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06-4ECQ Quality improvement initiative implementing a safety dehospitalization in patients using parenteral antimicrobial therapy
  1. Priscila Garzella1,
  2. Thais Galoppini Felix Borro2,
  3. Nancy Oliveira dos Santos1,
  4. Lital Bass1,
  5. Leonardo Henrique Fiuza de Meireles1,
  6. Caroline Pimenta Nunes3,
  7. Carlos Eduardo Santa Cruz Vieira4,
  8. Daniela Nobrega Pavão5,
  9. Suellen Moniz da Silva6,
  10. Maria Aparecida Machado4,
  11. Fabiano Isidio de Lima4,
  12. Maria Fernanda Trindade4,
  13. Beatrice Barros4,
  14. Ana Claudia Mallet de Souza4,
  15. Priscilla Santini Ramalho4,
  16. Renata Maria Cabral4,
  17. Maria de Fatima Ferreira Cota4,
  18. Karina Suzane Pereira Schapowal4,
  19. Fabiana Rolla4,
  20. Claudia Garcia de Barros1
  1. 1Hospital Israelita Albert Einstein (Escritório de Excelência)
  2. 2Hospital Israelita Albert Einstein (Departamento de Consultoria e Gestão)
  3. 3Hospital Israelita Albert Einstein (Departamento Financeiro)
  4. 4Hospital Municipal Vila Santa Catarina ( Hospital Municipal Vila Santa Catarina)
  5. 5Hospital Municipal Vila Santa Catarina (Gerencia)
  6. 6Hospital Municipal Vila Santa Catarina (Hospital Municipal Vila Santa Catarina)

Abstract

Background Infection prevention and control programs promote a set of recommendations for rational antimicrobial management, encouraging outpatient parenteral antimicrobial therapy (OPAT) or step-down transitions to oral administration, when possible. However, proper selection of the right patient is critical for safe dehospitalization. This study aims to report on the implementation of an outpatient antimicrobial management project in a public hospital in a middle-income country using an improvement science framework.

Methods This is an analytical case report assessing a pilot quality improvement (QI) initiative implementing an antimicrobial management project, Safe Dehospitalization (DESOSP), in a public tertiary hospital in Brazil from July 2022 to June 2023. The intervention was implemented using a Breakthrough Series model, including plan-do-study-act cycles to promote OPAT and oral antimicrobial therapy (OAT) transitions. Clinical assistance outcomes were assessed from October 2022, including the rate of dehospitalization of patients using antimicrobials in compliance with the eligibility criteria, mean length of stay (MLS) of selected patients, and hospital admission turnover rate. Additionally, we used the financial data of OAT cases as a sample to estimate DESOSP savings.

Results After nine months, DESOSP increased the dehospitalization rate of eligible patients from 70% to 91%. The MLS scores of these patients dropped from 4.2 to 2.8 days. Turnover rate increased from 0.5 to 0.9. The readmission rates of patients receiving antibiotic therapy who were discharged for the same pathology within 30 days were not modified. Considering the OAT sample, we estimated savings of R $186,988.18 (US$ 38,238.89), with a return on investment of 201.2%. Additionally, regarding the decrease in MLS, we estimated the creation of 28 virtual hospital beds, with a savings projection of R$48.8 million (US$ 9.97 million), based on 100% occupancy.

Conclusion Promoting a safe, structural, and systematic process, training, and engaging clinical teams seems feasible and valuable for promoting stewardship recommendations in the public healthcare system.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2024-QSH.6

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