Outpatient IV therapy improves patient experience and saves bed days

In 2012 we introduced a new service to treat patients who needed intravenous antibiotic therapy.

Until then patients requiring intravenous antibiotics had to stay in hospital for days and sometimes weeks. This put pressure on the acute beds and was inconvenient for patients, who, other than the requirement for antibiotics, were well enough to go home, which resulted in a poor experience.

Now our microbiologists, who are infection specialists, visit the wards every day to see every patient who is receiving intravenous antibiotics. Where appropriate, patients are either switched to oral antibiotics and discharged, or switched to the Outpatient Parenteral Antimicrobial Therapy (OPAT) service and discharged.

The patients recruited to OPAT are provided with an information leaflet and changed to intravenous antibiotics that can be given once per day. They then come to hospital daily as outpatients and hospital transport can be arranged, if required. The OPAT Clinic is a patient-friendly area where patients can relax in comfortable chairs, whilst receiving their treatment. The microbiology team clinically lead the service, direct the antimicrobial treatment and refer to other specialists when appropriate. As the service is infection specialist-led, a wider range of infectious diseases can be accepted for treatment.

A pilot OPAT service was started at the Clinical Investigation unit at Chorley and District General Hospital. An impact assessment of the pilot phase was undertaken and the results were so impressive that a much larger OPAT service was introduced in the Day Treatment Centre at the Royal Preston Hospital in October 2012.

To provide timely insertion of peripherally inserted central catheter (PICC) lines, a central venous access team of three nurses was established, who insert PICC lines and monitor their care and maintenance. PICC lines are required if a patient needs intravenous antibiotics more long-term. Patients continue with their normal lives and can stay at home, but attend the OPAT clinic for their therapy.

Our service is unique because it isn’t just about giving patients their antibiotics; it is also about infection control and making lives better and more comfortable for our patients. One patient who has been treated by the OPAT team said: “I found the care and professionalism of the centre's clinical and support staff exemplary. The advantages and effectiveness cannot be over-emphasised, it saves many patients who need daily and periodic treatment from the distress and inconvenience of long-term admission.”

From January 2012 until June 2014, 359 patients aged 16-89 years have been treated as part of the OPAT service.

So far it is estimated that a total of 5,008 inpatient-days have been saved representing a reduction of 5.7 occupied inpatient beds per day.

However, the OPAT service is growing as is reflected in performance for the last 6 months where 1,377 bed-days were saved (a reduction of 9 occupied inpatient beds).

The OPAT service has been designed around patients and their carers and they were involved in the design of the service. The team also carried out an audit of patient satisfaction and the results show an overwhelming support for the new OPAT service with very high patient satisfaction and much improved patient experience. 100% of respondents preferred the OPAT service to the in-patient service and 100% felt that they were informed of the treatment options and involved in treatment decisions. 85% were very happy and 15 % were happy with the OPAT service.
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