Medical Research: What is the background for this study? What are the main findings?
Dr. Mikkelsen: Sepsis is common, afflicting as many as 3 million Americans each year. It is also costly, both in terms of health care expenditures that exceed $20 billion for acute care and in terms of the impact it has on patients and their families. To date, studies have focused on what happens to septic shock patients during the initial hospitalization. However, because more patients are surviving sepsis than ever, we sought to examine the enduring impact of septic shock post-discharge. We focused on the first 30 days after discharge and asked several simple questions. First, how often did patients require re-hospitalization after septic shock? And second, why were patients re-hospitalized?
We found that 23% of septic shock survivors were re-hospitalized within 30 days, many of them within 2 weeks. A life-threatening condition such as recurrent infection was the reason for readmission and 16% of readmissions resulted in death or a transition to hospice.
Medical Research: What should clinicians and patients take away from your report?
Dr. Mikkelsen: Clinicians who care for patients with septic shock should be mindful of the road that lays ahead for such patients post-discharge. Through thoughtful collaboration with discharge planning experts and outpatient providers, and increased awareness of what patients will encounter, the opportunity to facilitate a safer transition home and more sustained recovery can be achieved.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Mikkelsen: There is an urgent need to better understand what care processes during the acute care hospitalization for sepsis result in better long-term outcomes. There is also an urgent need to identify the aspects of sepsis care and/or sepsis itself that lead to adverse outcomes so that we can modify our approach to care delivery in a way that meets our patients needs in the short- and long-term.
Alexandra Ortego, David F. Gaieski, Barry D. Fuchs, Tiffanie Jones, Scott D. Halpern, Dylan S. Small, S. Cham Sante, Byron Drumheller, Jason D. Christie, Mark E. Mikkelsen. Hospital-Based Acute Care Use in Survivors of Septic Shock. Critical Care Medicine, 2014; 1 DOI: 10.1097/CCM.0000000000000693