Sepsis survivors remain at significant risk for readmission, with unexpectedly high rates of returning to the hospital for those discharged to home health care or home settings, according to a study published in American Journal of Critical Care (AJCC).
The Surviving Sepsis Campaign, launched in 2002, has led to a significant decrease in sepsis prevalence and nearly 30% decrease in sepsis-related deaths from 1990 through 2017. As a result of these successes, the focus has shifted from in-hospital survival to post-discharge morbidity and mortality for the growing number of sepsis survivors.
“Readmissions in Sepsis Survivors: Discharge Setting Risks” explores the link between readmission rate, discharge setting, and associated diagnoses for patients who were diagnosed with sepsis during a hospital stay and survived to discharge.
The study found that patients were often discharged to inappropriate settings, placing them at increased risk for residual sepsis and readmission.
Co-author Priscilla Hartley, DNP, RN, is an assistant professor, College of Nursing, Augusta University, Athens, Georgia campus.
“Multiple readmissions stemmed from patients considered well enough to be discharged home or to home health care, often due to another episode of sepsis or another infection,” she said. “We must find ways to close the gap between hospitals and all discharge settings if we wish to continue to improve the odds of surviving sepsis.”
The retrospective cohort study used data from the Medical Information Mart for Intensive Care IV (MIMIC-IV, v0.4), a publicly available single-hospital database of electronic medical record data on individuals admitted to Beth Israel Deaconess Medical Center between 2008 and 2019.
The study sample included 7,107 adult patients with at least one initial admission with a diagnosis of sepsis and/or septic shock who survived to be discharged from the hospital. Of these, 1,674 (23.6%) were readmitted within 30 days of discharge.
Among all patients who were readmitted, the most common readmission diagnoses were related to infection, with 68.3% including another episode of sepsis. About 30% of those who were readmitted between one and three times, often driven by infection.
The data analysis also examined Charlson Comorbidity Index (CCI), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, hospital length of stay, and use of mechanical ventilation, which provided additional insights to the findings.
Identifying the patients at highest risk of readmission can facilitate discharge to the appropriate setting to continue their recovery and guide interventions and follow-up, according to the authors.
To access the article and full-text PDF, visit the AJCC website at www.ajcconline.org.
The study joins the growing collection of sepsis-related clinical resources on the website of the American Association of Critical-Care Nurses (AACN), including a new micro-credential for clinicians to validate their specialty knowledge of sepsis care. The repository is filled with evidence-based research, webinars, podcasts, books, as well as insights from clinicians.
About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of about 130,000 acute and critical care nurses and can be accessed at www.ajcconline.org.
About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.
American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; x.com/aacnme
