Impact of a nurse practitioner-led dedicated outpatient parenteral antibiotic therapy clinic on patient outcomes and administrative workload: a retrospective cohort study.

Abstract

Background: Outpatient parenteral antibiotic therapy (OPAT) enhances patient safety, improves outcomes, and reduces healthcare costs by decreasing 30-day readmissions and adverse events. However, the optimal structure and follow-up protocols for OPAT programs remain undefined. Identifying high-risk patients for readmission and managing adverse drug events (ADEs) are critical components of OPAT care.

Objectives: This study aimed to evaluate the impact of a dedicated OPAT clinic on hospital readmissions, and quantified the administrative workload required to manage patients on OPAT post-discharge.

Design: A retrospective, pre-post cohort study compared patient outcomes before and after the implementation of a dedicated OPAT clinic across a single clinic and multiple hospitals.

Methods: Patients discharged on OPAT from October 2018 to March 2019 (control group) and from September 2021 to February 2022 (intervention group) were included. The primary outcome was 30-day hospital readmission. Secondary outcomes included administrative workload measured by telephone calls and nursing tasks. Data were analyzed using univariate and multivariate logistic regression models to identify independent risk factors for readmission.

Results: A total of 361 patients were included (median age 63 years, 62.1% men). Of these, 239 patients (66.2%) received OPAT post-clinic implementation. Common diagnoses included bacteremia (17.7%) and osteomyelitis (17.5%), with MRSA (17.2%) and Streptococci (14.4%) as predominant pathogens. The median OPAT duration was 14 days, and the median hospital stay was 7 days. Readmissions within 30 days occurred in 24.9% of patients, while 27.7% visited the emergency department. ADEs were reported in 18.9% of patients. Readmission rates decreased from 30.5% in the pre-clinic cohort to 20.1% in the post-clinic cohort (p ⩽ 0.05). The OPAT clinic managed 690 calls, illustrating the substantial administrative burden associated with coordinating care. Most calls addressed lab results (22.6%) and peripherally inserted central catheter-related issues (11.3%).

Conclusion: The implementation of a dedicated OPAT clinic was associated with reduced readmissions and improved patient management, suggesting that structured follow-up care may improve outcomes. This study highlights the administrative challenges of OPAT, emphasizing the need for dedicated personnel and efficient coordination. Future research should focus on optimizing OPAT care models and establishing sustainable funding strategies.