Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Australia.
Department of Paediatric Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia.
Arch Dis Child. 2018 Feb;103(2):165-169. doi: 10.1136/archdischild-2017-313071. Epub 2017 Aug 28.
Despite the many benefits of paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT) programmes, there are risks associated with delivering inpatient-level care outside of hospital. There is a paucity of evidence defining how best to mitigate these risks. We examined the impact of introducing a dedicated medical team to OPAT, to define the role of increased medical oversight in improving patient outcomes in this cohort.
A prospective 24-month pre-post observational cohort study.
The Hospital in the Home (HiTH) programme at Princess Margaret Hospital (PMH) for Children, Western Australia.
All OPAT admissions to HiTH, excluding haematology/oncology patients.
PMH introduced a dedicated OPAT medical support team in July 2015 to improve adherence to best-practice guidelines for patient monitoring and review.
Duration of OPAT, adherence to monitoring guidelines, drug-related and line-related adverse events and readmission to hospital.
There were a total of 502 OPAT episodes over 24 months, with 407 episodes included in analyses. Following the introduction of the OPAT medical team, adherence to monitoring guidelines improved (OR 4.90, 95% CI 2.48 to 9.66); significantly fewer patients required readmission to hospital (OR 0.45, 95% CI 0.24 to 0.86) and there was a significant reduction in the proportion of patients receiving prolonged (≥7 days) OPAT (OR 0.67, 95% CI 0.45 to 0.99).
The introduction of a formal medical team to HiTH demonstrated a positive clinical impact on OPAT patients' outcomes. These findings support the ongoing utility of medical governance in a nurse-led HiTH service.
尽管儿科门诊肠外抗生素治疗（OPAT）方案有许多益处，但在医院外提供住院级别的护理也存在风险。目前，关于如何最好地降低这些风险的证据有限。我们研究了引入专门的医疗团队来管理 OPAT 的影响，以确定增加医疗监督对改善该队列患者结局的作用。
前瞻性的 24 个月前后观察性队列研究。
西澳大利亚州玛格丽特公主医院（PMH）家庭医院（HiTH）计划。
所有入住 HiTH 的 OPAT 患者，不包括血液/肿瘤学患者。
PMH 于 2015 年 7 月引入了专门的 OPAT 医疗支持团队，以提高患者监测和审查的最佳实践指南的依从性。
OPAT 持续时间、监测指南的依从性、药物相关和管路相关不良事件以及再次住院。
在 24 个月期间共有 502 例 OPAT 病例，其中 407 例纳入分析。引入 OPAT 医疗团队后，监测指南的依从性得到改善（比值比 4.90，95%置信区间 2.48 至 9.66）；需要再次住院的患者明显减少（比值比 0.45，95%置信区间 0.24 至 0.86），接受延长（≥7 天）OPAT 的患者比例显著降低（比值比 0.67，95%置信区间 0.45 至 0.99）。
向 HiTH 引入正式的医疗团队对 OPAT 患者的结局产生了积极的临床影响。这些发现支持在以护士为主导的 HiTH 服务中，医疗管理的持续实用性。
