A Quality Initiative to Improve Postdischarge Care for Patients on Outpatient Parenteral Antimicrobial Therapy

Improving the inpatient documentation of the outpatient parenteral antimicrobial therapy (OPAT) plan improves postdischarge care for OPAT patients. Creating a standardized OPAT note increased the proportion of OPAT patients getting appropriate monitoring after hospital discharge. Background Patients discharged from the hospital on outpatient parenteral antimicrobial therapy (OPAT) require close monitoring, including weekly blood tests and an early posthospital follow-up visit. However, because patients often receive OPAT in a separate healthcare system from where they received inpatient care, the OPAT plan often fails, with less than 75% of OPAT patients receiving the recommended laboratory monitoring. We sought to determine whether changing our inpatient OPAT documentation method would improve postdischarge care. Methods As a quality improvement initiative, we conducted 2 Plan-Do-Study-Act interventions on our OPAT documentation. Our first intervention was to create a standardized OPAT Progress Note, and our second was to turn that note into a SmartForm (Epic) with discrete fields for the key information. We examined the effects of these changes on the rate of completion of recommended laboratory monitoring, attendance at outpatient follow-up visits, and 30-day readmission rates. Results Changing our documentation to a standardized Progress Note and then to a SmartForm with discrete fields led to an increase in the proportion of patients with a serum creatinine checked within 10 days of discharge (from 63% to 71% to 73%) and who attended an infectious disease clinic visit within 3 weeks of discharge (from 21% to 36% to 47%). However, the rate of readmissions for OPAT-related problems did not change, nor did a composite outcome of 30-day mortality/unplanned readmission. Conclusions Changes in how and where care plans are documented in the inpatient medical record can have significant effects on patient care outcomes after discharge.

Automated summary

Improving inpatient documentation of outpatient parenteral antimicrobial therapy (OPAT) plan can enhance postdischarge care for OPAT patients. Standardized records and discrete fields can increase the proportion of patients receiving necessary monitoring and follow-up visits.