Emergency Department Utilization During Self-Administered Outpatient Parenteral Antimicrobial Therapy

Abstract

BackgroundSelf-administered outpatient parenteral antimicrobial therapy (S-OPAT) has been established as a clinically safe and effective alternative to inpatient or outpatient extended-course intravenous antibiotics while reducing healthcare resource utilization. However, previous research has not confirmed that transferring patients from the hospital to home for treatment does not cause a compensatory increase in emergency department (ED) visits. We sought to validate S-OPAT clinical safety and healthcare costs associated with S-OPAT by confirming that S-OPAT does not increase ED utilization during treatment.MethodsWe conducted a before-after study of ED utilization among S-OPAT patients. We compared ED visits, hospital admissions resulting from ED visits, hospital admissions due to OPAT-related causes, and hospital charges associated with all ED visits 60 days before and after initiation of S-OPAT. A 60-day time frame was selected to effectively encompass the maximum treatment duration (8 weeks) for S-OPAT. Paired t-tests were used to compare the change in ED utilization before and after initiation of S-OPAT.ResultsAmong our cohort of 944 S-OPAT patients, 430 patients visited the ED 60 days before or after starting treatment. Of the patients with ED visits, 69 were admitted to the hospital for OPAT-related causes and 228 incurred hospital charges from their visit. Initiation of S-OPAT was associated with a statistically significant reduction in total ED visits, all-cause hospital admission, OPAT-related hospital admission, and hospital charges (see Table 1).ConclusionOur review of ED utilization among S-OPAT patients demonstrates a reduction in multiple parameters of ED utilization with the initiation of S-OPAT treatment. Our findings confirm that S-OPAT does not yield an increase, but rather a decrease, in ED visits with the transfer of patients from hospital to home.Table 160 days before S-OPAT60 days after starting S-OPATPaired t-test p- valueED visits (encounters per patient) N = 4303.4 ± 2.92.9 ± 2.6<0.001Hospital admissions (inpatient-days per patient) N = 43014.8 ± 16.56.2 ± 13.2<0.001Hospital admissions: S-OPAT-related (inpatient-days per patient) N = 699.6 ± 9.54.0 ± 6.8<0.001Hospital charges (dollars per patient) N = 228$81,034 ± 59,552$36,105 ± 59,972<0.001Disclosures All authors: No reported disclosures.