title: Impact of a multidisciplinary team review of potential outpatient parenteral antimicrobial therapy prior to discharge from an academic medical center.
abstract: BACKGROUND
  Outpatient parenteral antimicrobial therapy (OPAT) is frequently prescribed at hospital discharge, often without infectious diseases (ID) clinician oversight. We developed a multidisciplinary team, including an ID pharmacist, to review OPAT care plans at hospital discharge to improve safety, clinical efficacy, practicality, and appropriateness of the proposed antimicrobial regimen.
  
  
  OBJECTIVE
  To evaluate the impact of the OPAT team on regimen safety, efficacy, and complexity; calculate the economic benefits of the service by avoiding hospital discharge delay, central venous catheter placement, or need for OPAT; and evaluate the discharge environment among OPAT referrals.
  
  
  METHODS
  In an observational design, we analyzed the impact of an OPAT team from July 2009 through June 2010 at a large academic tertiary care hospital. All patients with plans for continued parenteral therapy after discharge referred to the OPAT team were included in the analysis. Patients were excluded if OPAT was cancelled prior to processing of the referral.
  
  
  RESULTS
  During the 1-year study period, 569 of 644 consecutive referrals to the OPAT team met inclusion criteria, resulting in 494 OPAT courses. Interventions by an ID pharmacist were made for safety (56%), regimen complexity (41%), and efficacy (29%). Lack of formal ID physician consultation resulted in more interventions for safety (64% vs 48%, p < 0.001) and efficacy (36% vs 21%, p < 0.001). Discharge delays were avoided for 35 referrals, resulting in 228 hospital days avoided and approximately $366,000 in hospital bed cost savings. Use of OPAT was avoided in 75 referrals (13.2%), preventing central venous catheter placement in 48 patients (8.4%), resulting in an additional $58,080 in cost savings.
  
  
  CONCLUSIONS
  The OPAT team optimized safety, efficacy, and convenience of OPAT while providing substantial cost savings. Further studies are needed to confirm the program's cost-effectiveness.
authors: School of Pharmacy, University of California, San Francisco, CA, USA.
authors: Brett H
authors: BH
authors: Heintz
authors: Jenana
authors: J
authors: Halilovic
authors: Cinda L
authors: CL
authors: Christensen
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000379:methods; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D019090:Case Management / Q000191:economics; D003362:Cost-Benefit Analysis / Q000191:economics; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods* / Q000592:standards; D007263:Infusions, Parenteral / Q000009:adverse effects / Q000379:methods / Q000592:standards; D010045:Outpatients; D005791:Patient Care / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D010351:Patient Discharge / Q000191:economics; D010595:Pharmacists / Q000191:economics; D010820:Physicians / Q000191:economics
chemical_list: D000900:Anti-Bacterial Agents