1009. Integrating a Lean Six Sigma DMAIC approach to improve transitions of care in patients discharged on outpatient parenteral antimicrobial therapy. (15th December 2022)

• Record Type: Journal Article
• Authors: Monday, Lea M; Joshi, Seema; Goteti, Ravitej; Saba, Janan; Weinmann, Allison J
• Is Part Of: Open forum infectious diseases. Volume 9:(2022)Supplement 2
• Publication Date: 2022-12-15
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac492.850
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Outpatient Parenteral Antimicrobial Therapy (OPAT) programs aim to facilitate early discharge and improve patient care; however, rates of readmission remain high. After discharge, safe monitoring and follow-up is logistically heterogenous and prone to error. We aimed to utilize a Six Sigma framework to evaluate our OPAT process and define opportunities for improvement in patient care. Methods: A define, measure, analyze, improve, control (DMAIC) approach was used by a multidisciplinary group to evaluate errors and opportunities in the OPAT discharge process (Fig 1). Baseline analysis of 6-months of OPAT discharges revealed an all cause 30-day readmission rate of 19.7%, and less than half of all patients (45%) were seen in the infectious diseases (ID) clinic within 28-days. The group created a process map and identified potential opportunities for error and heterogeneity in the process. A define, measure, analyze, improve, control (DMAIC) approach was used by a multidisciplinary group to evaluate errors and opportunities in the OPAT discharge process Results: Process mapping revealed process heterogeneity depending on patient discharge location (Fig 2). Reliability of ordering labs and transporting patients to appointments varied by location (Skilled nursing facility (SNF) versus home infusion, etc.). Furthermore, the OPAT note was not included in the discharge summary and the process was reliant on an ID team member emailing the clinic to request follow-up. An Ishikawa diagram identified numerous factors contributing to OPAT related adverse events (Fig 3). Main opportunities for improvement included (1) the OPAT note, (2) delegation of laboratory ordering for monitoring patient after discharge, (3) patient follow-up scheduling and monitoring, and (4) skilled nursing facility (SNF) communication and expectations. Interventions resulting included working with information technology to update the OPAT note to include appointment dates, attaching OPAT note to discharge summary, and bridging communication and ensuring task completion by delegating certain reliable SNFs as centers of excellence. Process mapping revealed significant process heterogeneity depending on patient discharge location, that the OPAT note was not included in the discharge summary, and the process was heavily reliant on an ID team member emailing the clinic to request follow-up and ensure future laboratory tracking. An Ishikawa diagram identified numerous factors contributing to OPAT related adverse events including numerous system and individual factors Conclusion: The DMAIC approach was useful in identifying opportunities to improve transitions of care in patients discharged on OPAT and developing interventions for targeted process improvement. Other centers may use a similar strategy to analyze and improve the care of OPAT patients. Disclosures: All Authors : No reported disclosures.