Life After Sepsis: Post-Sepsis Syndrome. Sepsis Virtual Event July 6, :00 1:00 p.m. CT

Transcription

1 Life After Sepsis: Post-Sepsis Syndrome Sepsis Virtual Event July 6, :00 1:00 p.m. CT 1

2 Mallory Bender, LCSW Program Manager, HRET WELCOME AND INTRODUCTIONS 2

3 Today s Agenda 3

4 WEBINAR PLATFORM QUICK REFERENCE Mute computer audio Today s presentation Chat with participants Download slides/resources Register for upcoming events

5 How Did You Hear About Today s Virtual Event? A) HRET HIIN flyer B) HRET HIIN website C) HRET LISTSERV D) State hospital association E) QIN-QIO F) Your organization/colleague G) Other, please specify.

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7 Data Updates 7

8 Post-Sepsis Care Syndrome- Surviving Sepsis is Just the Beginning Elizabeth Scruth PhD MPH RN CCNS CCRN FCCM Clinical Practice Consultant Clinical Effectiveness Team- Quality Division Kaiser Permanente NCAL 8

9 Objectives Describe the sequelae most common in sepsis survivors Identify risk factors that contribute to post sepsis care syndrome 9

10 Background Sepsis is an increasing burden in the USA Sepsis management has led to decreased mortality rates Increased number of survivors Little known about survivors of sepsis Sepsis survivors have increased healthcare utilization post survival Ongoing mortality up to 2 years post sepsis Sun, et al. Critical Care Medicine. 2016: Dick, Liu, Zwanziger et al. BMC Health Services Research

11 Sepsis survivors increased healthcare usage in the first year Increased 30 day readmission rates RBC transfusion, TPN and longer duration of antibiotics ( main risk factors) Insurance status, hospitalizations in prior year, length of stay Study showed 50% of the readmissions unresolved or recurrent infections Sun et al. Crit Care Med

12 Long term care admissions and home healthcare Two times more likely to be admitted to SNF in the five years after a sepsis admission Dick et al. BMC Health Services Research

13 Beneath Our Understanding of Sepsis 13

14 Sepsis and Chronic Health Chronic conditions increase risk of sepsis Most common infectious disease of hospitalization pneumonia leading to severe sepsis Chronic Health Conditions Diabetes Heart failure Cardiovascular disease Reduced lung function-severe Cognitive impairments Chronic kidney disease Yende, Iwashyna, Angus. Trends Mol Med

15 Severe reduction in lung function and or diabetes increases risk of pneumonia by over six fold- common cause of severe sepsis Unmeasured subclinical changes thought to play a role Circulating interleukin (IL)- 6, tumor necrosis factor ( TNF) and C-reactive protein ( CRP) Yende, Iwashyna, Angus., Trends Mol Med,

16 The Sequelae of Sepsis Severe sepsis/septic shock worsens Cognitive function Physical impairment Chronic kidney disease Cardiovascular disease Sleep patterns ( Common up to one year after sepsis) May persist for several years and accelerate underlying chronic diseases Shah et al. Am J Resp Crit Care Med.2013; Wunsch et al. JAMA. 2010: Iwashyna et al. JAMA. 2010: Altman et al. Ann Amer Thorac Soc

17 During the sepsis event the following may affect the long term recovery: Interventions- medications, early rehabilitation Immobilization Delirium Depression/anxiety Magnitude of host immune response Shah et al. Am J Resp Crit Care Med. 2013; Kellum et al. Arch Intern Med. 2007; Wunsch et al. JAMA

18 Impaired Immune Response Septic shock- tissue damage Preserving organ function during sepsis- effect on chronic health- complex Impaired immune response from sepsisdeaths up to 1 year post index event Sepsis survivors- more susceptible to infections reducing their quality of life (herpes zoster, lower airway infections) Medzhitov et al. Science. 2012; Kellum et al. Arch Intern Med. 2007; Arens et al. Critical Care

19 Social and Environmental Factors Both influence the development of severe sepsis and its outcomes Race and marital status Exposure to infection and health behaviors Health systems and family environment restoration of function family involvement/equipment needed Cox et al. Intensive Care Med

20 Preventing Sequelae from Sepsis? We know how to prevent mortality-but what about mitigating morbidity in sepsis? 20

21 Our actions/inactions/delays have long-term effects on the lives of our patients 21

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23 Next Steps for Patients with Post Sepsis Syndrome Suzie Fletcher BSN, RN, CMSRN Sepsis Coordinator Wesley Healthcare 23

24 ABOUT US Wesley Healthcare Wichita, Kansas Tertiary hospital licensed for 850 beds Teaching Hospital Children s Hospital Women s Hospital Over 500 babies delivered per month Smaller 85 bed hospital (Wesley Woodlawn Hospital and ER) 3 Emergency departments Pediatric emergency department 2 free standing emergency departments 24

25 Post- Discharge Clinic Planning Need for clinic 30 for days post-discharge transitional care Health Promotion Model (Kessler, Renggli, & Swiss Centre for International Health, 2011) Almost 20 percent of all Medicare patients are readmitted within 30 days (Alper, O Malley, and Greenwald, 2017) The cost of unplanned readmissions is 15 to 20 billion dollars annually (Beresford, 2011) Reduction in readmits Reduction in mortalities 25

26 Resources for: o o o o Post- Discharge Clinic Planning Assessment of current medical status Medication review and education Disease management education Focus on social environment and other non-medical issues 26

27 Next Steps Resources Data gathering Finance Written Proposal? 27

28 Contact Information Suzie Fletcher BSN, RN, CMSRN Sepsis Coordinator Wesley Medical Center 550 N. Hillside Wichita, Kansas Phone: (316) Cell: (316) Fax: (316)

29 References Alper, E., O Malley, T.A., & Greenwald, J. (2017, April 3). Hospital discharge and readmission. Beresford, L. (2011, December). Is a post-discharge clinic in your hospital s future? The Hospitalist Retrieved from Kessler, C., Renggli, V., & Swiss Centre for International Health. (2011, March 21). Health promotion: Concepts and practices. Retrieved from motion+model&rlz=1c1ggrv_enus751us751&oq=swiss+center+for+international+hea lth+health+promotion+model&aqs=chrome..69i j0j9&sourceid=chrome&ie=ut F-8 29

30 Its Not Just About Mortality Tools for Prevention & Recognition Maryanne Whitney Steve Tremain 30

31 Our actions/inactions/delays have long-term effects on the lives of our patients 31

32 Early Recognition Back to Basics Screening all ED patients at triage Screening all seriously ill inpatient Use BPA s Create action with a (+) sepsis screen Alerts, rapid response teams 32

33 Decrease Morbidity & Mortality Treat with urgency Blood cultures and lactate Antibiotics within the golden hour Fluid 30ml/kg for patients who are hypotensive of lactate >4mmol/L Early source identification and control 33

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35 Resources df 35

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37 Let s hear from you! Open the Lines 37

38 Bring It Home Mallory Bender, Program Manager, HRET 38

39 THANK YOU! 39