sepsis

Stephanie Parks Taylor, MD, on Optimizing Post-Sepsis Care

Optimizing medications, screening for functional or mental health impairments, monitoring for common and preventable causes of health deterioration, and assessing for palliative care are 4 recommended care elements for patients who have been discharged after hospitalization for sepsis.

Authors of a new study1 evaluated the application rate of these elements in clinical practice and the effect of their application on mortality and hospital readmission within 90 days.

Of the 189 sepsis survivors included in the study, 117 (62%) had medications optimized, 123 (65%) had screening for functional or mental health impairments, 86 (46%) were monitored for common and preventable causes of health deterioration, and 110 (58%) had care alignment processes documented; 20 (11%) patients received all 4 care elements within 90 days. 

Ultimately, the researchers found that patients who had received 2 or more care elements had a lower risk of 90-day readmission and 90-day mortality compared with patients who had received 1 or no care element.

Infectious Diseases Consultant asked study co-author Stephanie Parks Taylor, MD, who is an internal medicine specialist from Atrium Health in Charlotte, North Carolina, about the variable delivery of the recommended post-sepsis care elements, the elements’ association with reduced morbidity and mortality after hospitalization for sepsis, and how barriers to the elements’ implementation can be overcome.

INFECTIOUS DISEASES CONSULTANT: What was the impetus for this study?

Stephanie Taylor: At Atrium Health—and around the world—we have made a lot of great strides in improving the early management of sepsis. We have seen decreasing mortality rates from initiatives that improve the early detection of sepsis, as well as from the rapid delivery of antibiotics, fluids, and other treatment. However, there is growing evidence that patients who survive an episode of sepsis face residual health deficits. Many sepsis survivors are left with new functional, cognitive, or mental health declines or worsening of their underlying comorbidities. They also face high rates of recurrent or new infections. Consequently, these patients have high rates of mortality and hospital readmission that persist for multiple years after hospitalization. In this study, we aimed to evaluate current care practices with the hope to identify a post-sepsis management strategy that could help nudge these patients toward a more meaningful recovery.

ID CON: What do the delivery rates of the 4 care elements suggest about the current outlook on and application of sepsis management?

ST: On face value, sure, it is disappointing to see that we are not providing these seemingly common-sense care processes to our patients who were hospitalized for sepsis upon their discharge. However, I actually found the results very encouraging—to show that providing these components was associated with improved outcomes gives us somewhere to start. We do not have to reinvent the wheel; we just have to work on implementation strategies for care processes we are already familiar with.

ID CON: Is any single care element—either alone or in combination with other care elements—most effective for lowering the odds of 90-day readmission or 90-day mortality? How may this influence the treatment plan clinicians prescribe their patients?

ST: In our setting, receiving physical assessment plus either swallowing assessment or mental health assessment was the element combination with the strongest association on reduced mortality and readmissions. I think this reinforces the importance of clinician awareness that sepsis survivors represent a vulnerable cohort and that close attention to downstream deficits might improve outcomes.

ID CON: What are the main barriers to achieving optimal delivery of the recommended post-sepsis care elements? How can these barriers be overcome?

ST: Transition out of the hospital is an extremely complex event, involving often-fragmented care settings, and patients with sepsis tend to require more-complicated management than other patients. It probably makes sense to provide an added layer of support during the transition out of the hospital for patients who are at high risk for poor outcomes. Fundamental questions about how to deliver post-sepsis care remain unanswered. This is where the field of implementation science plays such a great role, and we are currently conducting a hybrid implementation-effectiveness study—funded by the National Institutes of Health’s National Institute of Nursing Research—to investigate delivering post-sepsis care through a nurse navigator.

ID CON: How do you hope these results impact clinical practice?

ST: I think it is a call for clinicians to realize sepsis is more than just an episode of acute illness. The combination of a growing number of sepsis survivors and the increased health problems following sepsis creates an urgent public health challenge. We found that there is room for improvement in post-sepsis care to better address the complex factors affecting patients who survive sepsis. However, encouragingly, we do have a signal suggesting that strategies to more-effectively implement these routine care processes may improve outcomes for this vulnerable population.

Reference:

  1. Taylor SP, Chou S, Sierra MF, et al. Association between adherence to recommended care and outcomes for adult survivors of sepsis. Ann Am Thorac Soc. 2020;17(1):89-87. https://doi.org/10.1513/AnnalsATS.201907-514OC.