“Growing evidence indicates that survivors of sepsis face multiple health challenges after their initial hospitalization, along with high rates of healthcare utilization and mortality,” explains Stephanie Parks Taylor, MD, MS. “With any serious illness, it is important to make sure that patients’ goals are known and that subsequent care delivered to the patient aligns with their goals. Although sepsis is one of the leading causes of death and post-discharge morbidity among hospitalized patients, little is known about how often care goals are measured prior to discharge and adhered to during the 90 days following sepsis hospitalization.”
For a paper published in the Journal of Hospital Medicine, Dr. Taylor and colleagues sought to investigate whether survivors of sepsis were having their care goals met and adhered to following discharge and whether hospitalization and/or hospital discharge might provide an opportunity to address those goals. They conducted a retrospective review of EHRs for 679 patients enrolled in a clinical trial of a sepsis transition and recovery program. Physicians and advance practice providers reviewed all available clinical documentation in the EHR to identify whether patients’ primary goals were noted. They classified goals as focused primarily on longevity, function, or comfort. Afterwards, palliative care physicians reviewed the EHR to determine whether the care patients received aligned with their stated goals. A total of 160 (24%) patients were discharged to home with health services, 145 (21%) to a skilled nursing facility, 44 (6%) to long-term acute care or other acute care hospital, and 21 (3%) to hospice.
Missing Opportunities to Identify & Document Care Goals
“The major takeaway from our study is that we are missing opportunities to identify and document the care goals of sepsis survivors,” Dr. Taylor says. “Following hospitalization for sepsis, patients have sustained mortality risk, high rates of declining health, and high rates of healthcare utilization. For patients with serious illnesses such as sepsis, it is crucial to know what their health goals are to ensure that we provide care that aligns with these goals. We found that only 19% of survivors of sepsis had goals documented explicitly in the EHR care alignment tool at discharge and only 40% of patients had identifiable goals after thorough review of the EHR. Moreover, for patients whose goals could be identified, 32% received care that was discordant with their goals.”
Additionally, the study team found that survivors of sepsis with documented goals were older, had higher comorbidity scores, a greater number of failed organs, longer hospital length of stay, and were more frequently discharged to hospice or facility-based care settings compared with patients whose goals were not documented (Table).
Hospitalization for Sepsis Is Life-Altering Event
“Physicians and other healthcare providers need to recognize that hospitalization for sepsis is a life-altering event that often evolves into a chronic illness with residual health problems and excess mortality risk,” Dr. Taylor says. “With this in mind, physicians need to capitalize on opportunities to identify and document patients’ health goals. We found that the goals of survivors of sepsis were fairly stable during the 90 days after discharge, suggesting that this period provides a ‘pause point’ to assess and document patients’ goals.”
Dr. Taylor and colleagues would like to see future research in this area focus on improving explicit documentation of patient goals following sepsis. “This would be an important first step towards the delivery of goal-concordant care,” Dr. Taylor concludes. “We found that explicit documentation of goals in the EHR was associated with 3.6-fold increased odds of receiving goal-concordant care. However, patients still receive goal-discordant care when their goals are known. Future research should identify key implementation factors that increase the likelihood that survivors of sepsis receive care that is consistent with their preferences.”