Best Practices for Optimizing Recovery from Sepsis; Results of an Expert Panel.

BACKGROUND

Over one million patients survive sepsis annually in the USA. After sepsis, patients often experience new morbidity, with high rates of readmission and post-acute mortality. However, there are limited data to inform best practices to support recovery from sepsis.

METHODS

We convened an expert panel to rate the validity, importance, and resource intensity of 18 care practices aimed to support recovery from sepsis using the RAND/UCLA appropriateness method (a modified Delphi approach). The multidisciplinary panel consisted of 15 experts in sepsis, critical care, hospital medicine, primary care, geriatrics, nursing, and quality improvement, as well as Veteran patient representatives. In addition to the panel members' scores of care practices, panel deliberations were used to understand members' selections.

RESULTS

Among the 18 care practices considered, all received agreement in final grading, 10 (56%) were rated as valid, and eight (44%) were rated as uncertain validity. Among 10 valid practices, five were rated as high importance and only moderately resource-intensive-suggesting they should be prioritized for implementation. The high-importance, moderate resource-intensity practices were as follows: scheduling recommended follow-up prior to discharge; screening for limitations in basic and instrumental activities of daily living (I/ADLs) and need for durable medical equipment (DME); educating patients on signs and symptoms of sepsis; educating patients on common symptoms after sepsis (e.g., fatigue, shortness of breath, brain fog); and counseling patients and/or caregivers on discharge medications and their indications. Study limitations include the panel composition (majority VHA clinicians, no social work representation), which may have impacted ratings.

CONCLUSIONS

The expert panel used a validated method to prioritize care practices for supporting recovery from sepsis. These ratings can be used to improve management, inform quality improvement efforts, and guide resource allocation.