Dedicated paediatric Outpatient Parenteral Antimicrobial Therapy medical support: a pre-post observational study

Ariel O Mace, Charlie McLeod, Daniel K Yeoh, Julie Vine, Yu-Ping Chen, Andrew C Martin, Christopher C Blyth, Asha C Bowen

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)165-169
Number of pages5
JournalArchive Diseases of Childhood
Volume103
Issue number2
DOIs
Publication statusPublished - Feb 2018

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Observational Studies
Outpatients
Pediatrics
Patient Readmission
Therapeutics
Practice Guidelines
Guidelines
Western Australia
Drug Monitoring
Physiologic Monitoring
Hematology
Inpatients
Cohort Studies
Nurses

Cite this

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title = "Dedicated paediatric Outpatient Parenteral Antimicrobial Therapy medical support: a pre-post observational study",
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.",
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Dedicated paediatric Outpatient Parenteral Antimicrobial Therapy medical support : a pre-post observational study. / Mace, Ariel O; McLeod, Charlie; Yeoh, Daniel K; Vine, Julie; Chen, Yu-Ping; Martin, Andrew C; Blyth, Christopher C; Bowen, Asha C.

In: Archive Diseases of Childhood, Vol. 103, No. 2, 02.2018, p. 165-169.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Dedicated paediatric Outpatient Parenteral Antimicrobial Therapy medical support

T2 - a pre-post observational study

AU - Mace, Ariel O

AU - McLeod, Charlie

AU - Yeoh, Daniel K

AU - Vine, Julie

AU - Chen, Yu-Ping

AU - Martin, Andrew C

AU - Blyth, Christopher C

AU - Bowen, Asha C

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2018/2

Y1 - 2018/2

N2 - 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.

AB - 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.

U2 - 10.1136/archdischild-2017-313071

DO - 10.1136/archdischild-2017-313071

M3 - Article

VL - 103

SP - 165

EP - 169

JO - Archive Diseases of Childhood

JF - Archive Diseases of Childhood

SN - 0003-9888

IS - 2

ER -