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Quality improvement
Original article
Dedicated paediatric Outpatient Parenteral Antimicrobial Therapy medical support: a pre–post observational study
  1. Ariel O Mace1,
  2. Charlie McLeod2,
  3. Daniel K Yeoh2,
  4. Julie Vine3,
  5. Yu-Ping Chen4,
  6. Andrew C Martin1,5,
  7. Christopher C Blyth2,5,6,7,
  8. Asha C Bowen2,5,6,8
  1. 1 Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Australia
  2. 2 Department of Paediatric Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia
  3. 3 Ambulatory Care Service, Princess Margaret Hospital for Children, Perth, Australia
  4. 4 Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Australia
  5. 5 School of Medicine, University of Western Australia, Perth, Australia
  6. 6 Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
  7. 7 Department of Microbiology, PathWest Laboratory Medicine, Perth, Australia
  8. 8 Menzies School of Health Research, Charles Darwin University, Darwin, Australia
  1. Correspondence to Dr Ariel O Mace, Department of General Paediatrics, Princess Margaret Hospital for Children, GPO Box D184, Perth, WA 6840, Australia; ariel.mace{at}health.wa.gov.au

Abstract

Objective Despite the many benefits of paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT) programmes, there are risks associated with delivering inpatient-level care outside of hospital. There is a paucity of evidence defining how best to mitigate these risks. We examined the impact of introducing a dedicated medical team to OPAT, to define the role of increased medical oversight in improving patient outcomes in this cohort.

Design A prospective 24-month pre–post observational cohort study.

Setting The Hospital in the Home (HiTH) programme at Princess Margaret Hospital (PMH) for Children, Western Australia.

Patients All OPAT admissions to HiTH, excluding haematology/oncology patients.

Interventions PMH introduced a dedicated OPAT medical support team in July 2015 to improve adherence to best-practice guidelines for patient monitoring and review.

Main outcome measures Duration of OPAT, adherence to monitoring guidelines, drug-related and line-related adverse events and readmission to hospital.

Results There were a total of 502 OPAT episodes over 24 months, with 407 episodes included in analyses. Following the introduction of the OPAT medical team, adherence to monitoring guidelines improved (OR 4.90, 95% CI 2.48 to 9.66); significantly fewer patients required readmission to hospital (OR 0.45, 95% CI 0.24 to 0.86) and there was a significant reduction in the proportion of patients receiving prolonged (≥7 days) OPAT (OR 0.67, 95% CI 0.45 to 0.99).

Conclusion The introduction of a formal medical team to HiTH demonstrated a positive clinical impact on OPAT patients’ outcomes. These findings support the ongoing utility of medical governance in a nurse-led HiTH service.

  • outpatient parenteral antimicrobial therapy (OPAT)
  • hospital in the Home
  • medical governance

https://doi.org/10.1136/archdischild-2017-313071

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    Footnotes

    • Contributors AOM drafted the manuscript, developed the project, contributed to and compiled data, edited the draft and approved the final manuscript. CM, DKY and YPC contributed to and compiled data, reviewed and edited the draft, and approved the final manuscript. JV, ACM and CCB developed the project, edited the draft and approved the final manuscript. ACB conceived and designed the project, reviewed the data, reviewed and edited the draft, and approved the final manuscript.

    • Competing interests None declared.

    • Ethics approval Princess Margaret Hospital for Children Governance, Evidence, Knowledge, Outcomes (GEKO, Quality Activity #8237 and #10233).

    • Provenance and peer review Not commissioned; externally peer reviewed.