Philadelphia-based Penn Medicine is working to reduce sepsis readmissions and improve life after sepsis for survivors with a new post-discharge care pathway.
Mark Mikkelsen, MD, chief of medical critical care and an associate professor of medicine at the Hospital of the University of Pennsylvania, played a critical role in developing the new pathway.
Here, Dr. Mikkelsen discusses the new pathway and shares how hospitals can help reduce sepsis-related readmissions.
Editor's note: Responses have been lightly edited for style and clarity.
Question: A 2017 JAMA study found sepsis is a leading cause of unplanned 30-day readmissions. What do you think is driving this trend?
Dr. Mark Mikkelsen: Sepsis is a leading cause of unplanned 30-day readmissions for several, related reasons. First, the population is aging. While sepsis can afflict anyone, anytime, it is more common among the elderly and the infirm. Second, national efforts prioritizing timely sepsis care have led to improved outcomes and improved short-term mortality, specifically.
Third, the immune system is impaired after sepsis, leading to an increased risk for new or recurrent infections. This leads to a vicious cycle where more patients with sepsis are entering our hospitals, more sepsis survivors are being discharged, and those survivors are at an increased risk for hospital readmission, often due to new or recurrent infection.
Q: Can you talk about Penn Medicine's post-discharge care pathway? How did you create the pathway and what types of benefits have you seen?
MM: Sepsis survivors spend, on average, a week or more in the hospital. Life after sepsis is challenging, with most patients experiencing new or worsening functional impairments that make returning home difficult at the time of hospital discharge. From this perspective, it is not surprising that most patients require post-acute care, such as home health services or admission to a skilled nursing facility.
We recognized that partnering with our post-acute care providers was a key strategic priority to improve outcomes for our sepsis survivors. Last year, we partnered with home health services, designing a program to rehabilitate their functional impairments and to recognize the signs and symptoms of a new or recurrent infection in the home care setting.
This year, we have begun to work with our skilled nursing facility partners to design an evidence-based care pathway to identify infection in sepsis survivors in the skilled nursing facility environment. These innovative approaches, focused on care coordination for the sepsis survivor, are designed to accelerate recovery and prevent any setbacks.
While initial analyses suggest reduced 90-day readmission rates for sepsis survivors enrolled in CMS' BPCI Advanced since we started participating in October 2018, we attribute these potential improvements to our general readmissions work. We look forward to assessing the impact of these more recent programs this upcoming year.
Q: What are some best practices to prevent sepsis readmissions?
MM: There are several practices that, when combined, reduce hospital readmissions and [that] we are applying to sepsis survivors.
First, we know that timely follow-up reduces hospital readmissions. To that end, we have prioritized that patients receive timely follow-up appointments prior to hospital discharge. Second, we recognize the importance of engaged and empowered patients and caregivers. As such, we have prioritized timely and effective education, beginning in the hospital for these critical team members.
Third, and related, surveillance post-discharge is a key strategy to improve health outcomes for sepsis survivors. By keeping an eye out for early signs and symptoms of infection, patients can identify minor setbacks before they became major setbacks, or worse.
Q: How can hospitals help improve survivors' lives post-sepsis?
MM: Hospitals should educate and empower sepsis survivors and their caregivers about sepsis survivorship. They can also partner with post-acute care providers to design care pathways that facilitate an enduring recovery (e.g., physical rehabilitation for those with new or worsening functional impairments) and avoid major, debilitating setbacks.
Q: Why is patient communication so crucial in sepsis care?
MM: Most patients with sepsis are unaware they had sepsis and have no understanding of the long-term consequences of sepsis. Long-term outcomes can only be improved with engaged, empowered and educated sepsis survivors.