Background and objectives

Outpatient parenteral antimicrobial therapy (OPAT) for infections has been in use for nearly 40 years, and although it has been found safe and efficacious, its use has been studied primarily among otherwise healthy patients. We aimed to develop and evaluate an OPAT program for patients with cancer, particularly solid tumors.

Methods

We implemented multiple quality improvement interventions between June 2018 and January 2020. We retrospectively and prospectively collected data on demographics, the completeness of infectious diseases (ID) physician consultation notes, rates of laboratory test result monitoring, ID clinic follow-up, and 30-day outcomes, including unplanned OPAT-related readmissions, OPAT-related emergency center visits, and deaths.

Results

Completeness of ID provider notes improved from a baseline of 77 to 100% (p < .0001) for antimicrobial recommendations, 75 to 97% (p < .0001) for follow-up recommendations, and 19 to 98% (p < .0001) for laboratory test result monitoring recommendations. Completion of laboratory tests increased from a baseline rate of 24 to 56% (p = .027). Thirty-day unplanned OPAT-related readmission, ID clinic follow-up, 30-day emergency center visit, and death rates improved without reaching statistical significance.

Conclusions

Sustained efforts, multiple interventions, and multidisciplinary engagement can improve laboratory test result monitoring among solid tumor patients discharged with OPAT. Although demonstrating a decrease in unplanned readmissions through institution of a formal OPAT program among patients with solid malignancies may be more difficult compared with the general population, the program may still result in improved safety.

中文翻译：

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提高实体瘤患者门诊肠外抗菌治疗的安全性

背景和目标

用于感染的门诊肠外抗菌治疗 (OPAT) 已使用近 40 年，尽管已发现它安全有效，但主要在其他健康患者中对其使用进行了研究。我们旨在为癌症患者，尤其是实体瘤患者开发和评估 OPAT 计划。

方法

我们在 2018 年 6 月至 2020 年 1 月期间实施了多项质量改进干预措施。我们回顾性和前瞻性地收集了有关人口统计数据、传染病 (ID) 医生咨询记录的完整性、实验室检测结果监测率、ID 诊所随访和 30-日结果，包括计划外与 OPAT 相关的再入院、与 OPAT 相关的急诊中心就诊和死亡。

结果

ID 提供者说明的完整性从 77% 提高到 100% ( p  < .0001) 的抗菌建议，75 到 97% ( p  < .0001) 的后续建议，19 到 98% ( p  < .0001 ) ) 用于实验室测试结果监测建议。实验室测试的完成率从 24% 的基线率增加到 56% ( p  = .027)。30 天计划外 OPAT 相关再入院、ID 诊所随访、30 天急诊中心就诊和死亡率均有所改善，但未达到统计学意义。

结论

持续的努力、多重干预和多学科参与可以改善对 OPAT 出院的实体瘤患者的实验室检测结果监测。尽管与一般人群相比，通过正式的 OPAT 计划在实体恶性肿瘤患者中减少非计划再入院可能更困难，但该计划仍可能提高安全性。