Organisational and financial consequences of the early discharge of patients treated for acute bacterial skin and skin structure infection and osteomyelitis in infectious disease departments in Greece, Italy and Spain: a scenario analysis

• Published in: BMJ open Vol. 9; no. 9; p. e031356
• Main Authors: Restelli, Umberto, Bonfanti, Marzia, Croce, Davide, Grau, Santiago, Metallidis, Symeon, Moreno Guillén, Santiago, Pacelli, Valeria, Rizzardini, Giuliano, Soro, Marco, Vozikis, Athanasios, Gray, Alastair
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-09-2019; BMJ Publishing Group
• Subjects: Antibiotics; Bacterial infections; Budgets; Costs; Disease prevention; Efficiency; Hospitals; Infectious Diseases; Nosocomial infections; Patients; Sovereign debt; Greece; Italy; Europe; Spain; Hospital acquired infection; Hospital beds; Infectious Diseases; Organisation; Economic evaluation
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-031356

ObjectiveThe aim of the analysis is to assess the organisational and economic consequences of adopting an early discharge strategy for the treatment of acute bacterial skin and skin structure infection (ABSSSI) and osteomyelitis within infectious disease departments.SettingInfectious disease departments in Greece, Italy and Spain.ParticipantsNo patients were involved in the analysis performed.InterventionsAn analytic framework was developed to consider two alternative scenarios: standard hospitalisation care or an early discharge strategy for patients hospitalised due to ABSSSI and osteomyelitis, from the perspective of the National Health Services of Greece, Italy and Spain. The variables considered were: the number of annual hospitalisations eligible for early discharge, the antibiotic treatments considered (ie, oral antibiotics and intravenous long-acting antibiotics), diagnosis-related group (DRG) reimbursements, number of days of hospitalisation, incidence and costs of hospital-acquired infections, additional follow-up visits and intravenous administrations. Data were based on published literature and expert opinions.Primary and secondary outcome measuresNumber of days of hospitalisation avoided and direct medical costs avoided.ResultsThe total number of days of hospitalisation avoided on a yearly basis would be between 2216 and 5595 in Greece (−8/−21 hospital beds), between 15 848 and 38 444 in Italy (−57/−135 hospital beds) and between 7529 and 23 520 in Spain (−27/−85 hospital beds). From an economic perspective, the impact of the early discharge scenario is a reduction between €45 036 and €149 552 in Greece, a reduction between €182 132 and €437 990 in Italy and a reduction between €292 284 and €884 035 in Spain.ConclusionsThe early discharge strategy presented would have a positive organisational impact on National Health Services, leading to potential savings in beds, and to a reduction of hospital-acquired infections and costs.