scholarly journals 754. Evaluation of Standardized Dalbavancin Use to Facilitate Early Hospital Discharge for Patients Inappropriate for Outpatient Parenteral Antibiotic Therapy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S336-S337 ◽  
Author(s):  
Katherine C Shihadeh ◽  
Heather Young ◽  
David L Wyles ◽  
Timothy C Jenkins
Keyword(s):  
Antibiotic Therapy ◽  
Hospital Discharge ◽  
Injection Drug Users ◽  
Drug Users ◽  
Medical Center ◽  
Cost Savings ◽  
Patient Discharge ◽  
Early Discharge ◽  
Early Hospital Discharge ◽  
Serious Infections

Abstract Background Patients frequently remain in the hospital for prolonged intravenous (IV) antibiotic therapy for serious infections when outpatient IV antibiotic therapy is unsafe or unfeasible. A protocol was developed to facilitate early discharge by administering one dose of dalbavancin 7 – 10 days prior to the planned end of treatment, allowing patient discharge the same day as the infusion. The purpose of this analysis was to describe the effectiveness, safety, and financial impact by using dalbavancin to facilitate early discharge. Methods This is a retrospective observational analysis of all inpatients who received dalbavancin at Denver Health Medical Center from April 2018 to April 2019. One dose of dalbavancin 1,500 mg was administered over 30 minutes to each patient. The medical record was reviewed 30 days after discharge to determine safety (adverse reaction to dalbavancin) and effectiveness (readmission or receipt of additional antibiotics). The estimated cost of one hospital day was $1,800; one dose of dalbavancin costs $3,000. Results Sixteen patients (69% male; average age 45 years) received dalbavancin. The majority of patients were homeless (81%), injection drug users (75%), and infected with HCV (56%). One patient was infected with HIV (6%) and none had diabetes, kidney disease, or cirrhosis. Antibiotics administered prior to dalbavancin were vancomycin or cefazolin, based on organism, for a median duration of 25 days (IQR 11–34). Patients were infected with methicillin-resistant S. aureus (n = 8), methicillin-susceptible S. aureus (n = 7), and one co-infection with S. epidermidis and S. pyogenes. The infections included complicated bacteremia (n = 6), uncomplicated bacteremia (n = 4), osteomyelitis (n = 2), right-sided endocarditis (n = 2), and osteomyelitis with bacteremia (n = 2). No adverse reactions were noted. Readmission 30 days from discharge occurred for two patients for reasons unrelated to the infection or dalbavancin. None received additional antibiotics. 115 hospital days were averted (average of 7 days per patient). Cost savings to the hospital were estimated to be $159,000. Conclusion A standardized approach to use dalbavancin for serious infections to facilitate early hospital discharge appears to be safe and effective and led to substantial cost savings. Disclosures All authors: No reported disclosures.

Troponin T: role in altering patient management and enabling earlier discharge from a district general hospital

2001 ◽  
Vol 38 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Avril Owen ◽  
Waqas Khan ◽  
Keith D Griffiths
Keyword(s):  
Hospital Stay ◽  
General Hospital ◽  
Patient Management ◽  
Troponin T ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Patient Discharge ◽  
District General Hospital ◽  
Early Discharge ◽  
Control Group

The use of troponin T to facilitate early patient discharge was investigated in a prospective study in a district general hospital. Troponin T was measured in 91 patients admitted over a period of 6 months with chest pain but without evidence of myocardial infarction. The main outcome measure was length of hospital stay. A negative troponin T was found in 70 patients. Fifty of these were discharged within 24h of the troponin result being available and they had a significantly shorter hospital stay than a case-control group and a historical control group from the previous 6 months. Troponin T measurement has a role in altering patient management by enabling early discharge, resulting in significant cost savings and increasing bed availability.

On- and off-label utilization of dalbavancin and oritavancin for Gram-positive infections

2019 ◽  
Vol 74 (8) ◽  
pp. 2405-2416 ◽  
Author(s):  
Taylor Morrisette ◽  
Matthew A Miller ◽  
Brian T Montague ◽  
Gerard R Barber ◽  
R Brett McQueen ◽  
...  
Keyword(s):  
Health System ◽  
Injection Drug Users ◽  
Drug Users ◽  
Cost Savings ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Gram Positive ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Off Label

AbstractBackgroundLong-acting lipoglycopeptides (laLGPs) are FDA approved only for acute bacterial skin and skin structure infections (ABSSSIs). However, these antibiotics show promise for off-label use, reductions in hospital length of stay (LOS) and healthcare cost savings.ObjectivesTo assess the effectiveness, safety, impact on LOS and estimated cost savings from laLGP treatment for Gram-positive infections.MethodsRetrospective cohort of adult patients who received at least one dose of laLGPs at the University of Colorado Health system. Descriptive statistics were utilized for analysis.ResultsOf 59 patients screened, 56 were included: mean age 47 years, 59% male and 30% injection drug users/polysubstance abusers (dalbavancin, 71%; oritavancin, 25%; both, 4%). Most common indications for laLGP: ABSSSIs (36%), osteomyelitis (27%) and endocarditis (9%). Most common isolated pathogens: MSSA and MRSA (25% and 19%, respectively), Enterococcus faecalis (11%) and CoNS (11%). Previous antibiotics were administered for a median of 13 days (IQR = 7.0–24.5 days) and laLGPs for a median of one dose (IQR = 1–2 doses). Ten (18%) patients were lost to follow-up. Clinical failure was found in 7/47 (15%) cases with adequate follow-up. Mild adverse effects occurred in six (11%) patients. Projected reduction in hospital LOS and health-system costs were 514 days (9.18 days/person average) and $963456.72 ($17204.58/person average), respectively.ConclusionsProspective trials are needed to validate the use of these antibiotics for Gram-positive infections in practice, with the hope that they will reduce hospital LOS and the need for daily antibiotic infusions to provide alternative options for patients not qualifying for outpatient parenteral antimicrobial therapy.

scholarly journals Is early discharge safe after naloxone reversal of presumed opioid overdose?

CJEM ◽  
2000 ◽  
Vol 2 (03) ◽  
pp. 156-162 ◽  
Author(s):  
Jeremy Etherington ◽  
James Christenson ◽  
Grant Innes ◽  
Eric Grafstein ◽  
Sarah Pennington ◽  
...  
Keyword(s):  
Injection Drug Users ◽  
Drug Users ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Early Discharge ◽  
Supplemental Oxygen ◽  
Opioid Overdose ◽  
Patients At Risk ◽  
Prolonged Observation ◽  
Critical Intervention

ABSTRACT Introduction: Patients with suspected opioid overdose frequently require naloxone treatment. Despite recommendations to observe such patients for 4 to 24 hours after naloxone, earlier discharge is becoming more common. This prospective, observational study of patients with presumed opioid overdose examines the safety of early disposition decisions and the accuracy of outcome prediction by physicians 1 hour after the administration of naloxone. Methods: The study was carried out at St. Paul’s Hospital, an inner city teaching centre that cares for most of the injection drug users in Vancouver, BC. Patients were formally assessed 1 hour after receiving naloxone for presumed opioid overdose. Demographics, medical history and physical examination were documented on specific data forms, and physicians recorded their comfort with early discharge. Patients were followed up, and those who required a critical intervention or suffered a pre-defined adverse event (AE) within 24 hours of their 1-hour assessment were identified. Results: Of 573 patients, 48% were discharged in less than 2 hours, 23% in 2–4 hours and 29% in >4 hours. 94 patients who were held in the emergency department (ED) or admitted required a critical intervention, including supplemental oxygen for hypoxia (74), repeat naloxone (52), antibiotics administered intravenously (IV) (14), assisted ventilations (13), fluid bolus for hypotension (12), charcoal for associated life-threatening overdose (6), IV inotropic agents (2), antiarrhythmics for sustained tachycardia >130 beats/min (1), and administration of bicarbonate for arterial [HCO3] <5 or venous CO2 <5 (1). Physicians predicted adverse events with 94% sensitivity and 59% specificity. No discharged patients suffered a serious AE within 24 hours of ED discharge. Conclusions: Emergency physicians can clinically identify patients at risk of deterioration after naloxone reversal of suspected opioid overdose. Prolonged observation or hospital admission is not usually required. Selective early discharge of patients with presumed opioid overdose is feasible and appears safe. A clinical prediction rule may be useful in identifying patients eligible for early discharge.

scholarly journals 206. Clinical and Molecular Characteristics of Community-associated Staphylococcus aureus Bacteremia in Injection and Non-injection Drug Users at a New York City Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S211-S211
Author(s):  
Sherif Shoucri ◽  
Angela Gomez-Simmonds ◽  
Amir Lankarani ◽  
Qiuhu Shi ◽  
Franklin D Lowy ◽  
...  
Keyword(s):  
New York ◽  
Staphylococcus Aureus ◽  
New York City ◽  
York City ◽  
Injection Drug Users ◽  
Drug Users ◽  
Medical Center ◽  
Injection Drug ◽  
History Of ◽  
Sequence Types

Abstract Background The opioid epidemic has resulted in a dramatic resurgence of bacterial infections, most notably those due to Staphylococcus aureus (SA). We compared the demographic, clinical, and molecular factors of injection drug users (IDUs) and non-IDUs with SA bacteremia. Methods Patients with SA bacteremia were identified through a query of the electronic medical record EMR from January 2018 to December 2019 at a New York City medical center. All cases of community-associated (CA) SA bacteremia among adults with a history of active injection drug use were evaluated. Patients with positive SA blood cultures ≤ 72 hours of admission were considered CA. IDUs were identified with keyword searches and were deemed active if they had a history of use in the 12 months prior to admission. A randomly selected group of non-IDUs with CA SA bacteremia was used for comparison at a 4:1 ratio. Available SA isolates underwent Illumina whole genome sequencing (WGS). Using SRST2 multilocus sequence types (MLST), antimicrobial resistance genes and putative virulence factors were extracted. Results From January 2018 to December 2019, 669 patients with SA bacteremia were identified. 29 patients were active IDUs. Compared to 112 randomly selected non-IDUs, IDUs were significantly younger and more likely to be unstably housed (Table 1). Rates of MRSA were similar in IDUs (31%) and non-IDUs (32.1%). Endocarditis (44.8% vs 11.6%) and abscesses (27.6% vs 8.9%) were diagnosed more frequently in IDUs than non-IDUs. A positive hepatitis C antibody was strongly associated with SA bacteremia in IDUs (62.1% vs 6.3%, p< 0.001). WGS demonstrated comparable proportions of sequence types across IDUs and non-IDUs. ST8 accounted for the majority of infections in both groups (Table 2). MRSA bacteremia due to ST8 occurred in a higher proportion of IDUs (7/29, 24.1%) than non-IDUs (14/112, 12.5%). Conclusion IDUs with CA SA bacteremia have unique demographic and clinical features that differentiate them from non-IDUs. Endocarditis rates in IDUs are of particular concern. Use of these risk factors could allow hospitals to rapidly identify IDUs and offer them necessary medical and social services. WGS revealed a majority of MRSA bacteremia was due to one sequence type in IDUs (ST8). Further analysis of virulence genes in this cohort are ongoing. Disclosures Franklin D. Lowy, MD, GlaxoSmithKline (Advisor or Review Panel member)UpToDate (Other Financial or Material Support, Topic Writer and Editor) Anne-Catrin Uhlemann, MD, PhD, Merck (Grant/Research Support)

#35: Safety of Early Hospital Discharge of Neutropenic Pediatric Oncology Patients After Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S16-S16
Author(s):  
Asia Castro ◽  
Miguel Minero ◽  
Martha Avilés-Robles
Keyword(s):  
Septic Shock ◽  
Febrile Neutropenia ◽  
Hospital Discharge ◽  
Antibiotic Treatment ◽  
Pediatric Oncology ◽  
Early Discharge ◽  
Infectious Complications ◽  
Oncology Patients ◽  
Early Hospital Discharge ◽  
The Mean

Abstract Background Cancer is one of the leading causes of death in children in Mexico. Infections are the main cause of morbidity and mortality in these patients. Febrile neutropenia (FN) constitutes an infectious emergency and early aggressive antibiotic treatment is the standard of care. Recent guidelines suggest discontinuing empirical antibiotics in patients who have negative blood cultures at 48 hours, who have been afebrile for at least 24 hours, and who have evidence of marrow recovery. Nevertheless, recommendations about discontinuing antibiotics and discharging patients while they are still neutropenic are less clear. We aimed to evaluate the safety of early hospital discharge of FN patients who are still neutropenic. Methods Observational, case–control study nested in a prospective cohort of pediatric oncology patients with FN at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from May 2015 to September 2017. We defined early discharge as when a patient is discharged while neutropenic (ANC <500 cell/mm3) and has completed at least 7 days of antibiotics. Patients with FN who were discharged with neutropenia were defined as cases and patients with FN who were discharged after recovering from neutropenia were controls. To assess the safety of hospital early discharge, the following outcomes were analyzed until 7 days after discharge: new onset of fever, hospital readmission, need to restart antibiotic treatment, septic shock, and death. Descriptive statistics were performed with measures of central tendency. Variables of interest were compared with Pearson’s χ 2 or Student’s test. Results In total, 929 febrile neutropenia episodes were analyzed. The mean age was 7.5 years, 55.3% were female. Hematologic malignancies were the most frequent type of malignances in 50.8%. Acute lymphoblastic leukemia (ALL) was the underlying disease in 41%. Of the 929 FN episodes, 180 (19.3%) were discharged with neutropenia. Patients with ALL were the most frequent in 49.4%, followed by acute myeloid leukemia 18.8% and rhabdomyosarcoma 6.6%. Thirty-five percent were in maintenance therapy, 22% in remission induction therapy, and 9% in consolidation. 19.4% of discharged patients received granulocyte-colony stimulating factor. Ten patients (5.5%) were re-admitted during the 7 days following discharge. Six patients returned for chemotherapy administration and one was scheduled for liver biopsy. Three patients were re-admitted due to infectious complications (1.6%), none of them were under oral antibiotic treatment; two patients due to FN without microbiological isolation and one patient with septic shock due to multi-drug-resistant Pseudomonas aeruginosa. Older patients had a higher risk of readmission, with a mean age of 14.6 years (SD 4.6 years, 95% CI 7.7–21.6) (P = 0.01), compared with the mean of 7.7 years (SD 2.7 years, (95% CI 7.0, – 8.4) of patients who were not re-admitted. Conclusions In our population of pediatric patients with FN who were discharged before neutrophil recovery, readmission due to infectious complications was low (1.6%). Discharging patients with persistent neutropenia who are afebrile and had completed a course of antibiotics seems an acceptable practice with a low risk of readmission.

scholarly journals Mobilization and early hospital discharge for patients with acute myocardial infarction: literature review

2008 ◽  
Vol 21 (2) ◽  
pp. 345-350 ◽  
Author(s):  
Juliana de Lima Lopes ◽  
Juliana Turca dos Santos ◽  
Sheila Cristina de Lima ◽  
Alba Lúcia Bottura Leite de Barros
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Literature Review ◽  
Hospital Discharge ◽  
Early Mobilization ◽  
Bed Rest ◽  
Early Discharge ◽  
Early Hospital Discharge ◽  
Resting Period

OBJECTIVE: This study was a literature review with the purpose of analyzing articles comparing early and late mobilization and those comparing early and late discharge for patients with acute myocardial infarction. METHODS: The literature review was performed using the Lilacs and Medline databases (1966-2007), and the length of the resting period, the hospitalization and possible complications were analyzed. RESULTS: We selected 18 articles; 11 of them compared early and late mobilization and 7 compared early and late discharge. The length of the resting period in the early mobilization group varied from 2 to 10 days and 5 to 28 days for the longest resting period. The early discharge group stayed in the hospital from 3 to 14 days and the late discharge group stayed in the hospital from 5 to 21 days. CONCLUSION: The studies show that there is no evidence of complications related to short periods of bed rest and hospitalization.

Early Discharge Programme on Hospital-at-Home Evaluation for Patients with Immediate Postoperative Course after Laparoscopic Colorectal Surgery

2017 ◽  
Vol 58 (5-6) ◽  
pp. 263-273 ◽  
Author(s):  
Marcos Pajarón-Guerrero ◽  
Manuel Francisco Fernández-Miera ◽  
Juan Carlos Dueñas-Puebla ◽  
Carmen Cagigas-Fernández ◽  
Iciar Allende-Mancisidor ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Hospital Discharge ◽  
Laparoscopic Colorectal Surgery ◽  
Early Discharge ◽  
Care Model ◽  
Early Hospital Discharge ◽  
Discharge Care ◽  
The Mean ◽  
Hospital At Home

Background: To audit the safety of the early hospital discharge care model offered by a Hospital-at-home (HAH) unit during early postoperative follow-up of these patients, and to determine whether this care model is more efficient compared to the traditional care model. Methods: A prospective study of 50 patients included consecutively for 1 year in an early discharge programme after laparoscopic colorectal surgery was performed. As of day 3 after surgery, if the patient met the relevant inclusion criteria they were transferred to the HAH unit. The domiciliary protocol consists of daily clinical follow-up and a series of analytical controls with the purpose of early detection of postoperative complications. If the clinical course was favourable on day 7 after the postoperative period the patient was discharged. Results: A total of 66% were males, and the mean age was 60.6 years. The surgical procedure most commonly performed was sigmoidectomy. The mean stay was 5.5 days. There were no deaths during follow-up. The average estimated cost per day of stay in a HAH system was EUR 174.29 whilst the same average cost on a surgery ward stood at EUR 1,032.42. Conclusions: For patients undergoing major colorectal surgery with minimally invasive surgical technique, an early hospital discharge care programme by means of referral to a HAH unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system.

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