Cargando…

625. Sustained Efforts Improve Adherence to Monitoring for Solid Tumor Patients Discharged on Outpatient Parenteral Antimicrobial Therapy (OPAT) at a Comprehensive Cancer Center

BACKGROUND: OPAT helps reduce hospital length of stay, but 1 in 4 patients is readmitted within 30 days of discharge. Follow up < 30 days after discharge and laboratory monitoring during therapy have been shown to reduce hospital readmissions. However, few OPAT studies have included patients with...

Descripción completa

Detalles Bibliográficos
Autores principales: Robins, Alison, McDaneld, Patrick, Garnes, Natalie J Dailey, Rowan, Meagan, Bartek, Jalen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777282/
http://dx.doi.org/10.1093/ofid/ofaa439.819
_version_ 1783630866256232448
author Robins, Alison
McDaneld, Patrick
Garnes, Natalie J Dailey
Rowan, Meagan
Bartek, Jalen
author_facet Robins, Alison
McDaneld, Patrick
Garnes, Natalie J Dailey
Rowan, Meagan
Bartek, Jalen
author_sort Robins, Alison
collection PubMed
description BACKGROUND: OPAT helps reduce hospital length of stay, but 1 in 4 patients is readmitted within 30 days of discharge. Follow up < 30 days after discharge and laboratory monitoring during therapy have been shown to reduce hospital readmissions. However, few OPAT studies have included patients with malignancies, who may not experience the same benefits due to increased risks for hospital admission and infection related to antineoplastic therapy. We started an OPAT program to increase laboratory monitoring and clinic follow up among patients with solid tumors, attempting to also decrease readmissions. METHODS: We obtained demographic data and baseline frequencies of laboratory monitoring, ID clinic follow up, 30-day OPAT-related readmissions, Emergency Center (EC) visits, and deaths by retrospective chart review. We conducted multiple interventions from June 2018-January 2020: clarifying physician recommendations for laboratory monitoring and follow up by using a standardized electronic medical record template, communicating recommendations to case management, and changing the lab ordering workflow. We compared frequencies after interventions to baseline by using Fisher’s exact test. RESULTS: Most commonly observed malignancies in our patient cohort included genitourinary, breast, gastrointestinal, gynecologic, and head and neck. The most commonly treated infections included abscess, bacteremia, and skin and soft tissue. The percentage of patients without recommended lab monitoring decreased from 32.3% to 15.3% (p=0.03). We observed trends toward improved ID clinic follow up (54.8% to 71.8%; p=0.12) and decreased 30-day OPAT-related readmissions from 16.7% to 8.6% (p = 0.17). We observed no difference in mortality or EC visits. CONCLUSION: OPAT-treated infections in our solid tumor patient cohort differed from those reported commonly. Through continued interventions, we improved lab monitoring rates among solid tumor patients with trends toward improved ID clinic follow up and decreased readmission rates. Our findings suggest that despite competing reasons for hospital readmission, OPAT may still benefit this population. DISCLOSURES: All Authors: No reported disclosures
format Online
Article
Text
id pubmed-7777282
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-77772822021-01-07 625. Sustained Efforts Improve Adherence to Monitoring for Solid Tumor Patients Discharged on Outpatient Parenteral Antimicrobial Therapy (OPAT) at a Comprehensive Cancer Center Robins, Alison McDaneld, Patrick Garnes, Natalie J Dailey Rowan, Meagan Bartek, Jalen Open Forum Infect Dis Poster Abstracts BACKGROUND: OPAT helps reduce hospital length of stay, but 1 in 4 patients is readmitted within 30 days of discharge. Follow up < 30 days after discharge and laboratory monitoring during therapy have been shown to reduce hospital readmissions. However, few OPAT studies have included patients with malignancies, who may not experience the same benefits due to increased risks for hospital admission and infection related to antineoplastic therapy. We started an OPAT program to increase laboratory monitoring and clinic follow up among patients with solid tumors, attempting to also decrease readmissions. METHODS: We obtained demographic data and baseline frequencies of laboratory monitoring, ID clinic follow up, 30-day OPAT-related readmissions, Emergency Center (EC) visits, and deaths by retrospective chart review. We conducted multiple interventions from June 2018-January 2020: clarifying physician recommendations for laboratory monitoring and follow up by using a standardized electronic medical record template, communicating recommendations to case management, and changing the lab ordering workflow. We compared frequencies after interventions to baseline by using Fisher’s exact test. RESULTS: Most commonly observed malignancies in our patient cohort included genitourinary, breast, gastrointestinal, gynecologic, and head and neck. The most commonly treated infections included abscess, bacteremia, and skin and soft tissue. The percentage of patients without recommended lab monitoring decreased from 32.3% to 15.3% (p=0.03). We observed trends toward improved ID clinic follow up (54.8% to 71.8%; p=0.12) and decreased 30-day OPAT-related readmissions from 16.7% to 8.6% (p = 0.17). We observed no difference in mortality or EC visits. CONCLUSION: OPAT-treated infections in our solid tumor patient cohort differed from those reported commonly. Through continued interventions, we improved lab monitoring rates among solid tumor patients with trends toward improved ID clinic follow up and decreased readmission rates. Our findings suggest that despite competing reasons for hospital readmission, OPAT may still benefit this population. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7777282/ http://dx.doi.org/10.1093/ofid/ofaa439.819 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Robins, Alison
McDaneld, Patrick
Garnes, Natalie J Dailey
Rowan, Meagan
Bartek, Jalen
625. Sustained Efforts Improve Adherence to Monitoring for Solid Tumor Patients Discharged on Outpatient Parenteral Antimicrobial Therapy (OPAT) at a Comprehensive Cancer Center
title 625. Sustained Efforts Improve Adherence to Monitoring for Solid Tumor Patients Discharged on Outpatient Parenteral Antimicrobial Therapy (OPAT) at a Comprehensive Cancer Center
title_full 625. Sustained Efforts Improve Adherence to Monitoring for Solid Tumor Patients Discharged on Outpatient Parenteral Antimicrobial Therapy (OPAT) at a Comprehensive Cancer Center
title_fullStr 625. Sustained Efforts Improve Adherence to Monitoring for Solid Tumor Patients Discharged on Outpatient Parenteral Antimicrobial Therapy (OPAT) at a Comprehensive Cancer Center
title_full_unstemmed 625. Sustained Efforts Improve Adherence to Monitoring for Solid Tumor Patients Discharged on Outpatient Parenteral Antimicrobial Therapy (OPAT) at a Comprehensive Cancer Center
title_short 625. Sustained Efforts Improve Adherence to Monitoring for Solid Tumor Patients Discharged on Outpatient Parenteral Antimicrobial Therapy (OPAT) at a Comprehensive Cancer Center
title_sort 625. sustained efforts improve adherence to monitoring for solid tumor patients discharged on outpatient parenteral antimicrobial therapy (opat) at a comprehensive cancer center
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777282/
http://dx.doi.org/10.1093/ofid/ofaa439.819
work_keys_str_mv AT robinsalison 625sustainedeffortsimproveadherencetomonitoringforsolidtumorpatientsdischargedonoutpatientparenteralantimicrobialtherapyopatatacomprehensivecancercenter
AT mcdaneldpatrick 625sustainedeffortsimproveadherencetomonitoringforsolidtumorpatientsdischargedonoutpatientparenteralantimicrobialtherapyopatatacomprehensivecancercenter
AT garnesnataliejdailey 625sustainedeffortsimproveadherencetomonitoringforsolidtumorpatientsdischargedonoutpatientparenteralantimicrobialtherapyopatatacomprehensivecancercenter
AT rowanmeagan 625sustainedeffortsimproveadherencetomonitoringforsolidtumorpatientsdischargedonoutpatientparenteralantimicrobialtherapyopatatacomprehensivecancercenter
AT bartekjalen 625sustainedeffortsimproveadherencetomonitoringforsolidtumorpatientsdischargedonoutpatientparenteralantimicrobialtherapyopatatacomprehensivecancercenter