Sepsis Among Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012–2018*

Buchman, Timothy G.; Simpson, Steven Q.; Sciarretta, Kimberly L.; Finne, Kristen; Sowers, Nicole; Collier, Michael; Chavan, Saurabh; Oke, Ibijoke; Pennini, Meghan E.; Santhosh, Aathira; Wax, Marie; Woodbury, Robyn; Chu, Steve; Merkeley, Tyler; Disbrow, Gary L.; Bright, Rick A.; MaCurdy, Thomas; Kelman, Jeffrey A.

doi:10.1097/ccm.0000000000004226

Cited by 42 publications

(29 citation statements)

References 16 publications

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“…Although data are limited regarding the proportion of patients with COVID-19 in other countries who have needed some form of postacute care, historical data from Medicare suggest that more than 30% of patients hospitalized with sepsis, a condition with inpatient mortality similar to that associated with COVID-19, 2 require facility-based care and another 20% require home health care. 3 Postacute care is also a "pop-off valve" for hospital capacity, in that moving patients to a such a setting once they recover from the most acute phase of their illness could free up hospital beds. Medicare has already loosened restrictions on criteria for transfers by relaxing the 3-day rule, 4 which requires a Medicare beneficiary to spend 3 days in the hospital to qualify for the skilled nursing facility benefit.…”

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confidence: 99%

“…Depending on the patient’s needs, treatment may include a stay in a facility, such as a skilled nursing facility, inpatient rehabilitation facility, or long-term care hospital, or care in the home via a home health agency. Although data are limited regarding the proportion of patients with COVID-19 in other countries who have needed some form of postacute care, historical data from Medicare suggest that more than 30% of patients hospitalized with sepsis, a condition with inpatient mortality similar to that associated with COVID-19, require facility-based care and another 20% require home health care …”

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confidence: 99%

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Postacute Care Preparedness for COVID-19

Grabowski

Maddox

2020

JAMA

159

138

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National projections suggest that hospitals may be overwhelmed with patients with coronavirus disease 2019 infection in the coming months. Appropriately, much attention has addressed the acute challenges in caring for this surge of critically ill patients. What has received less attention, however, is what happens as patients-most of whom will recover, even in the highest-risk groups-begin to do so. Many patients with COVID-19 will need postacute care to recuperate from their infection. However, postacute care facilities currently lack the capacity and capability to safely treat patients with COVID-19 as they transition from the hospital to other care settings or to their homes. In this Viewpoint, we present the scope of the problem and outline a series of steps that may be helpful as postacute care organizations prepare for the coming increase in patients with COVID-19.Postacute care includes rehabilitation or palliative services that beneficiaries receive following a stay in an acute care hospital. 1 Depending on the patient's needs, treatment may include a stay in a facility, such as a skilled nursing facility, inpatient rehabilitation facility, or long-term care hospital, or care in the home via a home health agency. Although data are limited regarding the proportion of patients with COVID-19

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confidence: 99%

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confidence: 99%

Postacute Care Preparedness for COVID-19

Grabowski

Maddox

2020

JAMA

159

138

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“…Our findings that older age and higher frailty score are both associated with increased risk of mortality from sepsis, within an elderly population with high comorbidity burden, emphasise the threat of sepsis to patients throughout our hospitals 3 , 30 – 32 . The observations that heart failure and previous chemotherapy are associated with higher mortality from sepsis, are not new and are supported by results from large international cohorts 11 , 33 , 34 .…”

Section: Discussionmentioning

confidence: 83%

“…Previously much attention was dedicated to the identification and treatment of patients at risk of poor outcomes within intensive care units (ICU) 7 , 8 . However, it is now known that the majority of patients with sepsis present in the emergency department (ED) and on general wards, with associated high mortality 9 – 11 .…”

Section: Introductionmentioning

confidence: 99%

Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards

Kopczynska

Unwin

Pugh

et al. 2021

Sci Rep

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The ‘Sepsis Six’ bundle was promoted as a deliverable tool outside of the critical care settings, but there is very little data available on the progress and change of sepsis care outside the critical care environment in the UK. Our aim was to compare the yearly prevalence, outcome and the Sepsis Six bundle compliance in patients at risk of mortality from sepsis in non-intensive care environments. Patients with a National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled into four yearly 24-h point prevalence studies, carried out in fourteen hospitals across Wales from 2016 to 2019. We followed up patients to 30 days between 2016–2019 and to 90 days between 2017 and 2019. Out of the 26,947 patients screened 1651 fulfilled inclusion criteria and were recruited. The full ‘Sepsis Six’ care bundle was completed on 223 (14.0%) occasions, with no significant difference between the years. On 190 (11.5%) occasions none of the bundle elements were completed. There was no significant correlation between bundle element compliance, NEWS or year of study. One hundred and seventy (10.7%) patients were seen by critical care outreach; the ‘Sepsis Six’ bundle was completed significantly more often in this group (54/170, 32.0%) than for patients who were not reviewed by critical care outreach (168/1385, 11.6%; p < 0.0001). Overall survival to 30 days was 81.7% (1349/1651), with a mean survival time of 26.5 days (95% CI 26.1–26.9) with no difference between each year of study. 90-day survival for years 2017–2019 was 74.7% (949/1271), with no difference between the years. In multivariate regression we identified older age, heart failure, recent chemotherapy, higher frailty score and do not attempt cardiopulmonary resuscitation orders as significantly associated with increased 30-day mortality. Our data suggests that despite efforts to increase sepsis awareness within the NHS, there is poor compliance with the sepsis care bundles and no change in the high mortality over the study period. Further research is needed to determine which time-sensitive ward-based interventions can reduce mortality in patients with sepsis and how can these results be embedded to routine clinical practice.Trial registration Defining Sepsis on the Wards ISRCTN 86502304 https://doi.org/10.1186/ISRCTN86502304 prospectively registered 09/05/2016.

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“…This high incidence of sepsis coupled with poor clinical outcome places a heavy burden on health care systems and consumes a high proportion of already scarce hospital resources (e.g., personnel, hospital beds, intensive care capacity). According to a recent study by Buchman et al conducted in the USA, the human and economic costs of sepsis care continue to grow [6][7][8].…”

Section: Introduction 1backgroundmentioning

confidence: 99%

Diagnostic Performance of Procalcitonin for the Early Identification of Sepsis in Patients with Elevated qSOFA Score at Emergency Admission

Bolanaki

Möckel

Winning³

et al. 2021

JCM

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Infectious biomarkers such as procalcitonin (PCT) can help overcome the lack of sensitivity of the quick Sequential Organ Failure Assessment (qSOFA) score for early identification of sepsis in emergency departments (EDs) and thus might be beneficial as point-of-care biomarkers in EDs. Our primary aim was to investigate the diagnostic performance of PCT for the early identification of septic patients and patients likely to develop sepsis within 96 h of admission to an ED among a prospectively selected patient population with elevated qSOFA scores. In a large multi-centre prospective cohort study, we included all adult patients (n = 742) with a qSOFA score of at least 1 who presented to the ED. PCT levels were measured upon admission. Of the study population 27.3% (n = 202) were diagnosed with sepsis within the first 96 h. The area under the curve for PCT for the identification of septic patients in EDs was 0.86 (95% confidence interval (CI): 0.83–0.89). The resultant sensitivity for PCT at a cut-off of 0.5 µg/l was 63.4% (95% CI: 56.3–70.0). Furthermore, specificity was 89.2% (95% CI: 86.3–91.7), the positive predictive value was 68.8% (95% CI: 62.9–74.2), and the negative predictive value was 86.7% (95% CI: 84.4–88.7). The early measurement of PCT in a patient population with elevated qSOFA score served as an effective tool for the early identification of sepsis in ED patients.

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Sepsis Among Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012–2018*

Cited by 42 publications

References 16 publications

Postacute Care Preparedness for COVID-19

Postacute Care Preparedness for COVID-19

Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards

Diagnostic Performance of Procalcitonin for the Early Identification of Sepsis in Patients with Elevated qSOFA Score at Emergency Admission

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