Introduction:
The outpatient parenteral antibiotic therapy (OPAT) program of Vancouver General Hospital (VGH) was supervised solely by emergency physicians (EPs) until 2017 when infectious disease (ID) physicians began assisting in management. We designed a retrospective study to determine whether ID involvement led to improved outcomes.
Methods
This study analyses the impact of this increased ID involvement by comparing the mean days patients spend on OPAT with ID involvement versus EPs alone through a retrospective chart review. Our secondary research objectives were to compare patient care decisions, e.g., antibiotic choice, tests ordered, and final diagnosis.
Results
When directly compared, there was no difference between the mean number of days on OPAT between physician types. Compared to historic patterns, patients seen in OPAT after increased ID consultation spent an average of 0.5 fewer days in the program. However, when grouped by the first day of ID assessment, the average total days in OPAT was closely aligned with the day of first ID assessment, implying that ID frequently discharged patients close to initial assessment. Patients seen by ID were less likely to return within one month of discharge compared to those not seen by ID. Secondary findings include ID physicians prescribing a greater range of antibiotics, providing more varied final diagnoses, prescribing antibiotics less frequently, and ordering more cultures, diagnostic imaging and specialist consults.
Discussion
The findings of this study support the hypothesis that ID involvement in OPAT programs leads to changes in care that may have beneficial outcomes for patients and the healthcare system.