Opportunity

Outpatient parenteral antimicrobial therapy (OPAT) enables patients to complete intravenous therapy in various outpatient settings, including the home, long-term care facilities, and infusion centers. The diversity of locations in which OPAT is delivered and the high acuity of the patient population receiving such treatments contribute to high readmission rates and complications.

In 2016, 29 percent of OPAT patients were readmitted to the Hospital at the University of Pennsylvania (HUP) within 30 days. Patient retention was also a challenge, with only 60 percent of patients attending their initial follow-up appointment in the infectious diseases (ID) clinic. As a result of these challenges, the Infectious Diseases Transition Service (IDTS), a multidisciplinary team of pharmacists, physicians, nurses, and patient service representatives, was formed to improve the monitoring of OPAT patients. After implementing IDTS, initial results were promising, with 30-day readmission rates dropping from 29 percent to 18 percent and show rates at follow-up appointments rising to 75 percent. 

However, to offer services to patients, the IDTS team had to manually identify those who qualified – which proved to be a very time-consuming process. Due to staffing constraints and lack of capture by ID consultant services, the IDTS team estimated that only 40 percent of OPAT patients discharged from HUP were being enrolled in IDTS services.

Intervention 

The IDTS monitoring system is a comprehensive dashboard that aggregates actionable real-time information about OPAT patients at Penn Medicine.  

The tool leverages data from multiple systems to identify patients scheduled for discharge with IV antibiotics and track follow-up appointment scheduling and attendance. When important clinical events occur, or lab reports become available, alerts are pushed so that care team members can act promptly.

Impact 

During the initial pilot period, the IDTS monitoring system enabled the care team at HUP to identify 100 percent of patients discharged on IV antibiotics at or before the time of discharge – up from 40 percent. And by streamlining data and integrating lab reports into the tool, the care team saved an estimated 10-12 hours per week.

The IDTS monitoring system is projected to save over $2,500 per patient, ultimately leading to $4.5 million in savings for the health system at scale.

Based on the success of the program at HUP, the IDTS Monitoring System has been scaled to Penn Presbyterian Medical Center.