Sepsis Transition Program May Lower Mortality in Certain Patients

Sepsis survivors discharged to post-acute care facilities are at high risk for mortality and hospital readmission, according to Nicholas Colucciello, MD, and few interventions have been shown to reduce these adverse outcomes.

Colucciello and colleagues compared the effects of a Sepsis Transition And Recovery (STAR) program vs Usual Care (UC) alone on 30-day mortality and hospital readmission among sepsis survivors discharged to post-acute care.

In a study presented at the CHEST 2022 annual meeting, Colucciello, a primary care physician in Toledo, Ohio, presented data suggesting that the STAR intervention program is beneficial for patients discharged to post-acute care facilities and may lead to decreased 30-day mortality and readmission rates.

Study of IMPACTS

The study was a secondary analysis of patients from the IMPACTS (Improving Morbidity During Post-Acute Care Transitions for Sepsis) randomized clinical trial, focusing only on those patients who were discharged to a post-acute care facility. IMPACTS evaluated the effectiveness of STAR, a post-sepsis transition program using nurse navigators to deliver best-practice post-sepsis care during and after hospitalization. Colucciello said. The interventions included comorbidity monitoring, medication review, evaluation for new impairments/symptoms, and goals of care assessment.

"Over one third of sepsis survivors are discharged to post-acute care as they are not stable enough to go home," said Colucciello, and among these patients there is a high risk for mortality and hospital readmission.

Colucciello and his colleagues randomly assigned patients hospitalized with sepsis and deemed high risk for post-discharge readmission or mortality to either STAR or usual care. The primary outcome was a composite of 30-day readmission and mortality, which was assessed from the electronic health record and social security death master file.

Of the 175 (21%) IMPACTS patients discharged to post-acute care facilities, 143 (82%) were sent to skilled nursing facilities, and 12 (7%) were sent to long-term acute care hospitals. The remaining 20 patients (11%) were sent to inpatient rehabilitation. A total of 88 of these patients received the STAR intervention and 87 received usual care.

Suggestive Results

The study showed that the composite primary endpoint occurred in 26 (30.6%) patients in the usual care group vs 18 (20.7%) patients in the STAR group, for a risk difference of -9.9% (95% CI, -22.9 to 3.1), according to Colucciello. As individual factors, 30-day all-cause mortality was 8.2% in the UC group compared with 5.8% in the STAR group, for a risk difference of -2.5% (95% CI, -10.1 to 5.0) and the 30-day all-cause readmission was 27.1% in the UC group compared with 17.2% in the STAR program, for a risk difference of -9.8% (95% CI, -22.2 to 2.5). On average, patients receiving UC experienced 26.5 hospital-free days compared with 27.4 hospital-free days in the STAR group, he added.

The biggest limitation of the study was the fact that it was underpowered to detect statistically significant differences, despite the suggestive results, said Colucciello. However, he added: "This secondary analysis of the IMPACTS randomized trial found that the STAR intervention may decrease 30-day mortality and readmission rates among sepsis patients discharged to a post-acute care facility," he concluded.

Colucciello and colleagues report no relevant financial relationships.

CHEST. Published online October 1, 2022. Abstract

American College of Chest Physicians (CHEST) 2022 Annual Meeting. Presented October 16, 2022.

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