Quantitative analysis of the impact of infectious disease physicians on patients in the emergency department fast-track parenteral antibiotics program

TL;DR

This study found that involving infectious disease physicians in an outpatient antibiotic program led to shorter treatment times and fewer patient readmissions.

Contribution

The study provides empirical evidence on the impact of infectious disease physician involvement in outpatient parenteral antibiotic programs.

Findings

Patients seen by infectious disease physicians spent fewer days on the program compared to historic patterns.

Patients assessed by infectious disease physicians were less likely to return within a month of discharge.

Infectious disease physicians ordered more tests and prescribed a wider range of antibiotics.

Abstract

The outpatient parenteral antibiotic therapy (OPAT) program of Vancouver General Hospital (VGH) was supervised by emergency physicians (EPs) until 2017 when infectious disease (ID) physicians began assisting in management. We designed a retrospective study to determine whether ID involvement led to improved outcomes.

This study analyzes the impact of ID involvement by comparing the mean days patients spent on OPAT with ID involvement versus EPs alone through a retrospective chart review. Secondary research objectives were to compare patient care decisions, e.g., antibiotic choice, tests ordered, and final diagnosis.

There was no difference between the mean number of days on OPAT between physician types. Compared to historic patterns, patients seen in OPAT after increased ID consultation spent an average of 0.5 fewer days in the program. However, when grouped by the first day of ID assessment, the average total days in OPAT was closely aligned with the day of first ID assessment, implying that ID frequently discharged patients close to initial assessment. Patients seen by ID were less likely to return within one month of discharge compared to those not seen by ID. Secondary findings include ID physicians prescribing a greater range of antibiotics, providing more varied final diagnoses, prescribing antibiotics less frequently, as well as ordering more cultures, diagnostic imaging and specialist consults.

The findings of this study support the hypothesis that ID involvement in OPAT programs leads to changes in care that may have beneficial outcomes for patients and the healthcare system.

The online version contains supplementary material available at 10.1186/s12879-024-09305-0.

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