Abstract
Background: OPAT service has been in place in Tallaght University Hospital (TUH), Dublin; Republic of Ireland since 2013 and patients have been discharged under the governance of their primary teams since that time. The newly established Infectious Diseases (ID) department commenced the governance of OPAT Service at TUH on Sept 9th, 2022. A six-month evaluation of the new service was undertaken using Irish National guidelines1 as the standard and also to estimate the hospital bed days saved and financial savings via OPAT Service under the new governance.
Methods: The project was commenced after ethical approval from the local QI department. Data was collected prospectively from the OPAT patient database maintained securely for all patients discharged between 09/09/2022 and 31/03/2023.
Results: 48 patients were discharged on OPAT during the analyzed duration with 85.4% (n=41) discharged on H-OPAT and 95.8% (n=46) within 48 hours of referral after securing PICC line access in 95.8 % (n=46). Community Intervention team, south Dublin was among the highest OPAT service providers in 75% (n=36). Bone and Joint infections were the most common indication for OPAT in 54.16% (n=26) with Ceftriaxone most commonly used antibiotic. The frequency of polypharmacy was 56.2% (n=27) and excessive polypharmacy was 14.5% (n=7). Thirty (62.5%) patients received targeted culture-based therapy whereas 37.5% (n=18) were culture-negative and treated empirically. Overall 91% (n=44) of patients completed the planned course with Two (4.15%) readmissions for OPAT-related causes. Approximately, a total of 1252 bed days were saved equating to an approximate cost saving of 1,194,408 euros.
Conclusion: Overall OPAT was demonstrated to be a safe and cost-saving service for the treatment of patients. The study also indicated that for patients on OPAT, hospital readmissions can be avoided with regular dedicated weekly follow-ups in the OPAT clinic and by having clinical space and resources for unscheduled reviews if any problems arise on days other than the OPAT clinic days. Overall H-OPAT was utilised more commonly than S-OPAT with the Community Intervention team being the most popular provider of OPAT service. The barriers to S-OPAT will continue to be explored and addressed in the future.