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Exploring Outpatient Antibiotic Programs

Exploring Outpatient Antibiotic Programs

Several years ago, New York Hospital Queens (NYHQ) opened an Outpatient Parenteral Anti­biotic Therapy (OPAT) Unit as an alternative treatment option for patients who are healthy enough to be discharged from the hospital but still need once-daily intravenous (IV) antibiotics. “Our OPAT unit gives patients a chance to avoid spending days or weeks at the hospital for IV treatments,” explains Sorana Segal-Maurer, MD, who directs the OPAT unit at NYHQ. With the OPAT unit model, case managers help transition inpatients to an outpatient setting. These case managers are knowledgeable about patients’ care plans, insurance coverage, and discharge situation and can make referrals to the OPAT unit. Once discharged, patients return daily to receive IV antibiotics or other treatments on site by trained staff. The unit is supervised by physicians from the infectious diseases division who meet with patients and coordinate care with referring healthcare providers. The OPAT unit is also for people who need regular IV antibiotic infusions but do not otherwise require hospitalization—enabling them to avoid an inpatient admission. Important Benefits “With the OPAT unit model, patients can stay in the comfort of their own home and still receive effective treatment,” Dr. Segal-Maurer says. “In many instances, they can avoid future hospitalizations.” Quality of life and patient satisfaction improve because patients are discharged more efficiently and have shorter hospital stays. The OPAT unit is also convenient for those who can be treated on an outpatient basis and do not wish to self-administer IV antibiotics at home. Furthermore, the unit provides other IV options, including treatment for dehydration, anemia, and osteoporosis. Dr. Segal-Maurer and colleagues published a study in...

Adopting Evidence-Based Medicine in the Surgical Suite

Throughout many areas of hospitals, clinical teams are beginning to tap into standardized evidence-based data so that they can implement best practices as a way to supplement the knowledge gained through experience, colleagues, and mentors. At our 302-bed hospital at Berkshire Medical Center, clinical teams have developed protocols for more than 140 different clinical care scenarios based on data from evidence-based clinical decision support (CDS) systems. Use of the CDS system has resulted in improved outcomes. Although there are many CDS solutions available, our clinical team utilizes Zynx Health CDS. Out With the Old, In With the New In an effort to replicate successes seen in other clinical care scenarios, my colleagues and I at Berkshire Medical Center collaborated with a clinical team to develop an evidence-based colectomy module. It was designed to address the perioperative management of adults undergoing colon surgery. The module included medical evidence for each stage of surgery. After reviewing the evidence, we realized that we were practicing with old principles and without standardization. For example, it was discovered that several principles needed to be changed based on the current best practice evidence, including perioperative fluid intake, reintroduction of oral antibiotics, and postoperative use of antibiotics. “The culture of quality initiatives coming from hospital committees and departments has been replaced by an environment where a multidisciplinary team develops and implements best practices.”  These practices were then modified to create a “fast track” colon surgery protocol that included techniques for reducing complications and costs while also decreasing pain, shortening length of stay (LOS), and facilitating earlier returns to everyday activities. Instead of developing committees and spending...
Bronchitis in the ED: Analyzing Antibiotic Use

Bronchitis in the ED: Analyzing Antibiotic Use

Although antibiotics are often used in patients with common bacterial causes of acute bronchitis, current guidelines recommend against this practice, especially for cases of uncomplicated acute bronchitis, as most are viral in etiology. Fever, purulent sputum, shortness of breath, the presence of comorbid conditions, and a provider age of 30 or younger are factors that increase the likelihood of prescribing antibiotics for acute bronchitis. Better characterization of prescribing practices in the ED is needed in order to guide efforts to reduce the inappropriate use of antibiotics. A Closer Look at Antibiotic Use My colleagues and I had a study published in the Journal of Emergency Medicine that reviewed antibiotic and bronchodilator prescribing practices of emergency physicians at two EDs in patients with acute bronchitis. The investigation aimed to characterize key factors that were associated with antibiotic prescribing practices. Specifically, we looked at the frequency of antibiotic prescriptions, the class of antibiotic prescribed, and related factors, including age, gender, chief complaint, duration of cough, and comorbid conditions. In our analysis, antibiotics were grossly overprescribed in acute bronchitis, with 74% of adults receiving these therapies. Of those who were prescribed these medications, most (about 77%) received broad-spectrum antibiotics. Prescribing practices for acute bronchitis did not decrease significantly from what has been shown in prior studies. Patients aged 50 and older and those who smoked were more likely to be prescribed antibiotics, but no other factors appeared to increase antibiotic prescribing practices. Among patients without asthma, nearly half were discharged without a bronchodilator, and more than 90% were discharged without a spacer device. Impact on Patient Care for Acute Bronchitis Although there...
Guidelines for Diagnosing & Treating Diabetic Foot Infections

Guidelines for Diagnosing & Treating Diabetic Foot Infections

As the incidence of diabetes has steadily increased over the last several decades throughout the United States, diabetic foot infections have also become increasingly common. As many as one in four people with diabetes will have a foot ulcer in their lifetime, and these wounds can easily become infected. If left unchecked, they can spread and may ultimately require amputation of the toe, foot, or part of the leg. Nearly 80% of all nontraumatic amputations occur in people with diabetes, 85% of which begin with a foot ulcer. “Lower extremity amputation severely affects quality of life in people with diabetes because it reduces independence and mobility,” says Warren S. Joseph, DPM, FIDSA. “Furthermore, about 50% of patients who have foot amputations die within 5 years, which ranks as a worse mortality rate than for most cancers.” However, about half of lower extremity amputations that are not caused by trauma can be prevented through proper care of foot infections. Preventing amputations is vital. In most cases, these infections can be prevented or cured when properly managed. Recommendations for Diabetic Foot Infections In a 2012 issue of Clinical Infectious Diseases, the Infectious Diseases Society of America (IDSA) published a clinical practice guideline for diagnosing and treating diabetic foot infections. The guideline addresses 10 common questions with evidencebased answers that experts have determined are most likely to help healthcare providers treating these infections. The guideline is a revision and update of IDSA’s 2004 recommendations for managing diabetic foot infections. With regard to diagnosis, the guideline recommends that infections in foot wounds be defined clinically by the presence of inflammation or purulence, and...
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