Outpatient parenteral antimicrobial therapy (OPAT) enables patients to complete intravenous therapy in various outpatient settings including the home, long-term care facilities, and infusion centers.
Due to the diversity of OPAT locations and the high-acuity of this population, readmission rates and complications are high.
Prior to any intervention, 29% of OPAT patients were readmitted within 30 days at the Hospital at the University of Pennsylvania (HUP). Patient retention was also a challenge, with only 60% of patients attending their initial follow-up appointment in the infectious diseases (ID) clinic.
As a result of these challenges, the Infectious Diseases Transition Service (IDTS), a multidisciplinary team of pharmacists, physicians, nurses, and patient service representatives, was formed to monitor OPAT patients safely.
Initial results after the implementation of IDTS were promising, with 30-day readmission rates dropping from 29% to 18%, and show rates at follow-up appointments rising to 75%.
However, to offer IDTS services to patients, the team had to first manually identify those who qualified – which proved to be a very time-consuming process. Due to staffing constraints and lack of capture by ID consultant services, the IDTS team estimated that only 40% of OPAT patients discharged from HUP were being enrolled in IDTS services.
We worked with a team led by Keith Hamilton, MD to create a comprehensive dashboard to identify and monitor OPAT patients.
With the help of the Agent team, we identified features for the dashboard that would not only improve care delivery but also result in time saved for the care team. Leveraging data from multiple systems, the dashboard is designed to:
- Identify patients scheduled for discharge with IV antibiotics in real-time
- Track follow-up appointment scheduling and attendance
- Alert the team when important clinical events like readmissions occur, or data such as lab reports become available
- Track aggregate metrics across the OPAT population
During the pilot period, the Agent dashboard enabled the IDTS team to identify 100% of patients discharged on IV antibiotics at or before the time of discharge – up from 40%.
By streamlining data and integrating lab reports into the dashboard, the care team saved an estimated 10-12 hours per week, which allowed them to maximize time with every patient.
Finally, the team piloted a texting program to relay information about appointments and lab results to patients and answer questions. Of the patients who participated in the pilot, 88% attended follow-up appointments with a readmission rate of 13%.
The optimized IDTS monitoring system is projected to save over $2,500 per patient, ultimately leading to $4.5 million in savings at scale.