Scaling Safe Resident Driven OPAT bundle in a Lower Middle-Income Country: A Quality Improvement Intervention
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KEY POINTS
Question
To what extent does a standardized quality improvement care bundle improve Outpatient Parenteral Antimicrobial Therapy (OPAT) utilization and clinical outcomes in a resource constrained Indian hospital?
Findings
This quality improvement initiative demonstrates that a standardized package of interventions centered on physician education and formal monitoring successfully scaled OPAT utilization to 100% of eligible encounters. The intervention established a highly reliable clinical pathway, maintaining 100% adherence to monitoring indicators without compromising patient safety or increasing hospital readmission rates.
Meaning
These results suggest that standardizing the transition to outpatient therapy through a low-cost care bundle can overcome barriers to OPAT utilization in resource-limited settings, achieving universal enrollment and high safety compliance without increasing hospital readmissions.
Importance
OPAT is an underutilized strategy in low- and middle-income countries (LMICs). Addressing the knowledge gaps among frontline physicians through structured interventions is vital for optimizing hospital bed utilization and antimicrobial stewardship.
Objective
To assess whether a structured multidisciplinary care bundle is associated with improved patient enrollment and clinical care quality in an OPAT program in India.
Design, Setting, and Participants
This pre-post quality improvement study was conducted in the Department of General Medicine at a tertiary care referral hospital in Rishikesh, India. Data from patient encounters during a 6-month pre-intervention period (December 1, 2023 to May 31, 2024) were compared with encounters during a 6-month post-implementation period (January 1, 2025 to June 31, 2025). Participants included all postgraduate residents serving as frontline clinical practitioners.
Interventions
A structured OPAT bundle comprising a formalized educational curriculum (interactive didactic sessions and bedside practical training), standardized eligibility screening, and a coordinated telephonic monitoring protocol (from June 1, 2024 to December 31, 2024).
Main Outcomes and Measures
The primary outcome was the change in the number of eligible patients enrolled in OPAT. Secondary outcomes included clinical process quality indicators (counseling, IV access arrangement, and monitoring compliance), 30-day rehospitalization rates, and therapy-related complications.
Results
A total of 20 preintervention patient encounters were compared with 39 postintervention encounters, with similar baseline characteristics between groups (mean age, 37 vs 40 years; male gender, 65% vs 69.2%). Prior to implementation, only 33.3% (20 of 60) of eligible patients received OPAT, whereas 100% (39 of 39) of eligible patients were enrolled following the intervention (p < 0.001). Key clinical processes reached 100% compliance post implementation, including patient counseling (40% vs 100%; p < 0.001), pre-discharge IV access (40% vs 100%; p < 0.001), and daily telephonic monitoring (10% vs 100%; p < 0.001). Safety outcomes remained stable, with no significant differences in readmission rates (5.0% vs 0%; p = 0.34) or drug-related complications.
Conclusions and Relevance
This quality improvement study provides evidence that a structured package of OPAT bundle interventions is associated with a transition to universal enrollment of eligible patients and perfect adherence to safety indicators. These results suggest that standardizing the outpatient transition through physician education and coordinated monitoring is a feasible and effective strategy for optimizing hospital resource utilization in LMICs.
