Antimicrobial Stewardship in an Outpatient Parenteral Antibiotic Therapy Program
Spearheaded by a multidisciplinary team, this outpatient parenteral antibiotic therapy program provided a cost-effective, safe alternative to a hospital stay for the administration of antibiotics.
Catheter complication rates in the OPAT program were lower than those reported in the literature. According to the 2009 NHSN report, the catheter complication rate in the inpatient long-term care units was 1.0 CRBSI/1,000 catheter days.9 Moreover, this program has been instrumental in providing care that otherwise would be administered through the use of home health agencies.
In the private sector, OPAT is frequently contracted to agencies that provide the same type of service to outpatients who have insurance. These agencies charge for the antimicrobials, IV supplies, nursing visits, and laboratory costs for patient-safety monitoring. Use of an agency could raise expenses by a factor of 8-fold or more above the cost of a hospital-based OPAT program, an estimate based on a comparison with a local federally contracted home-infusion agency that provides specialized home-infusion services at a cost.
Although costs related to hospital readmissions were not factored in to the cost savings calculations, the rate of readmission was low in the snapshot analysis that was conducted at the Edward Hines, Jr. VA Hospital. It is believed that this is the result of the close follow-up and continuity of care that the patients in this OPAT program received.
In addition to cost containment, the data reflect the safe, effective care that resulted from treatment outside the hospital setting. One of the key attributes that has made the Edward Hines, Jr. VA Hospital OPAT program unique is that it is recognized in the community as the only VA facility in the area to provide OPAT as an option for the veteran patient. Other VA facilities in the area contract with home-infusion agencies, which are responsible for supplying the antibiotics and nursing care. The Edward Hines, Jr. VA Hospital is the only VA hospital in VISN 12 that has a facility-supported program that provides all supplies and antimicrobials from the VA—a major contributing factor to the cost savings. Continuity of care is provided to the patient who transitions from inpatient to outpatient status with the same team of providers contributing to the significant patient satisfaction that the program has engendered.
Conclusions
One of the main benefits realized with this transition of antibiotic therapy to the home setting is the avoidance of newly acquired nosocomial infections, including C difficile infection, fungal, and multidrug-resistant bacterial infections. Other benefits include early IV to oral switch in therapy when the patient is deemed a candidate, the ability to go back to work sooner, and the ability to receive treatment in the comfort of the patient’s home. Plans for data collection may include a more in-depth review of repeat admissions due to unresolved infections and the number of patients who are unable to complete OPAT at home.
The Edward Hines, Jr. VA Hospital OPAT program has shown that in a large, federally-funded hospital, OPAT is safe, cost-effective, convenient and leads to increased patient satisfaction in a diverse group of veterans.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
