The Right Patient at the Right Place: A Quality Improvement Initiative Implementing Safe Dehospitalization of Patients Using Parenteral Antimicrobial Therapy.

Abstract

Introduction: Infection prevention programs promote a set of recommendations for rational antimicrobial management, encouraging outpatient parenteral antimicrobial therapy (OPAT) or step-down transitions to oral administration, when possible. However, proper selection of the right patient is critical for safe dehospitalization. The aim of the study was to report on implementing an outpatient antimicrobial management project using an improvement science framework.

Methods: A case report assessing a quality improvement initiative implementing an antimicrobial management project, DESOSP, in a Brazilian public tertiary hospital from July 2022 to June 2023. The intervention was implemented using a Breakthrough Series model, including plan-do-study-act cycles to promote OPAT and oral antimicrobial therapy (OAT) transitions. Clinical assistance outcomes were assessed from October 2022, including the dehospitalization rate of patients using antimicrobials in compliance with the eligibility criteria, the mean length of stay (MLS) of selected patients, and the hospital admission turnover rate. In addition, we used the financial data of OAT cases as a sample to estimate savings.

Results: After 9 months, DESOSP increased the dehospitalization rate of eligible patients from 70% to 91%. The MLS of these patients dropped from 4.2 to 2.8 days. Turnover rate increased from 0.5 to 0.9. The readmission rates of patients receiving antibiotic therapy discharged for the same pathology within 30 days were not modified. Considering the OAT sample, we estimated savings of USD$76,949.86 (return on investment of 201.2%).

Conclusion: Promoting a safe, structural, and systematic process, training, and engaging clinical teams seems feasible and valuable for promoting stewardship recommendations in the public healthcare system.