Predicting staff capacity for OPAT programs
Abstract:
Background: Outpatient Parenteral Antibiotic Therapy (OPAT) patients require complex multidisciplinary coordination outside billable visits. Predicting and funding sufficient staff capacity for OPAT programs is poorly understood.
Methods: OPAT episodes at our center from January 1,2019-December 31,2020 were identified and categorized as requiring therapeutic drug monitoring(TDM) or non-TDM. Electronic health record(EHR) ambulatory encounters by Infectious Diseases clinic(IDC) staff from OPAT start to 14 days post-completion, or until study cessation, were extracted and categorized as billable, or non-billable. Weekly registered nurse(RN) time for non-billable tasks, stratified by monitoring acuity, was quantified using time-in-motion studies. RN overextension beyond a 40 hour-week was used to calculate optimal staffing ratios. OPAT monitoring days were converted into projected profit margin attributable to hospitalization avoidance through OPAT program operations.
Results: During 2019-2020, 1,645 OPAT courses were associated with 17,476 EHR IDC encounters; 15,163(87%) were non-billable. TDM episodes were 24.9% by volume, but generated significantly more EHR encounters and workload hours than non-TDM episodes. An optimal ratio of 1 RN to support 436 OPAT episodes per year was derived within local context and monitoring acuity mix. An estimated $83,379,292 in cost savings, or $11,757,596 net revenue from admissions turnover, were attributable to 49,350 hospital bed-days avoided through OPAT.
Conclusions: A program staffing model was derived from multimethod evaluation of billable and non-billable OPAT activities. Programs seeking to delineate and fund optimal staffing levels may perform similar analyses based on total volume, monitoring acuity of their OPAT panel, alongside a holistic assessment of financial benefits of OPAT to their organization.
Reference:
Yamshchikov AV, Burgoyne C, Calisir N, Goins P, Heffer T, Munsiff SS. Quantifying and Financing the Non-billable Workload of Outpatient Parenteral Antibiotic Therapy (OPAT) – a Model for Assessing and Supporting Staffing Needs for OPAT Programs. Clin Infect Dis. 2025 Mar 21:ciaf146. doi: 10.1093/cid/ciaf146. Epub ahead of print. PMID: 40117386.