Impact of a Dedicated Outpatient Parenteral Antimicrobial Therapy Program on Peripherally Inserted Central Catheter Removal at a Large Academic Medical Center

Abstract

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is a strategy to administer parenteral antibiotics in the outpatient setting through a vascular access device, such as a peripherally inserted central catheter (PICC). Prompt PICC removal after OPAT completion can minimize potential complications of phlebitis, catheter-associated infections, and venous thrombosis. There is no literature evaluating the impact of a dedicated OPAT clinic on PICC removal. Methods This was a single-center, retrospective observational study. Patients 18 years or older discharged on OPAT were included. In March 2018, Grady Health System implemented a multidisciplinary OPAT clinic. The pre-OPAT clinic group included patients referred from January 1, 2017, through March 31, 2018, and the post-OPAT clinic group included patients referred from April 1, 2018, through June 30, 2019. The primary outcome was the rate of documented PICC removal before and after implementation of a dedicated OPAT clinic. Secondary outcomes included difference in rates and reasons for emergency department (ED) visits and readmissions, and difference in rates of OPAT follow-up visits between the 2 groups. The PICC removal rates were fitted in linear regression models for pre- and post-OPAT clinic groups, and the slopes of the 2 regression models were compared. Results A total of 450 patients were included: 230 and 220 in the pre- and post-OPAT clinic groups, respectively. In the pre-OPAT group, 180 patients (73.8%) had a documented PICC removal compared with 213 patients (86.6%) in the post-OPAT group (P < 0.001). There were significantly more patients who visited the ED for a PICC-related reason in the pre-OPAT clinic group (62 vs 44, P = 0.006). Conclusions The proportion of patients with documented PICC removal increased and the proportion of patients with a PICC-related ED visit decreased after the establishment of a dedicated OPAT clinic.