OPAT gatekeeping avoids 13,909 IV-days through oral switch stewardship

An audit of a large OPAT service found that a substantial proportion of referrals were redirected to oral antimicrobial therapy rather than initiated on intravenous treatment. This gatekeeping function — assessing referrals for oral switch eligibility before OPAT initiation — avoided an estimated 13,909 intravenous therapy days over the audit period.

The finding reframes the value proposition of OPAT services beyond their traditional role of delivering parenteral therapy outside hospital. The stewardship function embedded in the referral-assessment process acts as a systematic intervention point for antimicrobial optimisation, reducing unnecessary intravenous access, associated complications, and nursing resource requirements. Services designing or evaluating OPAT pathways should consider measuring the oral switch rate as a quality indicator alongside conventional OPAT outcome metrics.