A research letter published in a 2017 issue of the Journal of the American Medical Association (JAMA) addressed a common misperception that sepsis—which accounts for 20 to 30% of all hospital deaths in the US every year—is a short-term condition that is fully resolved once a patient is discharged from the hospital. It is not.
In fact, sepsis accounts for more than 12% of all hospital readmissions—far exceeding rates of heart failure, pneumonia, chronic obstructive pulmonary disease, and heart attack, which are the four medical conditions the federal government tracks to measure quality of care. Worse, the estimated average cost per readmission for sepsis is $10,070—a figure that also exceeds the costs of each of the four other conditions.
Despite such findings, many hospitals and health systems underuse powerful resources for preventing readmission: patient education and patient engagement. Peer-reviewed research in the past few years has clearly demonstrated that failure to effectively engage patients and their circles of family and friends in the areas of sepsis prevention and the management of recurring symptoms after discharge from the hospital hurts both patients and hospitals. Following are some of the findings.
- 42% of readmissions for severe sepsis occurred based on diagnoses that could potentially have led to prevention or early treatment that would have avoided hospitalization, according to a 2015 JAMA article.
- A 2018 JAMA article found that in the months after hospital discharge for sepsis, it’s especially important that patients be monitored for physical, mental, or cognitive symptoms—including treatable conditions that commonly result in hospitalization—and that healthcare providers stay on top of medication adjustments.
- “Highly supportive discharge interventions will enhance patient capacity to enact burdensome self-care and avoid readmissions” for high-risk conditions. (Source: 2014 JAMA Internal Medicine).
What does a highly supportive sepsis discharge intervention look like?
For one, it goes beyond holding a bedside conversation and handing a sheaf of complicated discharge instructions to a patient who in many cases is compromised both physically and cognitively. Patients—and their families, too, who also are typically struggling in the aftermath of a loved one’s hospitalization—need a simple way to revisit key patient-care information—when they are ready.
Effective patient engagement recognizes that individuals absorb information in different ways and have different levels of health literacy. And although clinical teams should certainly continue with discharge discussions and written patient instructions, they should also give patients certain options for revisiting the information on their own time: when they are less compromised and in a better position to absorb such information. Studies have shown that well-designed patient education videos, clear visual presentations, and a simple, welcoming voice can make complex health conditions less frightening and more understandable. The more general understanding that these types of interventions give patients, fortifies them with the comfort and confidence they need to then review their specific discharge instructions and follow them more closely.
Patient-engagement interventions should also complement clinician interactions. By stressing self-care, by demonstrating how to prevent and recognize infection, by emphasizing the importance of adherence to medication instructions, and by specifying when to check in with a primary care provider, sepsis care outside the hospital can keep patients well and enable clinicians to focus on areas that truly demand clinical expertise.
Finally, hospitals should test the results and adapt their educational programs based on what they discover about their particular patient populations.
The thinking is simple. If hospitals can craft effective patient-engagement programs for sepsis prevention or recurrence, evidence is mounting that they will reduce costly and deadly readmissions and will garner genuine improvements in patient satisfaction.