Abstract
Rationale: To date frail, elderly patients who present to the Emergency Department (ED) for uncomplicated infection are routinely hospitalised for short term IV antibiotic therapy. This is attributed to a 48 hour delay in drug delivery on patient discharge via the OPAT programme. A novel approach initiated by the ED at SVUH to address this gap in service employs an integrated approach between Edith (Emergency Department in the Home) and Southside Community Intervention Team (CIT). A collaborative process was employed as per best practice guidelines (1) with the EDITH Consultant, Hospital OPAT ID Consultant, OPAT Nurse, Southside CIT Liaison Nurse, Hospital Microbiology, Hospital Pharmacy and Nurse Managers from the Southside CIT. The target population is frail adults presenting to the ED who are deemed suitable for short term IV antibiotic treatment. Inclusion criteria is restricted to patients with UTI, Cellulitis or Community Acquired Pneumonia. The pathway remains under the OPAT structure whilst incorporating patients with a requirement for short term intravenous therapy.
Aim: To expediate the discharge to the Southside CIT for a select cohort of patients deemed suitable for short term IV antibiotic therapy thereby avoiding hospital admission.
Implementation: Suitability of a patient for this pathway is determined by the Edith Consultant. The patient is reviewed in the ED by the OPAT CNS and a referral is sent to OPAT Management Control Centre (MCC) and Southside CIT. The patient receives their first dose of therapy via IV cannula in the ED. Hospital pharmacy supply the patient with IV antibiotic cover for a 48 hour period prior to discharge to community. Nursing staff from the Southside CIT administer therapy in the community. Clinical governance remains with the referring Consultant. The patient receives a clinical review in their home by EDITH after 48 hours and on the final day of treatment.
Evaluation/Outcomes: The number of patients being discharged on short term IV antibiotic therapy through EDITH/CIT OPAT pathway will be reviewed regularly at the Antimicrobial Advisory Committee and by both the EDITH and OPAT services. An initial quality improvement review process will take part after the following number of cases: 1, 10, and 20. All cases will be discussed at EMCOG the emergency medicine clinical operational group and morbidity and mortality meeting.
Conclusion: A significant advantage of this pathway is a treatment regimen for frail patients taking into account their circumstances and preferences. This initiative offers improved quality of life for patients, reduced healthcare cost and the avoidance of potential complication associated with hospital admission. Instrumental in the realisation of this pathway is the availability of Southside CIT to administer IV therapy therefore bypassing the time gap in the OPAT delivery of drug. Reflecting the Slaintecare vision, this initiative highlights innovation in care provision through an integrated hospital/community approach.
References:
1.Sweeney E, et al. National Guidelines on the Provision of Outpatient Parenteral Antimicrobial Therapy (OPAT). Ir Med J. 2020; Jul 30;113(7):123