756Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy (OPAT) Administered at Home

Abstract

• Although administration of OPAT at home is now common practice, there is a paucity of data on the frequency of emergency department (ED) visits during such treatment. • The purpose of this study was to describe ED visits while on OPAT at home among patients discharged from a tertiary care hospital. Introduction • OPAT courses at Cleveland Clinic were identified from the institution’s OPAT registry which includes all patients discharged from hospital on parenteral antimicrobials. • All OPAT courses for patients discharged from hospital from January 1, 2013 to January 1, 2014, and treated at home, were selected. • For each treatment course ED visits that occurred while on OPAT were sought in the electronic medical record. Methods The majority of ED visits for patients on OPAT at home are unrelated to OPAT. About one in 20 patients receiving OPAT at home has at least one ED visit for an OPAT-related complication during the course of treatment, and about a fourth of these ED visits result in hospitalization. Conclusions • From January 1, 2013 to January 1, 2014, of 3161 OPAT courses at Cleveland Clinic, 1941 courses (61%) were administered at home for 1461 patients. • The total number of OPAT days for these 1941 courses was 43787. The baseline characteristics of the home OPAT courses are outlined in Table 1. • The distribution of reasons for ED visits is shown in Figure 1. • Of 297 ED visits, 115 (28%) were for OPAT-related complications (2.63 visits per 1000 OPAT days). Of the 115 OPAT-related ED visits, 17 (15%) were for antimicrobial adverse events (0.39 per 1000 OPAT days) and 98 (85%) for vascular access complications (2.24 per 1000 OPAT days). • 98 (5%) OPAT courses had at least one ED visit for an OPAT-related problem, with a median time to first visit of 9 days after hospital discharge. Results Baseline Characteristics Characteristic Age in years, mean ± SD Inpatient OPAT starts, n (% of OPATs) Vascular access device, n (% of OPATs) PICC Hohn catheter Tunneled central venous catheter Tunneled dialysis catheter Dialysis fistula or graft Indwelling port Midline Peripheral catheter Non-tunneled central venous catheter Active injection drug use Cleveland Clinic Home Infusion Pharmacy, n (%) Cleveland Clinic at Home Nursing, n (%) OPAT duration in days, mean (SD) Frequency 55 ± 15 1682 (87) 1508 (78) 152 (8) 142 (7) 18 (<1) 7 (<1) 95 (5) 15 (<1) 1 (<1) 3 (<1) 16 (0.8) 901 (46) 811 (42) 23 (17) 24% 4% 72% Antimicrobial Adverse Event Vascular Access Complication Unrelated to OPAT Figure 1. Reasons for ED Visits Table 1 Characteristic Vascular Access complication (n = 98) Admit to hospital, n (%) 20 (20) Days after OPAT start, median (Q1, Q3) 11 (5, 19) Antimicrobial Adverse Event (n = 17) 5 (29) 5 (3, 11) Unrelated to OPAT (n = 182) 84 (46) 8 (3, 14) Table 2. Characteristics of ED Visits by Reason for Visit ED Visits