139 - Improving Access To Outpatient Parenteral Antimicrobial Therapy (OPAT) For Children In A Geographically Large Canadian Province

Publication Number: 139.5482

Tom A. McLaughlin, University of British Columbia Faculty of Medicine, North Vancouver, BC, Canada; Amanda Doucette, BC Children's Hospital, Port Moody, BC, Canada; Jennifer Smitten, University of British Columbia Faculty of Medicine, North Vancouver, BC, Canada; Clarissa Brennan, BC Children's Hospital, Port Moody, BC, Canada; Elizabeth Lamb, PHSA, Vancouver, BC, Canada

Background: The Canadian province of British Columbia (BC) has a single tertiary children’s hospital serving over 1 million children in an area twice the size of California. BC Children’s Hospital (BCCH) Outpatient Parenteral Antimicrobial Therapy (OPAT) historically only served patients who lived within the local health region. Since so many children lived outside this region, 10% of inpatient bed-days on the BCCH hospital pediatrics ward were occupied by children otherwise eligible for OPAT.

Objective: We used the Model for Improvement and a series of Rapid Improvement Events (RIE’s) to develop and iteratively improve a new model for OPAT in BC, which allowed us to support children outside of the local health region. The aim was to increase the number of patient-days receiving OPAT instead of inpatient care for eligible patients. The new program, named Pediatric IV Outpatient Therapy (PIVOT), launched in early 2023. This study evaluates the clinical outcomes, complication rates, and caregiver experience for children receiving care in the new program.

Design/Methods: This was a prospective cohort study using a database which captured information for all patients in the program, including demographics (age, health region), clinical information (infection, type of central line), outcomes (treatment success), complications (readmissions related to OPAT, central line issues, antibiotic side effects), and patient experience.

Results: The new model trains caregivers to use simplified IV pumps that can be mailed to families throughout BC, and uses virtual care to support patients in any community in BC. In the first 20 months, there were 101 instances of OPAT (2435 patient-days). Twenty-five instances were for patients who lived in health regions too far to be served by in-person care at BCCH. Patients had on average 2.4 complications per treatment course, most of which were minor line-related complications that could be managed over the phone or via virtual care with the PIVOT team. There were no statistically significant differences in complication or readmission rates for patients living in regions inaccessible by in-person care at BCCH. 95% of caregivers rated their experience 4 or 5 out of 5 on an experience survey.

Conclusion(s): Outcomes and complications were similar to existing literature, which focuses almost exclusively on children who live within the geographic catchment area of large urban children’s hospitals. Our model has the potential to expand access to OPAT for children living in non-urban regions, while maintaining care quality and outcomes, and saving significant health system costs.