Purpose The objectives of this study were to determine how many hospitals have active programs for converting patients from intravenous (IV) to oral (PO) therapy and obtain details of their conversion policies and documented cost savings and clinical impact from the IV to PO programs. In addition, the perceived benefits of these types of pharmacy programs will be highlighted. Methods Surveys were sent via e-mail to approximately 7,905 pharmacy managers and clinical pharmacists throughout the United States, which were obtained from American Society of Health-System Pharmacists (ASHP) and American College of Clinical Pharmacy (ACCP) by working through various list-serves that target this group of practitioners. The survey questioned participants regarding their hospital's policies for IV to PO conversion programs, including demographics, criteria, process, medications involved in the switches, clinical outcomes, and cost savings of such programs. Results Of 276 surveys completed and returned, 42% of responders were from the south; 81% had an active IV to PO program (larger hospital systems were more likely to have a program in existence for a longer period of time); and 82% identified patients via a computer-generated list of target patients and drugs for pharmacists to intervene. The majority of medications involved in IV to PO switches included antibiotics, GI, and antifungal drug classes. Fifty-four percent of responders indicated pharmacy manpower was the largest barrier to implementation and continuation of IV to PO conversion programs. Sixty-seven percent of responders documented cost savings and 47% of the 81 facilities that specified savings had saved at least $50,000 annually. Conclusion There was no change in the percent of facilities with IV to PO conversion programs (81%). There were minimal differences in the types of medications involved in conversion programs between 1996 and 2007. The policy and procedures supporting these type of programs have become more defined in the 11 years between surveys. In addition, methods of conversions have become more automatic since the first survey. Financial impact of IV to PO conversion programs were documented in both surveys.

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BackgroundThe objective of this study was to characterize treatment of patients with acute bacterial skin and skin structure infections (ABSSSIs) and describe the association between hospital admission and emergency department (ED) visits or readmissions within 30 days after initial episode of care (IEC).MethodsThis was a retrospective, observational, cohort study of adults with ABSSSI who presented to an ED between July 1, 2012, and June 30, 2013. Patient, health care facility, and treatment characteristics, including unplanned ED visits or readmissions, were obtained through manual chart review and abstraction. Adjusted logistic regression analysis examined likelihood of all-cause unplanned ED visits or readmissions between admitted and nonadmitted patients.ResultsRecords from 1527 ED visits for ABSSSI from 40 centers were reviewed (admitted, n = 578 [38%]; nonadmitted, n = 949 [62%]). Admitted patients were typically older (mean age, 52.2 years vs 43.0 years), more likely to be morbidly obese (body mass index > 40 kg/m2; 17.3% vs 9.1%), and had more comorbidities (Charlson Comorbidity Index ≥ 4; 24.4% vs 6.8%) compared with those not admitted. In the primary analysis, adjusted logistic regression, controlling for comorbidities and severity of illness, demonstrated that there was a similar likelihood of all-cause unplanned ED visits or readmissions between admitted and nonadmitted patients (odds ratio, 1.03; 95% confidence interval, 0.74–1.43; P = .87).ConclusionsABSSSI treatment pathways leveraging outpatient treatment vs hospital admission support similar likelihood of unplanned 30-day ED visits or readmissions, an important clinical outcome and quality metric at US hospitals. Further research regarding the decision criteria around hospital admission to avoid potentially unnecessary hospitalizations is warranted.