Brief
Patients managed by the Duke University Hospital System outpatient parenteral antimicrobial therapy (OPAT) team have historically low rates of early post-hospitalization follow-up in infectious diseases (ID) clinics and high rates of unplanned readmission within 30 days. We built a dashboard to monitor OPAT patients and developed an automated system to notify our team when OPAT patients are discharged from the hospital. This system helped facilitate early post-hospitalization follow-up in a new virtual care clinic for OPAT patients. Since July 1, 2023, we’ve improved early post-hospitalization follow-up with an infectious diseases (ID) provider from 26% to 40% of OPAT patients, with an associated trend towards lower 30-day readmission rates in this cohort.
The Problem
An estimated 1400 patients are discharged each year from Duke University Hospital System on outpatient parenteral antimicrobial therapy (OPAT), which is managed by the Duke OPAT team (“our team”). These patients have complex infections requiring prolonged intravenous antimicrobials across multiple care settings, placing them at high risk for complications. OPAT patients are monitored by an interdisciplinary team of pharmacists, clinicians, and nurses in the Infectious Diseases clinic. Historically, the 30-day unplanned readmission rate in the Duke OPAT cohort is approximately 20%, a higher rate than OPAT programs at peer institutions. A previous pair-matched case-control study demonstrated that patients who had follow-up in an Infectious Diseases clinic within two weeks of hospital discharge had a significantly lower risk of readmission [1]. Quality improvement interventions, including an OPAT bundle (a comprehensive set of coordinated interventions designed to improve OPAT patient care)[2], have also been shown to improve readmission rates. Our team aimed to create a dashboard to track OPAT patients through their treatment course and improve ID provider follow-up within two weeks of discharge.
Our Solution
We developed and implemented OPATracker, an automated real-time dashboard to track OPAT patients. This dashboard visualizes a comprehensive list of OPAT patients, including admitted patients, upcoming follow-up appointments, anticipated stop dates of therapy, medication lists, and laboratory data. We have also implemented an automated daily email to notify our team of newly discharged OPAT patients so they can be enrolled in a transitions-of-care pathway. We concurrently opened a new telemedicine clinic in collaboration with the Duke Virtual Care Clinic to see these patients for early post-hospitalization clinic visits with an ID provider. These visits provide an opportunity to identify early challenges, facilitate additional follow-up care, and provide comprehensive patient and family education.
(Figure 1 on page 9 in the Impact Volume 25.)
Impact
The clinical team utilized an “OPATracker” and automated notification system to facilitate early post-hospitalization follow-up for OPAT patients in the virtual care clinic. With these interventions, they improved their rates of ID provider follow-up within two weeks of discharge from a process mean of 26% to 40%. The proportion of OPAT patients seen in telemedicine follow-up increased since the virtual care clinic opened in September 2023 with a lower no-show rate than their conventional ID clinic (10.8% vs 19.5%). With improved access to early post-hospitalization ID care, they saw an accompanying trend towards a decrease in readmission rates, with nine of the last ten or nine project phases showing readmission rates below their prior process mean.
(Figures 2, 3 on page 9 in the Impact Volume 25).
Next Steps
In the 2026, our project team will work to refine our transitions of care pathway further. Specifically, our pharmacy team will discuss pending cases with our inpatient team prior to discharge to identify concerns, facilitate a transitions-of-care phone call with our OPAT nurse coordinator, and further improve our rates of early post-hospitalization ID clinic follow-up. We are committed to continuously improving our processes to ensure the sustainability and effectiveness of our initiative.
References
- Saini E, Ali M, Du P, Crook T, Zurlo J. Early Infectious Disease Outpatient Follow-up of Outpatient Parenteral Antimicrobial Therapy Patients Reduces 30-Day Readmission. Clin Infect Dis 2019; 69(5): 865-8.
- Madaline T, Nori P, Mowrey W, et al. Bundle in the Bronx: Impact of a Transition-of-Care Outpatient Parenteral Antibiotic Therapy Bundle on All-Cause 30-Day Hospital Readmissions. Open Forum Infect Dis 2017; 4(2): ofx097.
