P11 Improving the management of long-term palliative patients on outpatient parenteral antimicrobial therapy (OPAT) - a pathway development initiative

Q: What new pathway elements did the stakeholders propose?

They proposed screening for life-limiting conditions at OPAT referral, modifying the OPAT database to clarify treatment intent, making early palliative referrals for suppressive patients with prognosis <12 months, and improving documentation of patient goals and quality-of-life considerations.

Sep 29, 2026

Upload by Olivia Brown

Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used for long-term suppressive treatment, including patients with incurable infections or life-limiting conditions. As OPAT teams take on palliative care scenarios, defining appropriate goals and planning resources become challenging. This study evaluates current OPAT practices for life-limiting patients on suppressive antimicrobials and proposes a pathway that incorporates palliative care input. Methods include a January–June 2025 retrospective review and stakeholder integration to support patient-centred decisions.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Background

Objectives

Methods

Results

Conclusions

Proposal for a new pathway

Posters Abstract citation ID: dlaf239.015 P11 Improving the management of long-term palliative patients on outpatient parenteral antimicrobial therapy (OPAT): a pathway development initiative Shamanth Soghal1, Charlene Richards2, Katerina Corser2, Milind Arolker3, James Scriven2,4,5 1Department of Geriatric Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 2OPAT Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 3Supportive and Palliative Care Team, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 4Department of Infection and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 5School of Infection, Inﬂammation and Immunology, University of Birmingham, Birmingham, UK Background: OPAT is evolving to accommodate increasing numbers of patients receiving long-term suppressive treatment. These include individuals with incurable infections or life-limiting conditions where curative therapy is no longer the goal. As OPAT teams increasingly support palliative care scenarios, this shift presents challenges in deﬁning appropriate care goals and has signiﬁcant implications for resource allocation and service planning. Objectives: To evaluate current practices in managing patients with life-limiting conditions receiving long-term suppressive antimicrobial therapy via OPAT, and to develop a pathway incorporating palliative care input to support patient-centred decision-making. Methods: A retrospective review was undertaken of OPAT patients at University Hospitals Birmingham (UHB) who received more than six weeks of antibiotics between January and June 2025 . Electronic case notes were reviewed to determine the reason for antibiotic treatment (curative versus suppressive therapy) and whether the patient was identiﬁed as having a life-limiting condition, as deﬁned by the Gold Standards Framework (prognosis less than 12 months) . Limitations in the data system for identifying palliative patients were also assessed. Stakeholder discussions were conducted with the palliative care team to explore integration into the referral process and further management of patients receiving long-term suppressive therapy. Results: Between January and June 2025, a total of 306 patients were accepted onto the OPAT service at UHB, of whom 23 received antimicrobial therapy for more than six weeks. Of these 23 patients, seven were classiﬁed as receiving suppressive treatment. Within this cohort, treatment goals were often not clearly deﬁned by the referring teams. Patients with complex conditions such as LVAD-related infections (n=3), metastatic cancer (n=5), and vascular graft infections (n=1) were frequently treated for extended periods and experienced multiple readmissions. It was evident that our current data system does not reliably capture patients with life-limiting conditions, making retrospective identiﬁcation difﬁcult and limiting service evaluation. Discussions with the palliative care team identiﬁed opportunities for earlier involvement, particularly at the point of OPAT referral, to clarify treatment intent and align care with patient goals. Conclusions: Patients with life-limiting conditions receiving long-term suppressive therapy via OPAT represent a unique and growing cohort. Current data systems lack mechanisms to identify these patients early or to support shared decisionmaking around treatment duration and goals. Early identiﬁcation and involvement of palliative care can support shared decision-making, clarify treatment goals, and improve patient-centred outcomes. Proposal for a new pathway: This will include: (i) screening for life-limiting conditions at the point of OPAT referral; (ii) modifying our OPAT database to prospectively clarify treatment intent (curative versus suppressive); (iii) early palliative care referral for patients on suppressive therapy with prognosis less than 12 months; and (iv)imp

FAQs

What challenge does the study highlight about OPAT in palliative scenarios?

It highlights that treatment goals are often not clearly defined and that current systems do not reliably identify life-limiting patients, making service planning and evaluation difficult.

How were patients identified and assessed in the retrospective review?

OPAT electronic case notes at University Hospitals Birmingham were reviewed for patients receiving more than six weeks of antibiotics between January and June 2025, including classification by curative versus suppressive therapy and identification of life-limiting conditions (Gold Standards Framework prognosis <12 months).

What new pathway elements did the stakeholders propose?

They proposed screening for life-limiting conditions at OPAT referral, modifying the OPAT database to clarify treatment intent, making early palliative referrals for suppressive patients with prognosis <12 months, and improving documentation of patient goals and quality-of-life considerations.

Sep 29, 2026

Upload by Olivia Brown