NHS Glasgow's pioneering antibiotics service set to expand

The service - which first launched at Gartnavel General in 2001 but is now based at the Queen Elizabeth University Hospital - treats patients with bacterial infections which require short or long-term courses of IV antibiotics, but who are suitable for outpatient care.

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This can include ailments such as cellulitis - a common skin infection which is one of the leading causes of hospital admissions lasting less than a week - as well as more complex problems such as severe urinary infections, brain abscesses, heart valve infections, or diabetes-related complications.

In the past, patients requiring IV antibiotics would have had to remain in hospital - sometimes occupying a bed for weeks at a time.

Now they can come into OPAT to have a line fitted, but take supplies of the liquid antibiotics home to administer themselves.

The OPAT hub for Greater Glasgow and Clyde is based at the QEUH in Glasgow, but most mainland health boards now also have their own OPAT services (Image: Newsquest)

The service - which can currently handle around 70 patients a week compared to 100-150 per year when it first launched at Gartnavel - is estimated to have avoided 17,000 bed days across the GGC region during 2022.

One in three patients are referred direct by their GPs and avoid hospital admission altogether, while two thirds of people with more complex infections that require initial hospital investigations and treatment have their stay significantly reduced.

On average, without OPAT, this group of patients would each spend round three weeks in hospital.

It comes amid a push to monitor more patients - including those with cardiac and respiratory conditions - remotely through other initiatives such as hospital-at-home, to relieve pressure on hospitals.

Bed shortages have seen a number of health boards - including GGC, Borders, and Ayrshire & Arran - suspend all non-urgent elective operations in a bid to reduce exit block in A&E departments.

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Doctors in Glasgow pioneered OPAT in 2001, but similar services have since been adopted by most mainland health boards in Scotland.

Dr Andrew Seaton, a consultant in infectious diseases and lead for the OPAT service, said there was "huge untapped potential" to prevent admissions in the the first place, and get many more patients out of hospital earlier.

He said: "We want to maximise patients being referred by GPs so that we can stop them even setting foot in the emergency department or the acute admissions department, just to reduce the footfall and the impact on unscheduled care.

"GPs are now referring through 'consultant connect' which is a direct line on a phone app that the GPs have so that they can contact our team directly with people with serious skin and soft tissue infections, or complex urinary infections that would normally require admission.

"GPs are now increasingly contacting us direct about that, so we stop them even pitching up at the hospital."

In addition, there is a drive to identify as many patients as possible who could benefit and get them out of hospital.

"Every day, our [OPAT] nurses will be in all the different hospitals trying to identify patients and pull them out, and at the same time reacting to GP calls to try and manage patients," said Dr Seaton.

"For quite a long time we've been under the radar, but now our board has invested - we've got a bigger nursing team, we've got pharmacists involved, we've got a bit more time for myself and my colleagues in infectious diseases to devote time to get it off the ground.

"We know from our calculations that there's still patients we can get out earlier and there's still many more patients that we can identify and treat without them ever coming into the hospital.

"There's definitely much more potential to grow the service, not just in GGC but throughout Scotland."

Hilda Dodds, a grandmother and former auxiliary nurse from Kilsyth in Lanarkshire, is among those who uses the OPAT service regularly.

Hilda Dodds (Image: collect)

Mrs Dodds, 69, has bronchiectasis - an incurable condition which makes her lungs more vulnerable to infection.

She was diagnosed 40 years ago, but doctors believe that the damage to her lungs was actually caused by a bout of measles when she was aged three.

"I always joke that I'll start to worry when I don't have a cough," said Mrs Davidson.

"All of my life I've been on cough bottles and antibiotics, but I was an auxiliary nurse and I think being in that environment, I was picking up infections.

"In the end I was off with pneumonia and pleurisy and things like that, and every time I ended up in hospital.

"Eventually I was pensioned out on ill health, but it's classed as a disability because it's never going to get any better - it's always going to be there and it's going to get worse."

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She currently needs a two-week course of IV antibiotics every 10 weeks for a pseudomonas infection.

At home, she is able to change the bag herself every six hours - a far cry from the days when she used to spend two weeks at a time in hospital every couple of months.

Mrs Dodds said: "The OPAT clinic has been a lifesaver for me - not having to go into hospital.

"I'm here at home time for my grandchildren coming back from school.

"Three years ago, I lost my husband and I was in Strathcarron Hospice sitting with him for five days at the end and doing my medication at the same time.

"If I had been stuck in hospital I wouldn't have been able to be with him in his last days, so that made such a difference.

"It's a bit ridiculous to be taking up a bed just to get antibiotics."

Dr Scott Davidson, deputy medical director for acute services for NHSGGC added: “The work of the OPAT team has been instrumental in freeing up bed capacity for other patients requiring urgent care and has undoubtedly played a crucial role in helping us respond to pressures facing the service."