Becker's Clinical Quality & Infection Control

32 QUALITY IMPROVEMENT & MEASUREMENT How Penn Medicine is tackling sepsis readmissions By Mackenzie Bean P hiladelphia-based Penn Medicine is working to reduce sepsis readmissions and improve life aer 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 Pennsylva- nia, 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 prioritiz- ing timely sepsis care have led to improved outcomes and improved short-term mortality, specifically. ird, the immune system is impaired aer sepsis, leading to an in- creased risk for new or recurrent infections. is 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, oen 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 hos- pital. Life aer 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 sur- vivors. Last year, we partnered with home health services, design- ing 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. is year, we have begun to work with our skilled nursing facility part- ners to design an evidence-based care pathway to identify infection in sepsis survivors in the skilled nursing facility environment. ese inno- vative 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 [payment model] 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 read- missions? MM: ere are several practices that, when combined, reduce hospi- tal 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. ird, and related, surveillance post-discharge is a key strategy to im- prove health outcomes for sepsis survivors. By keeping an eye out for early signs and symptoms of infection, patients can identify minor setbacks before they become 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. ey 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. n "Hospitals should educate and empower sepsis survivors and their caregivers about sepsis survivorship." — Dr. Mark Mikkelsen, Chief of Medical Critical Care, Hospital of the University of Pennsylvania

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