Discharge setting following sepsis hospitalization linked to readmission

Key takeaways:

• Thirty-day hospital readmission was observed in 23.6% of sepsis survivors, and sepsis was often the reason behind readmittance.
• Readmission was frequent in those thought well enough to be discharged home.

Among adult sepsis survivors readmitted within 30 days, more than two-thirds had been previously discharged to a skilled nursing facility, home health care or home, according to results published in American Journal of Critical Care.

Priscilla Hartley

“Infection emerged as a key factor in sepsis readmissions and presents a monumental opportunity for everyday clinicians to mitigate risk by removing devices and catheters as soon as possible, instituting aggressive antibiotic stewardship, identifying high-risk readmission patients, designing robust post discharge plans, allocating targeted case management, initiating palliative care referrals and teaching patients and families at the appropriate literacy level to bridge these complex transitions and gaps in care,” Priscilla Hartley, DNP, RN, assistant professor in the College of Nursing at Augusta University, Athens, Georgia, told Healio.

Using the Medical Information Mart for Intensive Care database, Hartley and colleagues assessed 7,107 adults (mean age, 66.5 years; 46.2% women; 77.2% white) who survived sepsis hospitalization to find out how discharge setting impacts 30-day readmission rates.

Thirty-day hospital readmission was observed in 1,674 survivors, or 23.6% of the study population, and sepsis was often the reason behind this, occurring in 68.3% of readmitted patients. Other frequent diagnoses at readmission included acute renal failure (28.7%), aspiratory pneumonia (26.1%), urinary tract infection (14.9%), hospital-acquired infections (9.4%) and heart failure (6.9%).

Additionally, the number of readmissions within this time frame fell between one and three for 30% of the 1,674 survivors (mean, 1.6 times), according to researchers.

When checking for significant relationships between readmission and several different factors (age, sex, race/ethnicity, discharge setting, insurance type, Charlson Comorbidity Index, Sequential Organ Failure Assessment [SOFA] score, Acute Physiology and Chronic Health Evaluation [APACHE] III score, hospital length of stay and mechanical ventilation), researchers found that older age (P = .02), discharge setting (P < .001), Charlson Comorbidity Index (P < .001), SOFA (P = .02), APACHE III (P = .004) and hospital length of stay (P < .001) emerged.

In the 30 days following discharge, a little over two-thirds (67.7%) of survivors aged older than 65 years had a readmission for sepsis and 46.5% had a readmission for another infection, according to the study.

The discharge setting with the most readmissions was skilled nursing facilities (29.6%), followed closely by home health care (26.9%). Survivors discharged to long-term acute care or home also frequently experienced readmission (17.4% and 15.2%, respectively).

“It was surprising that not only high readmission rates stemmed from patients thought well enough to be discharged home or home with health care, but that patients from these settings had multiple readmissions within 30 days,” Hartley told Healio.

Notably, when comparing the readmitted patients discharged to these four settings, researchers noted comparable Carlson Comorbidity Index and APACHE III scores.

However, readmitted patients in the nonhome discharge group more often had a readmission diagnosis of pneumonia, urinary tract infections or hospital-acquired infections than the home/home health care discharge group (47% vs. 35%; P < .001), according to the study.

“In the future, studies which test emerging strategies, such as the AI-assisted virtual hospital, hold great promise to improve patient outcomes,” Hartley told Healio. “Longitudinal studies will also be helpful as we evaluate transitional care pathways which span the entire acute care episode and inform our understanding of the concept of residual sepsis.”

Reference:

• Sepsis survivors remain at risk for readmission. https://www.aacn.org/newsroom/sepsis-survivors-remain-at-risk-for-readmission. Published Sept. 3 2024. Accessed Sept. 3, 2024.