Integration of OPAT into an existing older persons' H@H service

Introduction

Prolonged inpatient stays are known to be associated with complications such as delirium, hospital-acquired infection and functional decline, particularly in frail elderly people. Frailty is also likely to limit a person’s ability to attend for conventional outpatient parenteral antimicrobial therapy (OPAT). Expansion of an existing Hospital at Home (H@H) service to provide OPAT to frail elderly people was therefore implemented with the aim of reducing the complications associated with inpatient admission.

Method

The service expansion was conducted in conjunction with the local OPAT service and a standard operating procedure was formulated. Particular effort was made regarding the acquisition of equipment and training of nursing staff on vascular access device care. Data was collected from patient case note in two phases, firstly from patients identified as potentially suitable for H@H OPAT prior to its existence and subsequently from the initial H@H OPAT service users. Treatment duration, completion rates and complications rates were analysed for both groups.

Results

Analysis of baseline data identified three distinct patient outcome groups. The first patient group had considerable baseline frailty with multiple inpatient complications leading to eventual palliation and death. The second patient group attempted to receive conventional OPAT but were eventually readmitted due to either treatment failure or compliance issues. The third group had a shorter treatment duration and successfully completed their treatment while inpatient without significant complications. Initial data from patients receiving H@H OPAT suggests there was a lower risk of delirium and secondary infection but vascular access issues were as frequent.

Conclusions

Integration of OPAT into an existing H@H service is a viable method of improving service access for frail elderly people with the benefit of reduced treatment complications and provision of specialist geriatric input. Further work is needed to assess the potential benefit of the service on patient experience.