Posted: 12/4/2018
Patients safely administer own long-term IV antibiotics, reduce hospital stays
In 2009, an innovative pilot program began in one of Parkland Health & Hospital System’s outpatient specialty clinics that quickly improved quality and safety outcomes for the four individuals who were part of the initial program to better serve those on complex antibiotic therapies. Today, thousands of patients have benefitted from services offered in Parkland’s Outpatient Antibiotic Therapy (OPAT) clinic. And, an added benefit has been the reduction in hospital stays and a savings to the system in the millions of dollars.
A four-year study recently compared outcomes of Parkland Memorial Hospital patients who either self-administered long-term IV antibiotics (S-OPAT) or had their long-term antibiotics administered in a traditional health care setting (H-OPAT). The results were published in the Feb. 3, 2016 edition of NEJM Catalyst. It is the first research on this topic to be published in the U.S. The study found similar or better outcomes for the group that administered their own antibiotics, a practice that is rare among hospitals. The study compared 944 uninsured patients who administered their own IV antibiotics with 224 insured patients whose antibiotics were administered by healthcare workers, analyzing 30-day hospital readmission rates and mortality. According to the study results, the self-administered group had a 47 percent lower rate of 30-day readmission.
“These are patients who would have historically been in the hospital for another four to six weeks with IV antibiotics,” said Kavita Bhavan, MD, Medical Director of the Infectious Diseases OPAT Clinic at Parkland and Assistant Professor of Internal Medicine at the University of Texas Southwestern Medical Center. “Our patient model is unique in that we are teaching our patients to safely self-administer IV antibiotics by gravity at home in a resource-limited safety net setting.
“Low levels of literacy and non-English speaking patients are among the challenges we face in caring for our patient population. Physicians have traditionally viewed these barriers as cause for concern and felt patients are safer completing therapy in a traditional healthcare setting,” Dr. Bhavan said. “What we have learned from this experience, however, is that empowered with the appropriate skill set, patient investment in the self-care process was both safe and effective and resulted in better clinical outcomes than standard of care.”
In order to be a part of the program patients or their family members must prove a minimum of three times that they can administer an IV antibiotic through a peripherally inserted central catheter line. They must know how to prepare the antibiotic, hang the bag, flush the catheter line and administer the antibiotic. The process is repeated countless times over a four- to six-week antibiotic treatment.
The self-administered antibiotics program saved more than 27,000 patient days at Parkland during the four years of the study – the equivalent of adding 26 beds.
“The hospital readmission rate is now lower among the patients who have been trained to self-administer IV antibiotics than among patients with insurance who receive home healthcare assistance,” said Fred Cerise, MD, MPH, Parkland’s President and Chief Executive Officer. “The uninsured patients go home earlier than they used to, and the hospital has saved nearly $70 million.”
Still, Dr. Bhavan credits the patients with the clinic’s success.
“Yes, we have developed an innovative approach to healthcare delivery in this clinic, but it’s the patients who have shown the greater impact of tapping into human potential by being empowered to do something that many didn’t think they could do,” Dr. Bhavan said. “They are the true heroes here – we just gave them the opportunity to shine.”