They are alive thanks to the most advanced care modern hospitals can provide. But for survivors of sepsis, a critical illness that shuts down internal organs in response to a major infection, the hospital door often looks like a revolving one, a new study from the University of Michigan Medical School shows. And many of the conditions that send them back to a hospital bed should be preventable.
[Photo: Dr. Kenneth Langa]
Published in the new issue of JAMA, the finding suggests a need for better post-hospital care for sepsis patients to avoid readmissions that drive up costs and interfere with recovery. The results could help medical teams customize care to the special risks that sepsis survivors face – and do the same for other conditions too.
The researchers—including the School of Public Health’s Dr. Kenneth Langa, a professor of health management and policy and a faculty member in the U-M Department of Internal Medicine—made their findings using detailed data from 2,600 sepsis survivors. They compared those patients with the same number of patients who went to the hospital for other acute illnesses.
In both groups, about 42 percent of patients ended up back in the hospital within three months of going home. But when the researchers looked closely at what sent them back, differences began to emerge.
Patients who had survived sepsis were significantly more likely to get readmitted for a condition that could possibly have been prevented or treated early to avoid a hospital stay. They were especially more likely to end up back in the hospital due to a second bout of sepsis, or kidney or lung failure. They also had more hospitalizations linked to infections, including in the lungs, skin, and soft tissue as well as systemic sepsis.
Digging deeper into these differences could lead to customized ways of estimating each patient’s risk of preventable conditions before they leave the hospital, the researchers say. That could guide their health care providers to spot symptoms earlier and intervene before they get bad enough to need another hospital stay.
The researchers, who have studied many aspects of sepsis and post-sepsis care, included in their analysis the range of relatively common conditions that experts call “ambulatory care sensitive”. For these, the care provided at doctor’s visits can make a major difference in how well the patient does overall, and how well they avoid the hospital.
But since sepsis patients face specific risks, for instance due to their weakened kidneys or swallowing weakness related to the breathing tubes used in intensive care units, the researchers also included conditions that aren’t common among the general population—but arise more often in sepsis survivors.
“Getting on the right medications and diet, receiving counseling on infection risks and signs, and having kidney function tested more often could be examples of post-hospital interventions that sepsis survivors could benefit more from,” says Dr. Hallie Prescott, the lead author of the new paper and a critical care physician at the U-M Health System.
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