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.
“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 Urology that investigated use of the OPAT unit to deliver targeted antibiotic prophylaxis to patients about to undergo transrectal ultrasound-guided prostate biopsies. “Targeted antibiotic prophylaxis is becoming necessary with these procedures because there are increasing reports of prostatitis, urinary tract infections, and septicemia due to multidrug-resistant bacteria,” says Dr. Segal-Maurer. “Our study demonstrated that the OPAT unit had a positive impact on the administration of prophylactic IV antibiotics for these difficult-to-treat organisms and significantly improved patient outcomes.”
With increasing pressure from CMS, Dr. Segal-Maurer says more hospitals should consider implementing OPAT units. “An OPAT unit champion must be identified to lead the effort,” she says. “There must also be buy-in from clinicians, nurses, and case managers as well as administration, pharmacy, ED personnel, and other medical staff. These efforts may be challenging, but the results are worthwhile and can go a long way toward enhancing patient care.”
Readings & Resources (click to view)
Shakil J, Piracha N, Prasad J, et al. Use of outpatient parenteral antimicrobial therapy for transrectal ultrasound-guided prostate biopsy prophylaxis in the setting of community-associated multidrug-resistant Escherichia coli rectal colonization. Urology. 2014;83:710-713. Available at: http://www.goldjournal.net/article/S0090-4295(14)00011-9/abstract.
Halilovic J, Christensen CL, Nguyen HH. Managing an outpatient parenteral antibiotic therapy team: challenges and solutions. Ther Clin Risk Manag. 2014;10:459-465.
Lane MA, Marschall J, Beekmann SE, et al. Outpatient parenteral antimicrobial therapy practices among adult infectious disease physicians. Infect Control Hosp Epidemiol. 2014;35:839-844.
Lai A, Tran T, Nguyen HM, Fleischmann J, Beenhouwer DO, Graber CJ. Outpatient parenteral antimicrobial therapy at large veterans administration medical center. Am J Manag Care. 2013;19:e317-e324.
Patel U, Dasgupta P, Amoroso P, et al. Infection after transrectal ultrasonography-guided prostate biopsy: increased relative risks after recent international travel or antibiotic use. BJU Int. 2012;109:1791-1795.
Rogers BRS, Batura D, Rao GG. Escherichia coli bloodstream infection after transrectal ultrasound-guided prostate biopsy: our experience in North West London. Clin Infect Dis. 2013;56:465-466.
Taylor AK, Zembower TR, Nadler RB, et al. Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol. 2012;187:1275-1279.