Abstract
Background and objectivesOutpatient parenteral antimicrobial therapy (OPAT) for infections has been in use for nearly 40 years, and although it has been found safe and efficacious, its use has been studied primarily among otherwise healthy patients. We aimed to develop and evaluate an OPAT program for patients with cancer, particularly solid tumors.MethodsWe implemented multiple quality improvement interventions between June 2018 and January 2020. We retrospectively and prospectively collected data on demographics, the completeness of infectious diseases (ID) physician consultation notes, rates of laboratory test result monitoring, ID clinic follow-up, and 30-day outcomes, including unplanned OPAT-related readmissions, OPAT-related emergency center visits, and deaths.ResultsCompleteness of ID provider notes improved from a baseline of 77 to 100% (p < .0001) for antimicrobial recommendations, 75 to 97% (p < .0001) for follow-up recommendations, and 19 to 98% (p < .0001) for laboratory test result monitoring recommendations. Completion of laboratory tests increased from a baseline rate of 24 to 56% (p = .027). Thirty-day unplanned OPAT-related readmission, ID clinic follow-up, 30-day emergency center visit, and death rates improved without reaching statistical significance.ConclusionsSustained efforts, multiple interventions, and multidisciplinary engagement can improve laboratory test result monitoring among solid tumor patients discharged with OPAT. Although demonstrating a decrease in unplanned readmissions through institution of a formal OPAT program among patients with solid malignancies may be more difficult compared with the general population, the program may still result in improved safety.
Highlights
Outpatient parenteral antimicrobial therapy (OPAT), first described in the 1970s, has increasingly been used as an alternative to hospitalization for stable patients with infections not amenable to oral therapy [1, 2]
We focused on patients with solid tumors as a pilot program with the goal to expand OPAT to additional patient populations
We evaluated the impact of the program on costs, hospital and provider charges, for 90 days after initial discharge with OPAT
Summary
Outpatient parenteral antimicrobial therapy (OPAT), first described in the 1970s, has increasingly been used as an alternative to hospitalization for stable patients with infections not amenable to oral therapy [1, 2]. The Infectious Diseases Society of America initially published guidelines for OPAT in 2004 with updates in December 2018 These guidelines recommend consultation with a physician specializing in infectious diseases (ID), outpatient follow-up, and periodic monitoring of laboratory test results, with the goal of reducing adverse events [12,. We retrospectively and prospectively collected data on demographics, the completeness of infectious diseases (ID) physician consultation notes, rates of laboratory test result monitoring, ID clinic follow-up, and 30-day outcomes, including unplanned OPAT-related readmissions, OPAT-related emergency center visits, and deaths. Conclusions Sustained efforts, multiple interventions, and multidisciplinary engagement can improve laboratory test result monitoring among solid tumor patients discharged with OPAT. Demonstrating a decrease in unplanned readmissions through institution of a formal OPAT program among patients with solid malignancies may be more difficult compared with the general population, the program may still result in improved safety
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