740. A Comparison of Process Outcomes Among Patients Receiving Outpatient Parenteral Antibiotic Therapy in Different Settings: A Quality Improvement Project

BACKGROUND: Outpatient parenteral antibiotic therapy (OPAT) is an effective way to provide long-term antibiotic therapy and simultaneously decrease hospital length of stay, minimize costs and improve patient satisfaction. However, OPAT is not always an efficient process and there are systemic challenges to providing adequate care and ensuring close follow-up. The aims of this project are to define the OPAT process at three New Orleans hospitals staffed by the Tulane Infectious Diseases Section and to determine process outcomes among patients receiving OPAT in different settings. METHODS: We utilized the knowledge of medicine residents, infectious diseases (ID) fellows and social workers to create a process map defining the current OPAT system [Figure 1]. We performed a retrospective chart review identifying patients who were discharged with OPAT from August 1, 2018 to November 30, 2018. The patients received OPAT in a variety of settings: long-term acute care facilities (LTACs), infusion centers, home, hemodialysis centers and prison. We measured the following process outcomes: if the patient arrived to an ID appointment, if safety laboratory results were available for review and if the patient completed the pre-specified antibiotic course. These outcomes were compared amongst the OPAT delivery settings. RESULTS: Our retrospective analysis identified 62 patients discharged with OPAT, although 2 patients were excluded due to lack of availability of records. Only 42% completed the pre-specified antibiotic course, 54% arrived to ID follow-up, and 38% had laboratory results available. We compared the completion of antibiotic course amongst the different OPAT settings (Figure 2). The highest rates of incompletion were amongst LTAC patients (n = 19, 73%) and prisoners (n = 3, 75%). Given that the highest number of patients who did not complete antibiotics were discharged to LTACs, we plan further investigation and intervention to target this population. CONCLUSION: Patient outcomes among OPAT patients discharged from three New Orleans hospitals are poor, as evidenced by 58% failing to complete their pre-specified antibiotic course. The highest number of patients who failed were LTAC patients. We propose a further investigation into this population in order to improve the efficacy of the OPAT system. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.