Healthcare News & Insights

Study shows self-administered IV antibiotics reduce hospital stays

A recent study shed light on a new treatment process that could help hospitals lower their readmissions rates, save millions of dollars and empower patients to take an active role in their care. 

IVFor patients fighting life-threatening infections, it’s often necessary to keep them in the hospital for four to six week to get long-term courses of intravenous (IV) antibiotics. In the beginning of their stay, these patients require intensive diagnostic and therapeutic care. But once the treatments start working, most patients only require regular IV antimicrobial infusions.

The good news is, outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective practice that allows medically stable patients to get IV antibiotics in an outpatient setting – freeing up beds for patients who truly need round-the-clock hospitalization.

The bad news is, it’s rarely an option for uninsured patients. Since they have to remain in the hospital for their treatments, it increases their potential exposure to hospital-acquired infections – something all hospital are working feverishly to prevent. Plus, these treatments and their associated costs fall on safety-net hospitals.

To combat this problem, six years ago Dallas-based Parkland Memorial Hospital started teaching its uninsured patients who needed an extended course of IV antibiotics to self-administer their treatments at home.

The results: Shorter hospital stays and lower readmission rates.

Study breakdown

The four-year study compared 944 uninsured patients who self-administered long-term IV antibiotics (S-OPAT) with 224 insured patients who had their long-term antibiotic administered in a traditional healthcare setting (H-OPAT), such as infusion centers, nursing homes and at home with skilled nursing assistance.

In order to be included in the study, patient had to meet written eligibility criteria that were assessed at an infectious diseases/OPAT consultation. Patients who were homeless, IV drug users or medically unstable were excluded.

The S-OPAT patients got standardized training in self-administration of IV antibiotics, and educational material written at a fourth-grade literacy level that included illustrations of the apparatus, supplies, hand hygiene practices, and techniques for aseptically connecting the antibiotic solution to the IV catheter.

Patients received their instructions bedside via a pamphlet that was available in English and Spanish. For patients who didn’t speak a common language, they received their training through the hospital’s multilingual telephone-translation service. Patient could also access written and video instruction posted on the facility’s website.

S-OPAT patients were repeatedly required to demonstrate mastery of all the steps involved in self-administration of IV antibiotics by gravity. Afterward, they were discharged and required to make weekly clinic visits for PICC-line (peripherally inserted central catheter) maintenance, laboratory monitoring and evaluation by an infectious disease physician or nurse practitioner. They also had access to a 24-hour nurse call center.

The results

The 30-day readmission rate was 47% lower in the S-OPAT group than in the H-OPAT group. However, the difference in the one-year mortality rate wasn’t statistically significant.

Due to the self-treatment in the S-OPAT group, the hospital avoided 27,666 inpatient days over the study period.

“The hospital readmission rate is now lower among the patients who have been trained to self-administer IV antibiotics than among patients with insurance who receive home healthcare assistance,” Dr. Fred Cerise, MPH, Parkland’s president and CEO, said in a news release. “The uninsured patients go home earlier than they used to, and the hospital has saved nearly $40 million.”

This study shows that uninsured patients with lower-literacy levels are capable of self-care. Previously, this population was perceived as having limited self-care capability.

“Yes, we have developed an innovative approach to healthcare delivery in this clinic, but it’s the patients who have shown the greater impact of tapping into human potential by being empowered to do something that many didn’t think they could do,” Dr. Kavita Bhavan, medical director of the Infectious Diseases OPAT Clinic at Parkland and assistant professor of internal medicine at the University of Texas Southwestern Medical Center, said in the same release. “They are the true heroes here – we just gave them the opportunity to shine.”

 

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