduced 30-day infectious disease-attributed readmissions. Disclosures All Authors: No reported disclosures

Impact of discharge medication bedside delivery service on hospital reutilization

2019 ◽  
Vol 76 (23) ◽  
pp. 1951-1957 ◽  
Author(s):  
Avni Patel ◽  
Melanie A Dodd ◽  
Richard D'Angio ◽  
Robert Hellinga ◽  
Ali Ahmed ◽  
...  
Keyword(s):  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Group Versus ◽  
Emergency Department Visits ◽  
Transitions Of Care ◽  
Control Group ◽  
Day Hospital ◽  
Index Visit ◽  
Significant Difference ◽  
The Impact

Abstract Purpose To evaluate the impact of a medication to bedside delivery (meds-to-beds) service on hospital reutilization in an adult population. Methods A retrospective, single-center, observational cohort study was conducted within a regional academic medical center from January 2017 to July 2017. Adult patients discharged from an internal medicine unit with at least one maintenance medication were evaluated. The primary outcome was the incidence of 30-day hospital reutilization between two groups: discharged patients who received meds-to-beds versus those who did not. Additionally, the incidence of 30-day hospital reutilization between the two groups was compared within predefined subgroup patient populations: polypharmacy, high-risk medication use, and patients with a principal discharge diagnosis meeting the criteria set by the Centers for Medicare and Medicaid Services 30-day risk standardized readmission measures. Results A total of 600 patients were included in the study (300 patients in the meds-to-beds group and 300 patients in the control group). The 30-day hospital reutilization (emergency department visits and/or hospital readmissions) related to the index visit was lower in the meds-to-beds group, but the difference was not statistically significant between the two groups (8.0% in the meds-to-beds group versus 10.0% in the control group; odds ratio, 0.78; 95% confidence interval, 0.45–1.37). There was no significant difference in the 30-day hospital reutilization related to the index visit between the control and meds-to-beds groups within the three subgroups analyzed. Conclusion There was no difference in 30-day hospital reutilization related to the index visit with the implementation of meds-to-beds service in the absence of other transitions-of-care interventions.

scholarly journals 772. Access Denied: Impact of Insurance Denials for High-Cost Outpatient Parenteral Antimicrobial Therapy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S343-S343
Author(s):  
Monica L Bianchini ◽  
Rachel Kenney ◽  
Robyn Lentz ◽  
Marcus Zervos ◽  
Manu Malhotra ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Private Insurance ◽  
Hospital Costs ◽  
The United States ◽  
Delay Group ◽  
Transitions Of Care ◽  
Insurance Companies ◽  
Institutional Perspective ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
The Impact

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) allows patients to receive prolonged antimicrobial therapy while reducing the length of hospitalization and healthcare costs. In the United States, most public and private insurance companies require prior authorization (PA) for OPAT. The impact of OPAT PA delays is not known. This study aimed to characterize discharge barriers and authorization delays associated with high-cost OPAT antibiotics. Methods IRB-approved study of adult patients discharged with high-cost OPAT antibiotics from January to December 2017. Antibiotics were included based on the frequency of OPAT use and average sales price (ASP) greater than $100 per day, including: daptomycin, ceftaroline, ertapenem, and the novel β-lactam β-lactam inhibitor combinations. Patients with an OPAT authorization delay >24 hours were compared with patients without an OPAT authorization delay. Primary endpoint: total direct hospital costs, starting from the start of treatment with the OPAT antibiotic, from the institutional perspective using Healthcare Cost and Utilization Project and Center for Medicare and Medicaid Services 2019 ASP Drug Pricing data. Secondary outcomes: discharge delay and 30-day readmission or mortality. Results Two-hundred patients included: 151 (76%) no OPAT delay vs. 49 (25%) OPAT delay. The use of antibiotics was similar between groups, except ertapenem was more common in the no OPAT delay group: 60 (43%) vs. 15 (25%), P = 0.022. Patients with no OPAT delay were more commonly discharged with home infusion and less commonly to a facility: 75 (53%) vs. 19 (32%), P = 0.007, and 52 (37%) vs. 37 (63%), P = 0.001, respectively. Discharge delays were more common in patients with OPAT delays: 21 (15%) vs. 31 (53%), P < 0.001. The median total direct hospital costs were higher in patients with OPAT delays: $7,770 (3,031–13,974) vs. $19,576 vs. (10,056–37,038), P < 0.001. Table 1 compares the total direct hospital costs of patients with and without an authorization delay. Conclusion OPAT with high-cost antibiotics requires significant care coordination. Authorization delays for these antibiotics are common and may contribute to a delay in discharge. OPAT transitions of care represent an important opportunity for Infectious Diseases providers to improve care and address access barriers. Disclosures All authors: No reported disclosures.

Comparison of Inpatient Standard-of-Care to Outpatient Oritavancin Therapy for Patients With Acute Uncomplicated Cellulitis

2021 ◽  
pp. 089719002110212
Author(s):  
Brandy Williams ◽  
Justin Muklewicz ◽  
Taylor D. Steuber ◽  
April Williams ◽  
Jonathan Edwards
Keyword(s):  
Hospital Readmission ◽  
Average Length ◽  
Hospital Readmissions ◽  
Standard Of Care ◽  
Economic Outcomes ◽  
Day Hospital ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Average Length Of Stay ◽  
Observational Cohort ◽  
The Difference

Background: Shifting inpatient antibiotic treatment to outpatient parenteral antimicrobial therapy may minimize treatment for acute bacterial skin and skin structure infections, including cellulitis. The purpose of this evaluation was to compare 30-day hospital readmission or admission due to cellulitis and economic outcomes of inpatient standard-of-care (SoC) management of acute uncomplicated cellulitis to outpatient oritavancin therapy. Methods: This retrospective, observational cohort study was conducted at a 941-bed community teaching hospital. Adult patients 18 years and older treated for acute uncomplicated cellulitis between February 2015 to December 2018 were eligible for inclusion. Information was obtained from hospital and billing department records. Patients were assigned to either inpatient SoC or outpatient oritavancin cohorts for comparison. Results: 1,549 patients were included in the study (1,348 in the inpatient SoC cohort and 201 in the outpatient oritavancin cohort). The average length of stay for patients admitted was 3.6 ± 1.5 days. The primary outcome of 30-day hospital readmission or admission due to cellulitis occurred in 49/1348 (3.6%) patients in the inpatient SoC cohort versus 1/201 (0.5%) in the outpatient oritavancin cohort (p = 0.02). The difference between costs and reimbursement was improved in the outpatient oritavancin group (p < 0.001). Conclusion: Outpatient oritavancin for acute uncomplicated cellulitis was associated with reduction in 30-day hospital readmissions or admissions compared to inpatient SoC. Beneficial economic outcomes for the outpatient oritavancin cohort were observed. Additional studies are required to confirm these findings.

Impact of oral anticoagulants on 30-day readmission: a study from a single academic centre

2018 ◽  
Vol 24 (1) ◽  
pp. 10-14 ◽  
Author(s):  
Mukul Bhattarai ◽  
Tamer Hudali ◽  
Robert Robinson ◽  
Mohammad Al-Akchar ◽  
Carrie Vogler ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Risk Factor ◽  
Length Of Stay ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Warfarin Therapy ◽  
Oral Anticoagulants ◽  
Emergency Department Visits ◽  
Day Hospital ◽  
The Impact

Researchers are extensively searching for modifiable risk factors including high-risk medications such as anticoagulation to avoid rehospitalisation. The influence of oral anticoagulant therapy on hospital readmission is not known. We investigated the impact of warfarin and direct oral anticoagulants (DOACs) on all cause 30-day hospital readmission retrospectively in an academic centre. We study the eligible cohort of 1781 discharges over 2-year period. Data on age, gender, diagnoses, 30-day hospital readmission, discharge medications and variables in the HOSPITAL score (Haemoglobin level at discharge, Oncology at discharge, Sodium level at discharge, Procedure during hospitalisation, Index admission, number of hospital Admissions, Length of stay) and LACE index (Length of stay, Acute/emergent admission, Charlson comorbidity index score, Emergency department visits in previous 6 months), which have higher predictability for readmission were extracted and matched for analysis. Warfarin was the most common anticoagulant prescribed at discharge (273 patients) with a readmission rate of 20% (p<0.01). DOACs were used by 94 patients at discharge with a readmission rate of 4% (p=0.219). Multivariate logistic regression showed an increased risk of readmission with warfarin therapy (OR 1.36, p=0.045). Logistic regression did not show DOACs to be a risk factor for hospital readmission. Our data suggests that warfarin therapy is a risk factor for all-cause 30-day hospital readmission. DOAC therapy is not found to be associated with a higher risk of hospital readmission. Warfarin anticoagulation may be an important target for interventions to reduce hospital readmissions.

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