Abstract
From January 1, 1996 to December 31, 1996, 343 patients received outpatient intravenous antibiotic therapy at Charles LeMoyne Hospital, a 436-bed, acute care hospital in Greenfield Park, south of Montréal, Québec. The infectious diseases department saved 2660 bed-days using outpatient therapy. The mean duration of outpatient therapy was 7.76 days; 81.6% of patients were admitted to the program directly from the emergency room, or outpatient hospital clinics or private offices in the community. Hospitalized patients constituted only 18.4% of admissions to the outpatient intravenous antibiotic therapy program. Forty per cent of the surgical/medical staff participated in the program and they were able to generate a significant impact by diverting patients to outpatient therapy. Two types of patients can benefit from an outpatient intravenous antibiotic therapy program. One group of patients needs empirical short term therapy and can be switched to oral sequential therapy after two to five days of outpatient intravenous antibiotic therapy. A second group of patients needs specific long term therapy for the full duration of the antibiotic therapy. Empirical short term therapy can be managed by emergency department or hospital-based primary physicians, or medical/surgical specialists. Specific long term therapy can be managed by microbiology/infectious disease specialists or medical/surgical specialists. Hospitals that want to relieve pressure on emergency rooms and hospital bed demands should create facilities for both types of patients. Cefazolin and gentamicine/tobramycine were the most commonly used antibiotics in empirical short term therapy and in terms of number of patients treated. Ceftriaxone and vancomycin were most commonly used for long term therapy. The Drug acquisition antibiotic cost was $73,117 but constituted only 20% of the total outpatient intravenous antibiotic therapy cost. The per diem ambulatory cost was $140/patient/day.
Highlights
From January 1, 1996 to December 31, 1996, 343 patients received outpatient intravenous antibiotic therapy at Charles LeMoyne Hospital, a 436-bed, acute care hospital in Greenfield Park, south of Montréal, Québec
Outpatient intravenous antibiotic therapy was introduced to the province of Quebec through pilot studies initiated in Quebec City from 1984 to 1987 [1,2,3]
Second-line antibiotics such as ceftriaxone (Rocephin, Hoffmann-La Roche Ltd, Mississauga, Ontario) or vancomycin were used for long term therapy
Summary
Ambulatory intravenous antibiotic therapy in Quebec: The Hôpital Charles LeMoyne experience in 1996. This initiative planned to decrease public hospitals’ budgets and the number of beds to liberate new funds and achieve a major medical/surgical ‘virage ambulatoire’ This reform allowed the promotion of less costly alternatives to hospitalization, such as outpatient intravenous antibiotic therapy. To generate a rapid and significant impact on cost, infectious disease specialists and organizers of the outpatient antibiotic intravenous therapy program requested the participation of a large proportion of the medical/surgical staff. Infectious disease specialists thought that outpatient antibiotic intravenous therapy had been well studied and successful results had been published [5,6,7,8,9] They thought that the Canadian guidelines [10] could be used to teach active medical/surgical staff at Hôpital Charles LeMoyne. The objective of the intrahospital ambulatory unit was to provide an alternative to hospitalization equivalent to 4.5 beds/year and 1.5 stretchers in emergency corridors/year (the equivalent to 2190 bed days/year)
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