OPAT screening redirected a third of declined referrals to oral therapy: 13,909 home days

A review of all referrals screened but not taken onto the NHS Greater Glasgow and Clyde OPAT service over three years (2022–2024) found that of 5,024 referrals, 1,467 (29.2%) were not accepted, and of those 517 (35%) were advised an oral antibiotic option needing neither close monitoring nor specialist OPAT follow-up. Those recommendations accounted for 13,909 days of oral therapy at home across the three years. Thirty-day mortality in that group was 3.9% (20 of 517) and readmission directly attributable to the infection or its treatment was 6.4% (32 of 498).

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.