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Outpatient Parenteral Antimicrobial Therapy in a Safety Net Hospital: Opportunities for Improvement
Rory Bouzigard1,2, Mark Arnold3, Sithembiso S Msibi4
1Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Reduced outpatient parenteral antimicrobial therapy (OPAT) staffing correlated with increased hospital length of stay, emergency department visits, and readmissions. This highlights the need for OPAT-specific quality measures and optimal staffing ratios.
Area of Science:
- Healthcare Management
- Infectious Diseases
- Patient Safety
Background:
- Outpatient parenteral antimicrobial therapy (OPAT) is a critical transitional care strategy with varying delivery models.
- Current OPAT programs lack standardized staffing guidelines, impacting patient outcomes and healthcare resource utilization.
- This study investigates the relationship between OPAT program staffing and patient outcomes.
Purpose of the Study:
- To examine the impact of different OPAT care models on patient safety and healthcare overuse.
- To identify strategies for improving OPAT program safety and efficiency.
- To assess the correlation between OPAT team staffing levels and patient outcomes.
Main Methods:
- A retrospective review of patient data from two distinct periods (April-June 2021 and January-March 2022) was conducted.
- Data were stratified by OPAT care model: self-administered, healthcare-administered, and skilled nursing facility OPAT.
- Changes in OPAT team staffing between the two periods were analyzed in relation to patient outcomes.
Main Results:
- Hospital length of stay increased from 12.4 to 14.3 days between 2021 and 2022.
- Emergency department visits and readmissions significantly increased in 2022, coinciding with decreased OPAT staffing.
- While overall readmissions rose, those directly related to OPAT did not show a significant increase.
Conclusions:
- Increased healthcare utilization (length of stay, ED visits, readmissions) was observed during periods of higher staff turnover in an established OPAT program.
- The findings suggest a need for OPAT-specific outcome measures for quality assessment.
- Establishing optimal OPAT program staffing ratios is crucial for ensuring patient safety and efficient care delivery.
Background:
Outpatient parenteral antimicrobial therapy (OPAT) is a safe and cost-effective transitional care approach administered via different delivery models. No standards exist for appropriate OPAT program staffing. We examined outcomes of patients receiving OPAT via different care models to identify strategies to improve safety while reducing health care overuse.
Methods:
Retrospective demographic, clinical, and outcome data of patients discharged with OPAT were reviewed in 2 periods (April-June 2021 and January-March 2022; ie, when staffing changed) and stratified by care model: self-administered OPAT, health care OPAT, and skilled nursing facility OPAT.
Results:
Of 342 patients, 186 (54%) received OPAT in 2021 and 156 (46%) in 2022. Hospital length of stay rose from 12.4 days to 14.3 in 2022. In a Cox proportional hazards regression model, visits to the emergency department (ED) within 30 days of OPAT initiation (hazard ratio, 1.76; 95% CI, 1.13-2.73; P = .01) and readmissions (hazard ratio, 2.34; 95% CI, 1.22-4.49; P = .01) increased in 2022 vs 2021, corresponding to decreases in OPAT team staffing. Higher readmissions in the 2022 cohort were for reasons unrelated to OPAT (P = .01) while readmissions related to OPAT did not increase (P = .08).
Conclusions:
In a well-established OPAT program, greater health care utilization-length of stay, ED visits, and readmissions-were seen during periods of higher staff turnover and attrition. Rather than blunt metrics such as ED visits and readmissions, which are influenced by multiple factors besides OPAT, our findings suggest the need to develop OPAT-specific outcome measures as a quality assessment tool and to establish optimal OPAT program staffing ratios.
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