Emergency Department Utilization during Selfadministered Outpatient Parenteral Antimicrobial Therapy

Author(s):

Anisha Ganguly, Deepak Agrawal, Steven Brown L and Kavita P Bhavan*

Background: Self-administered outpatient antimicrobial treatment (S-OPAT) program teaches patients to administer intravenous antibiotics themselves at their own home. Prior studies have shown that patients successfully complete S-OPAT, with a high satisfaction rate and substantial cost savings for the health system. The question remains if transition of care from hospital to home and from health care provider to self-care, results in increased utilization of emergency department (ED) services due to unmet needs. This is especially pertinent as interest in adopting S-OPAT is growing, especially in resource poor settings and countries. Objective: Determine usage of emergency care by patients who self-administered intravenous antibiotics at home. Methods: The study was conducted at Parkland Hospital, a large safety-net hospital serving Dallas County, Texas that has operated an S-OPAT clinic since 2009. We conducted a retrospective review of electronic medical records of 944 S-OPAT patients from our previous study between fiscal years 2009-2013, and determined emergency department (ED) visits and hospital admissions due to OPAT-related causes. Results: 944 patients were treated with S-OPAT. Patients were more likely to be male (62%), non-English-speaking (37%), lack insurance (61%), and have diabetes (21%). Of the 944 patients on S-OPAT, 99 patients (10.5% of the total cohort) presented at least once to the ED for S-OPAT-related causes. Fifty-one patients (5.4% of the total cohort) were admitted to the hospital, with a mean length of stay of 8 days. Conclusions: Our analysis confirms that transferring patients from hospital to home for self-administration of intravenous antibiotics is not associated with a compensatory increase in ED visits related to antimicrobial treatment.