Antibiotic management and early discharge from hospital: an economic analysis

To evaluate potential costs and savings from implementing an evaluation tool that uses bedside review of antibiotic use and infection management to assess whether patients with infections in acute medical and surgical wards could have their antibiotic regimen changed and be safely managed out of hospital. The tool was implemented in 30 acute wards in five UK hospital trusts. Data were collected on demographic variables, diagnosis, social situation, hospital stay and all current antibiotic prescribing for 291 patients. A physician and pharmacist assessed antibiotic therapy and feasibility of discharge. Resource use was measured for each patient, unit costs attached, and mean and total costs of implementing recommendations were calculated. Implementation of these recommendations could reduce total inpatient days by 494 at a saving of 186731, and save 20215 from adjustment of antibiotic therapy. Additional costs were associated with implementation of the assessment (2468), community support (6227) and outpatient parenteral antimicrobial therapy (5616). As a result, the net potential savings would be 192635 in total or 662 (95 CI: 393, 930) for every patient assessed. Excluding eight patients with the highest potentially avoidable inpatient stays (15 days), mean savings would fall to 363 per patient assessed but remain highly significant (95 CI: 261, 465). Careful assessment of antibiotic use in acute wards has the potential to reduce the use and cost of antibiotics, and length of stay. Added costs of assessment and out-of-hospital support services would offset a small proportion of these potential savings. Randomized studies are now needed to test these results.