1938. Sustained Reduction in 30-Day Readmission Rates After Implementation of an OPAT Program in an Academic Medical Center

Abstract

BackgroundThe Outpatient Parenteral Antibiotic Therapy Program at the University Of Pittsburgh Medical Center began in December 2013. UPMC Presbyterian is a Level I center consisting of 775 beds (150 ICU beds). Prior to program implementation, the 30-day readmission rate for patients discharged from our facility on an IV antibiotic was 32%.MethodsOur Program is a multidisciplinary team consisting of physicians, advance practice providers, pharmacists, nurses, and coordinators. We use a pharmacist-based monitoring program to review weekly laboratories and adjust dosing through a collaborative practice agreement. ID fellows participate in the management of patients while receiving IV antibiotics. Patients are evaluated one week post discharge and prior to end of therapy in the ID clinic. Weekly laboratories are monitored as per the IDSA Society Guidelines. In addition, all patients all reviewed in our weekly huddle prior to end of therapy. We also conduct a monthly M&M to review readmissions.ResultsOur overall patient population has increased from 847 in 2014 to 1,234 in 2015 to 1,569 in 2016 and 1,512 patients in 2017. Post-implementation, we have demonstrated an ongoing reduction in 30-day readmission rates. In 2014, our rate decreased to 17.2%, in 2015 to 15.6%, in 2016 to 11.5% and in 2017 to 18.5% (see Figure 1). 2,337 (54%) of patients were male; the average age of our patients was 56.4 years. 35% were diabetics; 35% have chronic kidney disease, 25.4% have CAD and 43.7% have HTN. More patients are discharged home (n = 2,246) vs. to a facility (n = 1,583). Over half of our patients receive vancomycin.Figure 1.ConclusionA pharmacist managed OPAT Program can successfully reduce and maintain lower 30-day readmission rates in an academic facility.Disclosures All authors: No reported disclosures.