Receipt of Recovery-Oriented Care Practices During Hospitalization for Sepsis

Abstract

Survivors of sepsis hospitalization are at high risk for postsepsis morbidity, readmission, and death, but these negative outcomes can be mitigated by receipt of recommended care practices. We sought to assess factors associated with the receipt of recommended recovery-oriented care practices during hospitalization for sepsis. We hypothesized that patients treated in the ICU may be more likely than ward-treated patients to receive recommended care practices given the increasing focus on survivorship in the critical care field.DESIGN: Observational cohort study. SETTING:Michigan Medicine, a tertiary academic medical center. PATIENTS:Adult patients discharged alive from a hospitalization with a primary diagnosis of sepsis or septic shock in 2019. We further limited our cohort to patients receiving longitudinal care viewable in the Michigan Medicine electronic health record to ensure ability to capture posthospital care and outcomes. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Three-hundred sixty-five sepsis hospitalizations met study inclusion criteria. Using structured chart review, we determined receipt of the following recovery-based care practices during hospitalization: medication optimization, functional status evaluation at discharge, sepsis education, and scheduled follow-up within 2 weeks. The cohort was 46.6% female, 81.1% White, with a median age of 64 years. 51.2% were treated in the ICU. Medication optimization occurred in 93.7%, functional status evaluation in 82.7%, sepsis education in 20.0%, and scheduled follow-up within 2 weeks in 54.5%. ICU-treated patients had lower receipt of medication optimization and follow-up scheduling but greater receipt of functional and mental health status evaluations. In multivariable models, ICU treatment was associated with lower odds of receiving medication optimization (adjusted odds ratio, 0.72; 95% CI, 0.03-0.69) and not associated with receipt of other care practices. CONCLUSIONS:Our study shows incomplete receipt of recommended recovery-based care practices during sepsis hospitalization in both ward and ICUtreated patients. Sepsis education and mental health evaluation were particularly uncommon.

Institutional Structures and Processes to Support Sepsis Care: A Multihospital Study

“…Meanwhile, multiple peridischarge and recovery-based practices, such as scheduling of timely outpatient follow-up, screening for new limitations, and provision of anticipatory guidance, were rated among the lowest of the practices evaluated. These findings are consistent with other studies showing low delivery of recovery-oriented practices and suggest that later sepsis care may be a key opportunity for improvement of hospital sepsis management (11, 12). Sepsis QI initiatives have traditionally focused on early recognition and treatment.…”

A Multi-Hospital Survey of Current Practices for Supporting Recovery From Sepsis

“…A retrospective cohort of sepsis survivors ( 7 ) found that 62% of patients received medication optimization (vs 68.2% “always/nearly always” in our study), and 58% had documented care alignment discussions (vs 50.0% “always/nearly always”). Watson et al ( 10 ) also reported high adoption of medication optimization and limited implementation of sepsis education and mental health evaluation. Our work adds to the growing body of evidence demonstrating variable implementation of best practices for sepsis recovery and newly demonstrates that these gaps in care are seen across hospitals with high and low sepsis survival rates.…”