Fewer people now die of sepsis in the hospital thanks to early intervention efforts, but new research shows that clinicians need better strategies to provide care to patients after discharge.
The life-threatening condition is the leading cause of death of hospital patients and readmissions and half of the survivors do not completely recover, according to researchers from the University of Pittsburgh and University of Michigan. Their review of medical literature found that a third of the patients who survive sepsis in the hospital die the following year and a sixth experience severe, persistent physical disabilities or cognitive impairment.
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The problem, they found, is that current treatment guidelines emphasize interventions that reduce short-term mortality, but don’t include strategies to minimize physical disability, cognitive impairment or health deterioration after sepsis.
"We need to focus not only on saving the patient's life, but on ensuring the patient will have the best possible quality of life after leaving the hospital,” said senior author Derek Angus, M.D., the Dr. Mitchell P. Fink Professor and chair of Pitt's Department of Critical Care Medicine, in a study announcement.
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Angus and Hallie Prescott, M.D., assistant professor of pulmonary and critical care medicine in U-M's Institute for Healthcare Policy & Innovation, suggest that clinicians focus on any new physical, mental and cognitive problems that may develop in patients in the months after hospital discharge for sepsis and quickly refer them for treatment of those problems. They must also review and adjust long-term medications and evaluate patients for treatable conditions that commonly result in hospitalization, such as infection, heart failure, renal failure and aspiration.
They also recommend that clinicians educate patients and their caregivers about sepsis and details of their hospital stay, refer them to support groups, and encourage them to establish their goals for future care and quality of life.
"While we are making these recommendations based on available research, many important questions about post-sepsis morbidity remain unanswered," said Prescott in the announcement. "Future research is needed to better characterize how pre-sepsis health affects long-term outcomes after sepsis so we can best tailor treatment and long-term recovery to the patient."