750Effectiveness, Safety, and Impact on Healthcare Decongestion by a Busy Canadian Infusion Centre for Outpatient Parenteral Antimicrobial Therapy
Bibliographic record
Abstract
Background. Outpatient Parenteral Antimicrobial Therapy (OPAT) provides intravenous (IV) antibiotic therapy to patients in an ambulatory setting. Typically OPAT is overseen by Emergency Room (ER) physicians. However, in 2011 a stand-alone infusion center was created to decongest the Surrey Memorial Hospital ER, the second busiest in Canada. The infusion centre is staffed by infectious diseases (ID) specialists who oversee care with a multidisciplinary care team. This study describes and evaluates the infusion center with respect to safety, efficacy, antibiotic de-escalation, and ability to decongest the ER. Methods. This retrospective observational study evaluated patients treated at the infusion centre between October 1, 2012 and September 30, 2013. Six hundred patients registered in the infusion centre were randomly selected. For subjects meeting inclusion and exclusion criteria, medical records were reviewed for demographics, clinical information, microbiology, antibiotic usage, and outcomes. Treatment success was defined as improvement in referral condition at end of therapy without relapse or hospital admission within 30 days of discharge. Results. During the study period, 1900 patients were referred to the infusion centre. Of the 600 patients, 523 met inclusion and exclusion criteria. The most common sites of infection were skin and soft tissue (44.8%), urinary tract (16.3%), and oral/ear-nose-throat (9.0%). Mean duration of therapy at the infusion centre was 6.1 days; resulting in 3456 patient-days diverted from ER and inpatient beds. In addition, 39.1% of episodes had discontinuation or oral step down of their antibiotic regimen. Of the 503 episodes with outcome data, treatment success was found in 414 episodes (82.3%). Mortality rate was 0.6%. Adverse drug reaction rate was 7.8/1,000 OPAT patient-days, with no C. difficile or serious IV line complications. Conclusion. The infusion centre model of OPAT is a safe and effective means of delivering IV antibiotics. It has shown significant impact on ER decongestion and potentially reduced unnecessary hospital admissions, which may lead to significant cost savings. In addition, antibiotic stewardship was achieved with early de-escalation of antibiotics. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".