Post–Acute Care Use and Hospital Readmission after Sepsis

Jones, T.K.; Fuchs, Barry D.; Small, Dylan S.; Halpern, Scott D.; Hanish, Asaf; Umscheid, Craig A.; Baillie, Charles A.; Kerlin, Meeta Prasad; Gaieski, David F.; Mikkelsen, Mark E.

doi:10.1513/annalsats.201411-504oc

Cited by 111 publications

(115 citation statements)

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“…The target population included survivors with a MICU length of stay of at least 2 days who were not discharged to hospice. Eligible subjects were identified using a previously validated administrative clinical database (20). The study was reviewed and approved by the institutional review board with the use of verbal informed consent (protocol #820066).…”

Section: Methods Study Design and Populationmentioning

confidence: 99%

Resilience in Survivors of Critical Illness in the Context of the Survivors’ Experience and Recovery

Maley¹,

et al. 2016

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Rationale: Post-intensive care syndrome (PICS), defined as new or worsening impairment in cognition, mental health, or physical function after critical illness, is an important development in survivors. Although studies to date have focused on the frequency of these impairments, fundamental questions remain unanswered regarding the survivor experience and the impact of the critical illness event on survivor resilience and recovery.Objectives: To examine the association between resilience and neuropsychological and physical function and to contextualize these findings within the survivors' recovery experience. Methods:We conducted a mixed-methods pilot investigation of resilience among 43 survivors from two medical intensive care units (ICUs) within an academic health-care system. We interviewed survivors to identify barriers to and facilitators of recovery in the ICU, on the medical ward, and at home, using qualitative methods. We used a telephone battery of standardized tests to examine resilience, neuropsychological and physical function, and quality of life. We examined PICS in two ways. First, we identified how frequently survivors were impaired in one or more domains 6-12 months postdischarge. Second, we identified how frequently survivors reported that neuropsychological or physical function was worse. Measurements and Main Results:Resilience was low in 28% of survivors, normal in 63% of survivors, and high in 9% of survivors. Resilience was inversely correlated with self-reported executive dysfunction, symptoms of anxiety, depression, and post-traumatic stress disorder, difficulty with self-care, and pain (P , 0.05). PICS was present in 36 survivors (83.7%; 95% confidence interval, 69.3-93.2%), whereas 23 survivors (53.5%; 95% confidence interval, 37.6-68.8%) reported worsening of neuropsychological or physical function after critical illness. We identified challenges along the recovery path of ICU survivors, finding that physical limitations and functional dependence were the most frequent challenges experienced in the ICU, medical ward, and on return to home. Spiritual and family support facilitated recovery. Conclusions:Resilience was inversely correlated with neuropsychological impairment, pain, and difficulty with self-care. PICS was present in most survivors of critical illness, and 54% reported neuropsychological or physical function to be worse, yet resilience was normal or high in most survivors. Survivors experienced many challenges during recovery, while spiritual and family support facilitated recovery.

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Section: Methods Study Design and Populationmentioning

confidence: 99%

Resilience in Survivors of Critical Illness in the Context of the Survivors’ Experience and Recovery

Maley¹,

et al. 2016

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“…(9) A growing body of literature describes hospital readmissions after initial treatment for severe sepsis. (6, 7, 10–12) Sepsis readmissions are important not only because of the potential financial implications, but also because these events may signify shortcomings in initial inpatient treatment or follow-up outpatient care. Studies of community medical centers and samples of tertiary care hospitals have identified increased short- and long-term readmission rates among patients discharged after treatment for sepsis.…”

Section: Introductionmentioning

confidence: 99%

“…Studies of community medical centers and samples of tertiary care hospitals have identified increased short- and long-term readmission rates among patients discharged after treatment for sepsis. (6, 7, 10, 11) However, there are no national data describing hospital readmissions after severe sepsis. Furthermore, few studies have focused on very early severe sepsis readmissions (i.e.…”

Section: Introductionmentioning

confidence: 99%

Unplanned Readmissions After Hospitalization for Severe Sepsis at Academic Medical Center–Affiliated Hospitals*

Donnelly

Hohmann

Wang

2015

Critical Care Medicine

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OBJECTIVE In the United States (US), national efforts to reduce hospital readmissions have been enacted, including the application of substantial insurance reimbursement penalties for hospitals with elevated rates. Readmissions after severe sepsis remain under-studied and could possibly signify lapses in care and missed opportunities for intervention. We sought to characterize 7- and 30-day readmission rates following hospital admission for severe sepsis as well as institutional variations in readmission. DESIGN Retrospective analysis of 345,657 severe sepsis discharges from University HealthSystem Consortium (UHC) hospitals in 2012. SETTING US PATIENTS We applied the commonly cited method described by Angus, et al. for identification of severe sepsis, including only discharges with sepsis present on admission. MEASUREMENTS AND MAIN RESULTS We identified unplanned, all-cause readmissions within 7- and 30-days of discharge using claims-based algorithms. Using mixed effects logistic regression, we determined factors associated with 30-day readmission. We used risk-standardized readmission rates (RSRRs) to assess institutional variations. Among 216,328 eligible severe sepsis discharges, there were 14,932 readmissions within 7 days (6.9%; 95% CI 6.8–7.0) and 43,092 within 30 days (19.9%; 95% CI 19.8–20.1). Among those readmitted within 30 days, 66.9% had an infection and 40.3% had severe sepsis on readmission. Patient severity, length of stay, and specific diagnoses were associated with increased odds of 30-day readmission. Observed institutional 7-day readmission rates ranged from 0–12.3%, 30-day rates from 3.6–29.1%, and 30-day RSRRs from 14.1–31.1%. Greater institutional volume, teaching status, trauma services, location in the Northeast and lower ICU rates were associated with poor RSRR performance. CONCLUSIONS Severe sepsis readmission places a substantial burden on the healthcare system, with one-in-fifteen and one-in-five severe sepsis discharges readmitted within 7 and 30 days, respectively. Hospitals and clinicians should be aware of this important sequela of severe sepsis.

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“…A maioria das mortes ocorreu nos primeiros seis meses, mas o risco permaneceu elevado aos dois anos. Após a alta do hospital, a sepse comporta um maior risco de morte (até 20%), bem como um risco aumentado de sepse adicional e internações hospitalares recorrentes (até 10% são readmitidos) (15)(16)(31)(32) . …”

Section: Discussionunclassified

Diagnóstico De Sepse Em Pacientes Após Internação Em Unidade De Terapia Intensiva

Moura¹,

Sanches²,

Pereira³

et al. 2017

ACS

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Conflito de interesses:Não Contribuição dos autores: JMM coleta, tabulação, delineamento do estudo e redação do manuscrito. EBS delineamento do estudo. RAPM delineamento do estudo e elaboração do manuscrito. ISF orientação do projeto, discussão dos achados, etapas de execução e elaboração do manuscrito, delineamento do estudo e elaboração do manuscrito. LMC orientação do projeto, delineamento do estudo e elaboração do manuscrito. ALW orientação do projeto, discussão dos achados, etapas de execução e elaboração do manuscrito, delineamento do estudo e elaboração do manuscrito. Contato para correspondência: Joice Marques Moura E-mail: joice_aww@hotmail. AbstractIntroduction: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Patients with sepsis (formerly called severe sepsis) should still be identified by the same organ dysfunction criteria (including lactate level greater than 2 mmol/L). Organ dysfunction may also be identified in the future using the quick Sepsis-Related Organ Failure Assessment (qSOFA). Currently, sepsis is one of the main causes of mortality in Intensive Care Units. In 2003, the Sepsis Surviving Campaign was created, elaborating a schedule of actions to reduce the incidence of sepsis, especially in intensive care units. Objective: To know the clinical characteristics and outcome of patients who developed sepsis during Intensive Care Units admission. Material and Methods: This is a retrospective, descriptive study using a quantitative approach performed at the Intensive Care Units. Data were obtained through an electronic medical record. The software Epi Info, version 7.2.1.0 was used to analyze data. Results:The largest number of patients hospitalized was male, aged from 51 to 70 years. The most common comorbidities were Systemic Hypertension, Diabetes Mellitus, alcoholism, smoking, and heart disease. The most analyzed post-sepsis outcome was discharge from Intensive Care Units, and the patients were considerably males. Conclusion: We conclude that the patients who most developed sepsis were men (62%), aged ranging from 51 to 70 years (36%). The main comorbidity was systemic hypertension (42%) and the most observed outcome was discharge from the Intensive Care Units (67%). consenso e novas definições de sepse foram publicadas, conhecidas como Sepsis 3, definida pela "presença de disfunção orgânica ameaçadora à vida secundária à resposta desregulada do organismo à infecção" (2) . Para avaliação do diagnóstico clínico de disfunção or gânica, atualmente são observados uma variação de dois ou mais pontos no escore Sequential Organ Failure Assessment (SOFA). Os critérios da síndrome da resposta inflamatória sistêmica (SRIS) não são mais usados para a definição. Os casos de sepse passam a ser considerados como doença grave, assim, não se usa mais a expressão "sepse grave". Choque séptico é definido como "um subgrupo dos pacientes com sepse que apresentam acentuadas anormalidades circulatórias, celulares e metabólicas e associadas com maio...

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Post–Acute Care Use and Hospital Readmission after Sepsis

Cited by 111 publications

References 53 publications

Resilience in Survivors of Critical Illness in the Context of the Survivors’ Experience and Recovery

Resilience in Survivors of Critical Illness in the Context of the Survivors’ Experience and Recovery

Unplanned Readmissions After Hospitalization for Severe Sepsis at Academic Medical Center–Affiliated Hospitals*

Diagnóstico De Sepse Em Pacientes Após Internação Em Unidade De Terapia Intensiva

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