Sepsis patients treated in ED, released for outpatient care see improved outcomes

Although national guidelines assume all patients diagnosed with sepsis in the emergency department will be admitted to the hospital for more treatment, a recent study suggests significantly more patients are treated and released for outpatient follow-up than formerly realized.

"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," principal investigator Ithan Peltan, MD, a pulmonary and critical care medicine specialist and researcher from Salt Lake City-based Intermountain Medical Center, said in a news release. 

The research suggests physicians may be able to identify a subset of sepsis patients who would see good outcomes with outpatient management.

"Outpatient management of sepsis is likely not automatically 'wrong,'" Dr. Peltan said. "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."

The researchers gathered clinical data from Intermountain Healthcare's Enterprise Data Warehouse at two referral hospitals and two community hospitals in Utah between July 2013 and January 2017. The study identified nearly 16,000 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 died in the ED, 12,002 of 13,419 eligible ED sepsis patients were included in the analysis. 

The researchers classified patients who transferred to another acute care facility as admitted and patients who transferred to non-acute care as discharges. The findings revealed patients who were discharged were significantly less ill than admitted patients.

However, after the research team took illness severity and other factors into account, they found discharged sepsis patients had about the same chance of dying in the next 30 days as admitted patients. Some ED physicians admitted all or nearly all of the patients they treated. Other ED physicians discharged up to 39 percent of their sepsis patients.

"Physicians seem to do a good job of knowing who can be discharged," Dr. Peltan said. "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 hospital, and to identify patients who can be considered for outpatient management and potentially avoid the inconvenience, expense and risks of hospitalization."

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