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Tool identifies PWID who can be safely discharged with IV antibiotics
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Researchers at the University of Alabama at Birmingham developed a nine-point risk assessment to identify “low-risk” patients who inject drugs who can be safely discharged with intravenous antibiotics.
Ellen F. Eaton, MD, MSPH, assistant professor of infectious diseases, and colleagues said the tool could allow hospitals to focus inpatient resources on patients who are at greatest risk for ongoing drug use, saving money and creating additional space.
“There are limited, conflicting data as to if and when outpatient care is appropriate for [persons who inject drugs (PWID)] needing prolonged IV antibiotics due to concerns that PWID may use their central access to inject opioids, home health agencies and/or pharmacies are unwilling to provide IV antibiotics to PWID, and lack of resources,” Eaton and colleagues wrote.
“A nine-point risk assessment for PWID requiring intravenous antibiotics may allow health systems to focus resources on those at greatest risk of ongoing [intravenous drug use (IVDU)] without compromising the care of others,” they added.
At UAB Hospital, Eaton and colleagues implemented the Intravenous Antibiotics and Addiction Team (IVAT) and the nine-point risk assessment to determine a patient’s risk for ongoing IVDU while receiving antibiotics, regardless of the drug they are abusing. They assessed patients based on nine factors: cravings, home environment, dual psychiatric diagnoses, history of overdose, relapse, trauma, use of multiple drugs, family history of addiction and willingness to change.
According to the study, low-risk patients — those scoring 1 to 3 on the assessment — were discharged with outpatient antibiotics and participated in outpatient addiction care. Medium-risk patients (score of 4-6) and high-risk patients (7-9) remained as inpatients and were offered group therapy, opioid agonist therapy and assessed for discharge readiness. Eaton and colleagues extended the data collection 14 months following implementation to increase sample size.
Pre-IVAT, the researchers analyzed the electronic patient database for inpatient admissions (n = 37) in which intravenous antibiotics were received for 14 days or longer. Patients were included if they disclosed or had documented history of IVUD. Post-IVAT, they included patients who were referred for IVAT consultation based on clinical suspicion for IVDU — a total of 100 patients with 111 admissions.
Eaton and colleagues reported that the IVAT intervention reduced costs by 33%, reduced hospital length of stay without increasing 30-day readmissions and created capacity for 333 additional patients. Overall, they found that costs across all services declined with IVAT. Direct costs increased from $922 to $1,182 per admission per day — not surprising, Eaton and colleagues said, because the shorter length of stay in the post-IVAT period was accompanied by an increased cost per day, with a greater number of necessary services occurring in that initial period.
“The results are intuitive and reassuring: providing outpatient care for PWID at low risk for continued IVUD reduces length of stay and hospital costs,” they concluded. “Transitioning these patients safely to outpatient care allows the health systems to prioritize care for those PWID at great risk for ongoing IVDU who will require resource-intensive admissions, including IV antibiotics.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
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