| Course | D916 MHA Capstone |
|---|---|
| Task | Task 1 |
| Paper type | Capstone business case |
| Length | About 1,100 words, 5 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | Master of Healthcare Administration |
| Updated | September 2026 |
Free sample paper for D916 Task 1
Ready to Go Home Except for the IV: A Business Case for an Outpatient Parenteral Antimicrobial Therapy Program at a Composite 320-Bed Hospital
Student Name
Leavitt School of Health, Western Governors University
D916: MHA Capstone, Task 1
Course Instructor
Month Day, Year
Ready to Go Home Except for the IV: A Business Case for an Outpatient Parenteral Antimicrobial Therapy Program at a Composite 320-Bed Hospital
The Organizational Challenge
Lakeview General Hospital, a composite 320-bed hospital, runs near full occupancy most weekdays, and its emergency department holds an average of 14 admitted patients a day waiting for beds. A review of last year's discharges found 610 patients who were medically ready to leave at least two days before they did, but who stayed because they needed to finish a course of intravenous (IV) antibiotics for infections such as osteomyelitis, complicated skin infections or endocarditis. Together they spent 3,050 days in the hospital only to receive antibiotics, the equivalent of about eight beds occupied every day of the year.
These days carry three costs. Patients stay in the hospital longer than they need to, with the risks of hospitalization and the loss of time at home and work. The hospital absorbs the cost of the days, because payment for most admissions is fixed by diagnosis rather than by length of stay. And the beds are unavailable to patients boarding in the emergency department.
How the Challenge Was Measured
The 610 patients were identified in two steps. First, case managers' discharge-delay codes flagged every stay in which a patient was recorded as medically ready but remained because of IV therapy. Second, a clinical pharmacist and I reviewed a random sample of 80 of those charts to confirm that the delay was truly due to antibiotics and not to another unresolved medical problem; 72 of the 80 were confirmed, so the count was reduced by 10% to avoid overstating the problem. The estimate is therefore conservative, and it excludes patients who were kept in the hospital for IV antibiotics without a delay code being entered.
The challenge also fits the hospital's strategy. Reducing emergency department boarding is one of Lakeview's three board-level goals this year, and the hospital is entering shared-savings contracts in which shorter, safer stays improve its financial results.
The Proposed Solution
An outpatient parenteral antimicrobial therapy (OPAT) program allows selected patients to receive IV antibiotics at home, in an infusion clinic or in a skilled nursing facility, under the supervision of a hospital team. The Infectious Diseases Society of America's guideline on OPAT describes the elements such programs need, including careful patient selection, involvement of infectious diseases expertise, vascular access management and regular laboratory monitoring (Norris et al., 2019).
Lakeview's program would be led by an infectious diseases physician as medical director, with two OPAT nurses, a clinical pharmacist and a coordinator. It would screen eligible inpatients, arrange home infusion or clinic visits before discharge, review weekly laboratory results, manage catheter problems and see patients in a weekly OPAT clinic.
Alternatives Considered
Continue as now. This requires no investment but leaves the 3,050 days, the cost and the boarding in place.
Discharge more patients to skilled nursing facilities for IV therapy. Local nursing facilities have limited beds and often decline complex IV regimens, and a skilled nursing stay is itself costly. A study of patients with substance use disorders receiving OPAT found that those discharged to skilled nursing facilities had similar rates of readmission and complications but longer hospital stays and a lower likelihood of engaging in addiction treatment afterward (Hawes et al., 2026).
Contract with a home infusion company without a hospital OPAT team. This would move some patients home but would leave no one at Lakeview responsible for monitoring them. Evidence favors a structured model: when one hospital introduced an OPAT program with mandatory infectious diseases assessment and a structured workflow, IV therapy duration fell by about 14 days on average, adverse clinical outcomes declined, therapy was adjusted in 36.3% of cases, and costs per patient fell (Manders et al., 2025).
Costs and Benefits
The estimate below assumes that 60% of the IV-only days, about 1,830 a year, can safely shift to OPAT once the program is established.
| Item | Annual estimate | Basis |
|---|---|---|
| Program staff (0.4 physician, 2 nurses, 0.5 pharmacist, 0.5 coordinator) | -$620,000 | Current salary and benefit rates |
| One-time start-up (EHR build, pumps, training) | -$150,000 in year one | Vendor quotes |
| Clinic and infusion services billed | +$300,000 | Projected visits and payer mix |
| Variable cost of avoided inpatient days | +$1,190,000 | 1,830 days at $650 variable cost per day |
| Contribution from admissions the freed beds allow | +$700,000 | About 290 additional admissions at a conservative $2,400 each |
| Net annual benefit after year one | About +$1,570,000 | Benefits minus ongoing costs |
The start-up cost would be recovered in the first few months. Even if only half the projected days shifted, the program would still produce a net benefit of more than $450,000 a year. The less measurable benefits may matter as much: fewer patients boarding in the emergency department, patients recovering at home, and an infectious diseases team able to shorten or simplify antibiotic courses.
Stakeholders
The chief medical officer sponsors the project. Hospitalists and surgeons refer patients and must trust the program. Case managers identify candidates and arrange discharges. The infectious diseases group supplies the medical director. Pharmacy, nursing, the vascular access team and the EHR team build the workflow. Home infusion companies and skilled nursing facilities are partners. Patients and families must be willing and able to manage therapy at home, and payers determine coverage, which differs for Medicare, Medicaid and commercial plans.
Risks
Patients at home can develop catheter infections, clots or drug reactions, so monitoring and rapid response are essential. Some patients will not be good candidates because of unstable housing, active drug use without support or inability to manage equipment; the program needs clear criteria and alternatives for them. Coverage for home infusion varies by payer, so some patients will need clinic-based infusion instead. Referrals may be slower than projected if physicians are unfamiliar with the program. Each of these risks will be addressed in the sustainability plan.
Recommendation
Lakeview should fund a hospital-led OPAT program for an initial two-year period, beginning with patients on the orthopedic and medicine services, and measure IV-only days avoided, 30-day readmissions, catheter complications and costs. The program addresses a measurable capacity problem with a model supported by national guidance and published evidence, and it is expected to repay its costs many times over.
References
Hawes, A. M., Yanek, L. R., Buresh, M. E., Abdel-Galil, R., Bodnar, A., Falade-Nwulia, O. O., & Keller, S. C. (2026). Outcomes in skilled nursing facilities versus other locations in outpatient parenteral antimicrobial therapy among patients with substance use disorders. Antimicrobial Stewardship & Healthcare Epidemiology, 6(1), e121. https://doi.org/10.1017/ash.2026.10364
Manders, I. G., Comello, D., Souverein, D., Euser, S., Herpers, B. L., Vetten, J., Kalpoe, J. S., Goeijenbier, M., & van Lelyveld, S. F. L. (2025). The impact of a structured outpatient parenteral antimicrobial therapy (OPAT) programme on quality of care, optimisation of antimicrobial use, and healthcare costs: A retrospective cohort study. Antibiotics, 14(11), 1103. https://doi.org/10.3390/antibiotics14111103
Norris, A. H., Shrestha, N. K., Allison, G. M., Keller, S. C., Bhavan, K. P., Zurlo, J. J., Hersh, A. L., Gorski, L. A., Bosso, J. A., Rathore, M. H., Arrieta, A., Petrak, R. M., Shah, A., Brown, R. B., Knight, S. L., & Umscheid, C. A. (2019). 2018 Infectious Diseases Society of America clinical practice guideline for the management of outpatient parenteral antimicrobial therapy. Clinical Infectious Diseases, 68(1), e1-e35. https://doi.org/10.1093/cid/ciy745
What the D916 Task 1 instructions ask
The first D916 task asks you to make the financial and clinical argument for a capstone project. Expect to describe an organizational challenge with data, explain how it was measured, propose a solution supported by evidence, compare alternatives, put numbers on what the project costs and saves, name who is affected and what could go wrong, and close with a recommendation. The organization may be yours or a composite. Graders want a challenge measured carefully, a solution with published evidence behind it, alternatives compared fairly, a financial estimate with stated assumptions and a sensitivity check, and risks named with responses. A business case that assumes the best outcome and hides its assumptions falls short of the financial aspects. The case sets up the sustainability plan and presentation that follow, so choose a project you can carry through all three.
How this D916 Task 1 example is built
The case opens with the operational pressure the hospital faces, measured in occupancy and boarding. A method section explains how the number of IV-only days was found and why a chart review lowered it, which builds trust in the figure. The solution section describes how the program selects patients, where they receive infusions and who oversees them. Three alternatives, including continuing as now and contracting with a home infusion company, are weighed with reasons. A cost and benefit table shows assumptions, and a paragraph tests the result at half the expected volume. Stakeholders and risks each take a section, and the recommendation names the services to start with and the measures that will judge the pilot.
Where the D916 Task 1 rubric puts the marks
D916 Task 1 aspects are rated competent, approaching competence or not evident. A challenge aspect asks for an organizational problem described with data. A measurement aspect rewards a clear method. A solution aspect looks for evidence supporting the proposal. An alternatives aspect wants options compared. A financial aspect asks for costs, benefits, assumptions and sensitivity. Stakeholder, risk and recommendation aspects look for completeness and judgment. Graders notice when a sensitivity check shows the case still holds under less favorable assumptions, and they expect research on the solution's safety and outcomes to be cited, since a capstone must stand on evidence as well as on finances. Tables with labeled assumptions help.
D916 Task 1 help: what sends it back
Business cases in D916 are weakened most by a number no one can trace. Explain how you counted the problem. They are also weakened by optimism; state assumptions and test the case at lower volume. Alternatives are often dismissed in a line, when each deserves a fair description and a reason. Risks are sometimes left out to make the case look stronger, but graders and executives trust cases that name clinical and financial risks with responses. Last, the recommendation should be specific about scope, timing and measures, so the sustainability plan in Task 2 has a clear program to sustain.
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D916 Task 1 questions, answered
Is the D916 hospital real?
No. Lakeview General Hospital and its figures are invented for the sample. The research on outpatient IV antibiotic programs, their safety and their outcomes is real and cited.
What is a sensitivity check in D916 Task 1?
A test of whether the case still holds when an assumption changes. The sample recalculates the benefit at half the expected volume and shows the program still produces a net gain.
How should D916 Task 1 compare alternatives?
Describe each option fairly, including doing nothing, and explain its costs, benefits and risks. The sample weighs the status quo, a contracted home infusion company and a hospital-led program.
Does D916 Task 1 connect to Tasks 2 and 3?
Yes. The business case defines the program, the sustainability plan in Task 2 keeps it running and the presentation in Task 3 brings both to leaders. Choose a project you can carry through all three.
Where can I find a free D916 Task 1 sample paper?
This page shows the complete IV antibiotic business case, cost table and sensitivity check included. Send the challenge your D916 capstone addresses, and your first custom business case is on us.