88. The Outpatient Access Soft Tissue Infection Service (OASIS) Clinic 20-year Review: An Educational, Cost-saving Initiative and Enhanced Patient Experience

PURPOSE: The management of soft tissue infections is a significant burden on the healthcare system and was previously the primary non-psychiatric reason for admission at Zuckerberg San Francisco General Hospital (ZSFG). The care of soft tissue infections becomes especially complex when considering social determinants of health such as access to healthcare, housing insecurity, and IV drug use. Furthermore, homelessness and unemployment have been identified as the strongest risk factors for hand infections in patients presenting to ZSFG. The Outpatient Access Soft Tissue Infection Service (OASIS) Clinic at ZSFG was opened 20 years ago to treat underserved patients for fulminating or emergent soft tissue infections. To this day, OASIS commonly treats patients by providing medical and surgical treatment for superficial soft tissue infections (SSTIs). Minor procedures are also offered such as foreign body removal and removal of subcutaneous masses. We sought to investigate the performance of OASIS 20 years after its opening to determine its efficacy in addressing the healthcare needs of underserved patients and reducing the burden on the healthcare system. METHODS: A review of the 20-year operating history of the OASIS Clinic was performed. Patient demographic data such as BMI, history of autoimmune disease, employment, IV drug use, housing status, and cost data related to emergency department visits, inpatient hospital stays, and operating room use, were collected using ZSFG databases. RESULTS: In its 20-year history, the OASIS Clinic has seen progressively fewer critically ill patients and chronically untreated wounds given the access and immediate drop-in care available for soft tissue services. OASIS also has grown to provide comprehensive wound care, substance abuse counseling, and social services that run in conjunction with drop-in services. The minor procedure clinic additionally reduces the operating room burden and helps to expedite care. In the first year of operation, emergency department visits decreased 33.9%, surgical admission decreased 47.3%, inpatient acute care bed days decreased 33.7%, and operating room procedures decreased 71%. These levels hold 20 years after the opening of OASIS. Based on the initial cost savings estimate of $8,756,200 per year, the clinic growth, and inflated healthcare costs, the OASIS Clinic has saved an estimated $160 million since it opened. Beyond financial savings, OASIS has provided a robust educational experience for medical students and surgical residents. UCSF medical students participate in an OASIS elective where they interact with patients and assist with clinic procedures. Junior surgical residents also perform independent minor procedures with attending physician oversight to further hone their surgical skills. CONCLUSIONS: Twenty years after its opening, the OASIS Clinic is a model intervention for uniquely tailored and expedited care to underserved and vulnerable patients. The OASIS clinic helps to reduce hospital burden and costs while delivering high-quality care with strong patient satisfaction. It also serves as a model for educational enrichment for medical students and surgical residents in managing SSTI and other soft tissue pathology.