Sepsis patients treated and released from emergency departments do well with outpatient follow-up

May 24, 2018, Intermountain Medical Center
National guidelines assume that all patients who're diagnosed with clinical sepsis in an emergency department will be admitted to the hospital for additional care, but new research has found that many more patients are being treated and released from the ED for outpatient follow-up than previously recognized. Credit: Intermountain Medical Center.

National guidelines assume that all patients who're diagnosed with clinical sepsis in an emergency department will be admitted to the hospital for additional care, but new research has found that many more patients are being treated and released from the ED for outpatient follow-up than previously recognized.

Despite the finding that about 16 percent of sepsis patients who are diagnosed in the emergency department are not being admitted to the hospital, but are treated in the ED and released for outpatient management, researchers at Intermountain Medical Center in Salt Lake City found that these patients are still experiencing good outcomes.

"We found that many more emergency department patients with sepsis are discharged from the ED than previously recognized, but by and large these patients had fairly good outcomes," said principal investigator Ithan Peltan, MD, MSc, a pulmonary and critical care medicine specialist and researcher from Intermountain Medical Center in Salt Lake City, which is part of the Intermountain Healthcare system.

Researchers presented results from the study of nearly 16,000 sepsis patientsthis week at the American Thoracic Society's annual international conference in San Diego.

Sepsis is a life-threatening response to an infection. It occurs when chemicals released into the bloodstream to fight an infection trigger inflammatory responses throughout the body, which can trigger a cascade of changes that can damage multiple organ systems and cause them to fail. Without timely treatment, sepsis can rapidly cause tissue damage, organ failure, and death.

"Sepsis is a common and deadly problem among patients who come to the ," said Dr. Peltan. "While widely-accepted guidelines assume all sepsis patients will be admitted to the hospital, we found that about 16 percent are in fact discharged from the ED for outpatient management. Our research looked at sepsis patients who were discharged and investigated their outcomes."

The sepsis disease process isn't fully understood, and treatment is often complicated, which is one of the reasons guidelines have assumed sepsis patients need to be admitted to the hospital. However, the Intermountain Healthcare research suggests that physicians can identify a subset of sepsis patients who do well with outpatient management.

"Outpatient management of sepsis is likely not automatically 'wrong.' But wide variation in care provided by different physicians suggests there's room to identify criteria and develop and test tools clinicians can use to guide and optimize sepsis triage decisions," said Dr. Peltan.

For the study, researchers searched Intermountain Healthcare's Enterprise Data Warehouse, which is one of the nation's largest depositories of clinical data, at two referral hospitals and two community hospitals in Utah between July 2013 and January 2017.

Researchers identified 15,832 adult ED patients who met clinical sepsis criteria. After excluding repeat ED visits, trauma patients, patients who left the ED against medical advice or on hospice, or those who passed away in the ED, 12,002 of 13,419 eligible ED sepsis patients were included in the analysis. Patients who transferred to another acute care facility were considered to be admitted, whereas transfers to non-acute care in skilled nursing or psychiatric facilities were classified as discharges.

Unsurprisingly, patients who were discharged were much less ill than admitted patients. However, after accounting for illness severity and other factors, Dr. Peltan and his team found that discharged sepsis patients had about the same chance of dying in the following 30 days as admitted patients. Some ED physicians admitted all, or almost all, of the patients they treated, while others discharged up to 39% of their sepsis patients.

Additionally, the researchers found that 65% of patients who were treated and released from the ED were women, compared to 35% of the male patients who were admitted to the hospital. Researchers plan more to examine this and other potential disparities more closely in their next study. An initial hypothesis is that women may come to the ED earlier in their illness, meaning they're less sick.

"Physicians seem to do a good job of knowing who can be discharged," said Dr. Peltan. "However, there was quite a bit of variation between physicians regarding how many of their patients get discharged, which suggests it may be important to give clinicians guidance to ensure patients who need it are admitted to the , and to identify who can be considered for outpatient management and potentially avoid the inconvenience, expense, and risks of hospitalization."

Explore further: Prompt sepsis treatment less likely when ERs overcrowded

Related Stories

Prompt sepsis treatment less likely when ERs overcrowded

May 21, 2017
According to a new study, patients with sepsis, a life-threatening complication of an infection, had delays approaching one hour in being given antibiotics when seen in emergency rooms that were overcrowded. The study was ...

Surviving sepsis campaign update focuses on critical first hour

May 17, 2018
For patients with sepsis, a serious infection causing widespread inflammation, immediate treatment is essential to improve the chances of survival. An updated "Hour-1 Bundle" of the international, evidence-based guidelines ...

Putting the brakes on sepsis

May 10, 2018
Sepsis—an extreme response to infection—can cause damage to multiple organ systems when it triggers an uncontrolled inflammatory response.

Early lactate measurements appear to improve results for septic patients

May 24, 2018
On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a bundle of recommendations defining optimal treatment of patients suffering from sepsis, a life-threatening response to infection ...

Large number of patients admitted through ED with sepsis not given a formal diagnosis code

April 11, 2016
A large number of patients admitted through the emergency department with severe sepsis or septic shock are not given a specific International Classification of Disease (ICD) code used around the world to collect data on ...

Emergency departments see few cases of sepsis in adolescents

August 16, 2017
(HealthDay)—A typical emergency department sees few cases of sepsis among adolescents, according to a research letter published online Aug. 14 in JAMA Pediatrics.

Recommended for you

Self-lubricating latex could boost condom use: study

October 17, 2018
A perpetually unctuous, self-lubricating latex developed by a team of scientists in Boston could boost the use of condoms, they reported Wednesday in the journal Royal Society Open Science.

How healthy will we be in 2040?

October 17, 2018
A new scientific study of forecasts and alternative scenarios for life expectancy and major causes of death in 2040 shows all countries are likely to experience at least a slight increase in lifespans. In contrast, one scenario ...

Study finds evidence of intergenerational transmission of trauma among ex-POWs from the Civil War

October 16, 2018
A trio of researchers affiliated with the National Bureau of Economic Research has found evidence that suggests men who were traumatized while POWs during the U.S. Civil War transmitted that trauma to their offspring—many ...

Father's nicotine use can cause cognitive problems in children and grandchildren

October 16, 2018
A father's exposure to nicotine may cause cognitive deficits in his children and even grandchildren, according to a study in mice publishing on October 16 in the open-access journal PLOS Biology by Pradeep Bhide of Florida ...

Many supplements contain unapproved, dangerous ingredients: study

October 13, 2018
(HealthDay)—U.S. health officials have issued more than 700 warnings during the last decade about the sale of dietary supplements that contain unapproved and potentially dangerous drug ingredients, new research reveals.

Age at which women experience their first period is linked to their sons' age at puberty

October 12, 2018
The age at which young women experience their first menstrual bleeding is linked to the age at which their sons start puberty, according to the largest study to investigate this association in both sons and daughters.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.