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Sepsis and Post-Sepsis Syndrome
The document discusses sepsis and its associated prognosis, including the impact of post-sepsis syndrome and the importance of early hospice referral. It highlights that sepsis affects millions annually, with significant mortality rates and healthcare costs, while emphasizing the role of hospice care for eligible patients in both acute and post-acute settings. The text outlines clinical characteristics, treatment considerations, and statistics on sepsis-related mortality and healthcare burdens.
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Sepsis and Post-Sepsis Syndrome
- 1. Sepsis and Post-Sepsis Syndrome Naturalhistory, determinants of prognosis and benefits of early hospice referral The information in the pages that follow is considered by VITASÂź Healthcare Corporation to be confidential.
- 2. Satisfactory Completion Learners mustcomplete an evaluation form to receive a certificate of completion. You must participate in the entire activity as partial credit is not available. If you are seeking continuing education credit for a specialty not listed below, it is your responsibility to contact your licensing/certification board to determine course eligibility for your licensing/certification requirement. Physicians In support of improving patient care, this activity has been planned and implemented by Amedco LLC and VITASÂź Healthcare. Amedco LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Credit Designation Statement â Amedco LLC designates this live activity for a maximum of 1 AMA PRA Category 1 CreditTM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. CME Provider Information
- 3. VITAS Healthcare programsare provided CE credits for their Nurses/Social Workers and Nursing Home Administrators through: VITAS Healthcare Corporation of Florida, Inc./CE Broker Number: 50-2135. Approved By: Florida Board of Nursing/Florida Board of Nursing Home Administrators/Florida Board of Clinical Social Workers, Marriage and Family Therapy & Mental Health Counseling. VITAS Healthcare programs in Illinois are provided CE credit for their Nursing Home Administrators and Respiratory Therapists through: VITAS Healthcare Corporation of Illinois, Inc./8525 West 183 Street, Tinley Park, IL 60487/NHA CE Provider Number: 139000207/RT CE Provider Number: 195000028/Approved By the Illinois Division of Profession Regulation for: Licensed Nursing Home Administrators and Illinois Respiratory Care Practitioner. VITAS Healthcare, #1222, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. VITAS Healthcare maintains responsibility for this course. ACE provider approval period: 06/06/2018 â 06/06/2021. Social workers completing this course receive 1.0 ethics continuing education credits. VITAS Healthcare Corporation of California, 310 Commerce, Suite 200, Irvine, CA 92602. Provider approved by the California Board of Registered Nursing, Provider Number 10517, expiring 01/31/2021. Exceptions to the above are as follows: AL: No NHAs, DE: No NHAs, DC: No NHAs, GA: No NHAs, KS: No NHAs, NJ: No NHAs, OH: No NHAs, PA: No NHAs, TX: No NHAs, VA: No NHAs, WI: No NHAs and Nurses are not required â RT only receive CE Credit in Illinois CE Provider Information
- 4. âą Appreciate therole of hospice in the care of patients who develop sepsis in acute-care hospital and post- acute care settings âą Discuss the role of post-sepsis syndrome and characteristics that support hospice eligibility Goal
- 5. âą Appreciate theidentification and natural history of sepsis âą Describe hospice eligibility for sepsis â Hospitalization â Post-acute âą Understand indicators of poor prognosis in sepsis âą Incorporate a care model for sepsis in hospice âą Integrate ICD-10 coding for sepsis Objectives
- 6. âą Sepsis affects1.7 million people per year in the US and 270,000 die from it1 â 30 million worldwide and 6 million deaths2 âą About 1 in 3 patients who die in a hospital have sepsis; many are hospice-eligible at admission1 âą Recommendations exist for inpatient hospital care â Standard/rapid identification and management âą No consensus recommendations exist on best post-acute care â New symptom burden â Pain, fatigue, dysphagia, poor attention, shortness of breath â Long-term disability: Cognitive and physical function âą Higher risk of hospital readmission and death compared to other conditions Background 1US Centers for Disease Control and Prevention. (2020). Data and Reports, retrieved from: https://www.cdc.gov/sepsis/datareports/index.html 2World Health Organization. 2020. Improving the prevention, diagnosis and clinical management of sepsis. Retrieved from: https://www.who.int/sepsis/en/
- 7. Rhee, C., Dantes,R., Epstein, L., Murphy, D. J., Seymour, C. W., Iwashyna, T. J., ... & Jernigan, J. A. (2017). Incidence and trends of sepsis in US hospitals using clinical vs claim data, 2009 to 2014. JAMA, 318(13), 1241-1249. Sepsis Incidence in US Hospitals, 2000 to 2014
- 8. âą The costof sepsis and post-sepsis care continues to be a serious healthcare burden âą Sepsis costs accounted for $23 billion, making it the most expensive condition treated in US hospitals âą The median hospital cost was $16,000 â Hospital-acquired: $38,000 â Community-acquired: $7,000 âą The comparative cost of care by disease states â Diabetes: $32,000 vs. non-diabetes: $13,000 âą Readmission cost averaged $25,000 Sepsis and Healthcare Costs
- 9. HPI: 66 y/ofemale presents to ED with multiple infected 1st- and 2nd-degree burn wounds to chest, abdomen, thighs, and arms after she slipped/fell on hot cooking oil seven days ago PMH: COPD with SOB at minimal exertion/rest on oxygen, AODM, severe PVD, obesity, s/p fall x 2, 1/6 ADL dependent Treatments: Spiriva and Advair Exam: Poor attention, temp. 104ÂșF, pulse 120 bpm, RR 28/min, BP 90/60, WBC 15 and 15% bands, lung sounds with bilateral congestion and wheezing to bases, grossly infected 1st- and 2nd-degree oil burn wounds (60% TBSA) Case of HS
- 10. What is Sepsis? âąSepsis is a life-threatening illness with host dysregulation brought on by the bodyâs response to an infection âą Sepsis can lead to: â Severe sepsis (acute organ dysfunction secondary to documented or suspected infection) â Septic shock (severe sepsis plus hypotension not reversed with fluid resuscitation) â Post-sepsis syndrome (immune, inflammatory, and endocrine changes resulting in cognitive and physical impairments)
- 11. SIRS: Systemic InflammatoryResponse Syndrome âą In 1991, SIRS criteria consensus conference established âSepsis-1â âą Sepsis-1 diagnosis requires at least two of the following: â Tachycardia (heart rate > 90 beats/min) â Tachypnea (respiratory rate > 20 breaths/min) â Fever or hypothermia (temperature > 38ÂșC or < 36ÂșC) â Leukocytosis, leukopenia or bandemia (white blood cells > 1,200/mm3, < 4,000/mm3 or bandemia â„ 10%) âą Sepsis is infection or suspected infection leading to SIRS
- 12. Max SOFA Score Mortality, % 0-6 <10 7-915-20 10-12 40-50 13-14 50-60 15 > 80 15-24 > 90 Marik P., Taeb A. (2017). SIRS, qSOFA and new sepsis definition. Journal of Thoracic Disease, 9(4), 943. SOFA: Sequential Organ Failure Assessment Score
- 13. qSOFA (Quick SOFA)Criteria Points Respiratory rate ℠22/min 1 Change in mental status 1 Systolic blood pressure †100 mmHg 1 qSOFA: quick Sequential Organ Failure Assessment Score
- 14. ©2019 VITASŸ HealthcareCorporation Adapted from Prescott, H., Angus, D. (2018). Enhancing Recovery from Sepsis: A Review. JAMA, 319(1), 62-75. Sepsis: Important Factors in Clinical Course and Outcomes Complex interactions among host, medical conditions, contextual, and pathogen factors Complex Interaction among host factors, medical conditions, manifestations of sepsis, and treatments Pre-sepsis (3 months) Onset of sepsis Hospitalization for sepsis Resolution of the acute septic episode Post-sepsis (3 months) Hot risk factors nutritional status, functional status, cognitive status, uncontrolled symptoms Medical conditions advanced illness, multimorbidity, fraility Contextual features recent hospitalizations, Ed visits, social determinants of health Pathogen factors virulence, load, antibiotic susceptibility, other Clinical manifestations circulatory shock, respiratory failure, renal injury, delirium, coma, coagulopathy, metabolic changes and increased lactate, other System dysregulation immune, inflammatory, endocrine, microbiome, other Treatment considerations Sepsis protocol, manage of pain and agitation, hospice care for non-responders/declining with treatment or goals-of-care comfort Clinical manifestations progression of host factors and/or medical conditions to end stage, recurrent infections, exacerbation of heart failure, COPD or acute renal failure, refractory delirium/cognitive impairment, swallowing dysfunction with dysphagia Contextual factors hospital readmission, ED visits Post-acute care skilled facility, home health, no post-acute care, hospice
- 15. ©2019 VITASŸ Healthcare CorporationAdapted from Prescott, H., Angus, D. (2018). Enhancing Recovery from Sepsis: A Review. JAMA, 319(1), 62-75. ⹠41% of patients admitted with sepsis die within 90 days ⹠42% of patients who survive are readmitted within 90 days Sepsis: Common Clinical Trajectories
- 16. Prescott, H., Angus,D. (2018). Enhancing Recovery from Sepsis: A Review. JAMA, 319(1), 62-75. Sepsis Characteristics âą Sepsis by physical location â 63% community-acquired â 26% health care-associated (NH/recent hospital/dialysis) â 11% hospital-acquired âą Sepsis by body location â Pneumonia (40%) â Abdominal â Genitourinary â Primary bacteremia â Skin/soft tissue infection
- 17. âą Admitted toICU from ED; Sepsis Alert System activated â Multiple IV antibiotics â Volume resuscitation â Wound care âą 48 hours post-admission, condition worsened â Mechanical ventilation initiated for acute respiratory failure secondary to bilateral pneumonia â Acute renal failure; hemodialysis initiated â IV vasopressors initiated â Thrombocytopenia â Hyperlactatemia Case of HS (cont.)
- 18. Rhee, C., Jones,T. M., Hamad, Y., Pande, A., Varon, J., OâBrien, C., ... & Klompas, M. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Network Open, 2(2), e187571-e187571. Sepsis and Hospital Mortality âą Approximately 25%-50% of hospital deaths are sepsis-related â 73.3% sepsis was present on admission â 26.3% developed sepsis during hospital stay âą Patients with hospital sepsis deaths compared to non-sepsis deaths were more likely to: â Be admitted from acute rehabilitation or long-term care â Be admitted to the intensive care unit â Die in the hospital than on hospice
- 19. Rhee, C., Jones,T. M., Hamad, Y., Pande, A., Varon, J., OâBrien, C., ... & Klompas, M. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Network Open, 2(2), e187571-e187571. Hospital Deaths, Sepsis and Hospice All Deaths âą 568 patients included in analysis â 395 (69.5%) died in the hospital â 173 (30.5%) discharged to hospice âą Of the 173 patients discharged to hospice â 59 (34.1%) died within one week Sepsis vs. Non-Sepsis Deaths âą 19% of sepsis deaths were referred to hospice âą 43.3% non-sepsis deaths were referred to hospice
- 20. Rhee, C., Jones,T. M., Hamad, Y., Pande, A., Varon, J., OâBrien, C., ... & Klompas, M. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Network Open, 2(2), e187571-e187571. Sepsis and Hospice Eligibility: Hospital âą 40% (121 of 300) of sepsis deaths met hospice eligibility guidelines at time of hospital admission âą Most common terminal conditions are as follows: â Solid cancer 20% â Hematologic cancer 5.3% â Advanced cardiac disease 16% â Dementia 5% â Stroke 4% â Advanced lung disease 4%
- 21. Sepsis and HospiceEligibility: Hospital âą Hospice-eligible, not previously identified: â Cancer, solid tumor, and hematologic â Advanced cardiac disease â Advanced lung disease â Dementia âą Clinical complications of sepsis associated with death: â Vasopressors â Mechanical ventilation â Hyperlactemia â Acute kidney injury â Hepatic injury â Thrombocytopenia
- 22. Causes of Deathin Patients with Sepsis Rhee, C., Jones, T. M., Hamad, Y., Pande, A., Varon, J., OâBrien, C., ... & Klompas, M. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Network Open, 2(2), e187571-e187571. 0 5 10 15 20 25 30 35 40 Sepsis Progressive Cancer Heart Failure Hemorrhage Cardiac Tamponade Stroke Myocardial Infarction Infection Without Sepsis Other Pulmonary Unknown Aspiration Other A Immediate cause of death in all patients All Deaths (Immediate Cause), % 0 5 10 15 20 25 Solid Cancer Chronic Heart Disease Hermatologic Cancer Dementia Chronic Pulmonary Disease Unknown Chronic Liver Disease Chronic Renal Disease Stroke Other B Cause of death in patients with sepsis Sepsis-Associated Deaths (Underlying Cause), %
- 23. 0 10 2030 40 50 60 Thrombocytopenia Hepatic injury Acute kidney injury Hyperlactatemia Mechanical ventilation initiation Vasopressor initiation Organ Dysfunction or Associated Mortality Rhee, C., Jones, T. M., Hamad, Y., Pande, A., Varon, J., OâBrien, C., ... & Klompas, M. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Network Open, 2(2), e187571-e187571. A greater number of organs with dysfunction increases the likelihood of hospital death and the need for a goals-of-care conversation. Organ dysfunction or mortality, % 0 20 40 60 80 100 â„4 â„3 â„2 â„1 Associated Mortality by Number of Organ Dysfunction Criteria Met Organ dysfunction or mortality, % Numberofcriteriamet Factors Associated with Hospital-Related Death Proportion of sepsis cases with organ dysfunction Associated mortality
- 24. Case of HS:Sepsis Scenario âą 7 days post-admission, condition has not improved â Ventilator-dependent â Palliative care consult to discuss GOC, and trach and PEG tube placement â Husband reveals patientâs specific request for DNR. Trach and PEG tube deferred â Referral for VITAS hospice services with GIP level of care
- 25. Case of HS:Sepsis Scenario (cont.) âą 8 days post-admission â Compassionate extubation along with admission to VITAS General Inpatient level of care for management of SOB and restlessness âą During the night, HSâs vital signs deteriorate, and she shows signs of restlessness: â Hospital nurse calls VITAS Telecare â VITAS Telecare clinician dispatches VITAS RN to hospital â VITAS RN confirms that HS is actively dying and administers medication for symptom management â VITAS RN notifies on-call psychosocial staff member to support husband at bedside â HS responds to medication and is resting comfortably âą 6 hours later HS passes peacefully with husband at bedside âą Bereavement support provided to family
- 26. Case of HS:Post-Sepsis Syndrome Scenario âą 23 days post-admission â Ventilator-dependent, trach and PEG tube placed â 20-lb. weight loss â Delirium is unresolved â Dependence in 4/6 ADLs; PT initiated âą 30 days post-admission â Delirium continues â GOC conversation with husband reveals patientâs specific request for DNR â D/C to SNF with hemodialysis, trach, PEG and antibiotics
- 27. Yende, S., Kellum,J. A., Talisa, V. B., Palmer, O. M. P., Chang, C. C. H., Filbin, M. R., ... & Hawkins, K. Long-term Host Immune Response Trajectories Among Hospitalized Patients With Sepsis. JAMA Network Open, August, 2(8), e198686. âą Inflammatory and immune changes persist in many patients Post-Sepsis Syndrome Inflammatory and Immunosuppression Biomarker Values Collected at Each Scheduled Collection Time Point
- 28. Prescott, H., Angus,D. (2018). Enhancing Recovery from Sepsis: A Review. JAMA, 319(1), 62-75. Post-Sepsis Syndrome (cont.) âą New functional limitations â 1-2 new ADL limitations on average âą Physical weakness âą Myopathy and neuropathy âą Increased cognitive impairment â Persistent delirium â Moderate to severe CI increased from 6.1% before hospitalization to 16.7% post-hospitalization âą Difficulty swallowing â 63% aspiration on fiberoptic endoscopic evaluation â Muscular weakness or damage
- 29. Iwashyna, T. J.,Ely, E. W., Smith, D. M., & Langa, K. M. (2010). Long-Term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis. JAMA, 304(16), 1797-1794. Sepsis Cognitive and Functional Outcomes
- 30. Prescott, H., Angus,D. (2018). Enhancing Recovery from Sepsis: A Review. JAMA, 319(1), 62-75. Post-Sepsis Syndrome (cont.) âą Cardiovascular events occurred in 29.5% of patients in the year after sepsis â Persistent myocardial dysfunction âą Increased risk of recurring sepsis â 9-fold elevated risk âą Increased depression and anxiety â About 33% prevalent 2-3 months later âą Exacerbation of chronic medical conditions â Heart failure, acute renal failure and COPD
- 31. Case of HS:Post-Sepsis Syndrome Scenario (cont.) âą 6 days after discharge to skilled care (36 days later from sepsis): â Congestion, fever, and agitation â SNF called 911; patient taken to ED â Readmitted for DX of aspiration pneumonia â Symptoms of pain, SOB/congestion, and wound care â Antibiotics initiated along with IV fluids â Renal failure had somewhat improved; dialysis was discontinued â TF not tolerated with some coughing
- 32. Buchman, T. G.,Simpson, S. Q., Sciarretta, K. L., Finne, K. P., Sowers, N., Collier, M., ... & Wax, M. (2020). Sepsis Among Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012â2018. Critical Care Medicine, 48(3), 289. Sepsis and Post-Acute Care Utilization
- 33. Jones, T. K.,Fuchs, B. D., Small, D. S., Halpern, S. D., Hanish, A., Umscheid, C. A., ... & Mikkelsen, M. E. (2015). Postâacute care use and hospital readmission after sepsis. Annals of the American Thoracic Society, 12(6), 904-913. 0 5 10 15 20 25 30 Cohort (N=112,578) AMI (N=2,597) Heart Failure (N=19,723) Pneumonia (N=4,949) Sepsis (N=3,620) 7-Day Hospital Readmission 30-Day Hospital Readmission âą Sepsis 30-day readmissions are twice as likely to die or enroll into hospice compared to non-sepsis readmissions Sepsis and Readmissions
- 34. Prescott, H. (2017).Variation in post-sepsis readmission patterns: A cohort study of VA beneficiaries. Annals of the American Thoracic Society. February, 14(2), 220-237. Sepsis and Readmissions (cont.) 2009 (N=15,836 readmissions) diagnosis category (proportion of readmissions that are for this diagnosis) 2010 (N=17,021 readmissions) diagnosis category (proportion of readmissions that are for this diagnosis) 2011 (N=16,844 readmissions) diagnosis category (proportion of readmissions that are for this diagnosis) 1 Congestive heart failure (7.0%) Congestive heart failure (7.6%) Congestive heart failure (7.4%) 2 Pneumonia (5.4%) Pneumonia (5.3%) Pneumonia (5.1%) 3 Sepsis (4.8%) Sepsis (4.9%) Sepsis (4.7%) 4 Urinary tract infection (4.6%) Urinary tract infection (4.6%) Urinary tract infection (4.5%) 5 Acute renal failure (4.3%) Chronic obstructive pulmonary disease (4.1%) Acute renal failure (4.4%) 6 Chronic obstructive pulmonary disease (3.9%) Acute renal failure (4.0%) Chronic obstructive pulmonary disease (4.0%) 7 Complication of device, implant, graft (2.8%) Acute respiratory failure (2.7%) Complication of surgical or medical care (2.8%) 8 Complication of surgical or medical care (2.7%) Fluid/electrolyte-disorder (2.7%) Complication of device, implant or graft (2.7%) 9 Fluid/electrolyte disorder (2.6%) Complication of device, implant or graft (2.4%) Acute respiratory failure (2.6%) 10 Acute respiratory failure (2.5%) Complication of surgical or medical care (2.4%) Fluid/electrolyte disorder (2.6%)
- 35. Case of HS:Post-Sepsis Syndrome Scenario (cont.) âą Hospitalized for aspiration pneumonia âą Slow improvement but still very ill â Resumes tube feeding at low rate â No longer febrile; improved secretions â Severe cognitive impairment/ delirium continues âą Goals of care â Continue 7 more days of antibiotics and tube feeding â Wound care â PT and speech â Stay out of the hospital
- 36. Sepsis and HospiceGuideline: Hospital Discharge âą Hospice-eligible, not previously identified â Cancer, solid tumor, and hematologic â Advanced cardiac disease â Advanced lung disease â Dementia âą Pre-hospital functional ability â Physical impairment âą 1 of 6 ADL or 1 of 5 IADL â Cognitive status âą Any degree of dementia
- 37. Pre-Sepsis Function andCognition on Post-Hospital Survival âą Patients with functional and cognitive impairment prior to sepsis who survive hospitalization have a high six-month mortality that supports hospice as a relevant and important post-acute care option Iwashyna, T. J., Ely, E. W., Smith, D. M., & Langa, K. M. (2010). Long-Term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis. JAMA, 304(16), 1797-1794.
- 38. Case of HS:Post-Sepsis Syndrome Scenario (cont.) âą Benefited from IDT for 4 weeks, but secretions and SOB increased over the weekend âą Intensive Comfort CareÂź (ICC) initiated again at home for symptoms of SOB, secretions, fever, and presumed pneumonia âą Patient not tolerating PEG tube feedings secondary to disease progression as evidence of second aspiration pneumonia âą Goals-of-care conversation with husband regarding treatment approach: 1. Feedings â husband elected to d/c further PEG tube feedings 2. Antibiotics â husband did not want to initiate treatment; preferred acetaminophen RCT and aggressive symptom management instead âą Patient passes away several days later with family at bedside
- 39. Quality âą Hospital readmissions âą Advancecare planning âą Symptom management âą Patient experience âą Hospital mortality âą Medicare spend per-beneficiary âą Bereavement HME and Supplies âą Oxygen âą Non-invasive ventilation âą Hospital bed âą Specialized mattress âą ADL assist devices âą Incontinence supplies âą Wound care supplies Complex Modalities âą Antibiotics âą IV hydration âą Parenteral opioids âą Respiratory therapist âą Therapy Services: PT, OT, speech âą Nutritional counseling âą Goals-of-care conversations High-Acuity Care âą Telecare âą Intensive Comfort CareÂź âą General inpatient care âą Visits after hours and on weekends/ holidays âą Visit frequency âą Physician support Levels of Care âą Home/Routine âą Respite âą Continuous âą Inpatient Benefits to Early Identification of Hospice-Eligible Sepsis Patients and Alignment with Care Goals
- 40. Antibiotics in Hospice âąSymptom benefits â Urinary tract response up to 92% â Respiratory infections symptom response up to 53% â Less symptomatic benefit to bloodstream infection âą Unclear whether antibiotics in the last week of life improve symptom burden âą Higher risk of medication toxicities âą Increased patient burden (diagnosis and monitoring) âą Patient preferences â Advanced cancer home hospice population, 79% preferred no antibiotics or for symptom benefit only
- 41. âą Erythema âą Malodor âąFever âą Pain Infections and Symptoms âą Frequency âą Dysuria âą Agitation âą Confusion âą Fever âą Short of Breath âą Cough âą Chest/back pain âą Agitation âą Fever âą Fatigue âą Cough âą Sneeze âą Sore throat âą Fatigue âą Sinus pressure âą Fever Skin Upper Respiratory Lower Respiratory UTI
- 42. Infections and ManagementConsideration âą Symptom assessment âą Pharmacologic and non-pharmacologic considerations âą Time of onset and duration of action â Nebs/opioids vs. antibiotics for SOB âą Adverse effects, including allergies âą Feasibility (ability to swallow, route available, cost) âą Treatment schedule â Scheduled vs. as-needed âą Prognosis âą Care goals
- 43. Goals-of-Care Conversation Build trust and respect Develop acollaborative plan Understand what patient and caregiver know Patient- Centered Care Inform of evidence- based information Listen to goals and expectations
- 44. ICD-10 Coding forSepsis, SIRS and Post-Sepsis Syndrome (Acute Causes of Death Only) ICD-10 Description A41.9 Sepsis, unspecified organism A41.52 Sepsis due to Pseudomonas J69.0 Pneumonitis due to inhalation of food and vomit ICD-10 Description R65.20 Severe sepsis without septic shock R65.21 Severe sepsis with septic shock R65.11 Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction ICD-10 Description J96.00 Acute respiratory failure, unspecified I50.9 Heart failure, unspecified K72.00 Acute and subacute hepatic failure N17.9 Acute renal failure, unspecified G93.40 Encephalopathy, unspecified Underlying Infection Sepsis / SIRS Organ Dysfunction
- 45.
- 46. Adapted from Prescott,H., Angus, D. (2018). Enhancing Recovery from Sepsis: A Review. JAMA, 319(1), 62-75. Buchman, T. G., Simpson, S. Q., Sciarretta, K. L., Finne, K. P., Sowers, N., Collier, M., ... & Wax, M. (2020). Sepsis Among Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012â2018. Critical Care Medicine, 48(3), 289. Hajj T., Natalie B., Salavaci J., Jacoby D. (2018). The âCentrality of Sepsisâ: A Review on Incidence, Mortality, and Cost of Care. Healthcare, 6, 90. Iwashyna, T. J., Ely, E. W., Smith, D. M., & Langa, K. M. (2010). Long-Term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis. JAMA, 304(16), 1797-1794. Jones, T. K., Fuchs, B. D., Small, D. S., Halpern, S. D., Hanish, A., Umscheid, C. A., ... & Mikkelsen, M. E. (2015). Postâacute care use and hospital readmission after sepsis. Annals of the American Thoracic Society, 12(6), 904-913. Marik P., Taeb A. (2017). SIRS, qSOFA and new sepsis definition. Journal of Thoracic Disease, 9(4), 943. Prescott, H., Angus, D. (2018). Enhancing Recovery from Sepsis: A Review. JAMA, 319(1), 62-75. Prescott, H. (2017). Variation in post-sepsis readmission patterns: A cohort study of VA beneficiaries. Annals of the American Thoracic Society, 14(2), 220-237. Rhee, C., Dantes, R., Epstein, L., Murphy, D. J., Seymour, C. W., Iwashyna, T. J., ... & Jernigan, J. A. (2017). Incidence and trends of sepsis in US hospitals using clinical vs claim data, 2009 to 2014. JAMA, 318(13), 1241-1249. Rhee, C., Jones, T. M., Hamad, Y., Pande, A., Varon, J., OâBrien, C., ... & Klompas, M. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Network Open, 2(2), e187571-e187571. US Centers for Disease Control and Prevention. (2020). Data and Reports, retrieved from: https://www.cdc.gov/sepsis/datareports/index.html World Health Organization. 2020. Improving the prevention, diagnosis and clinical management of sepsis. Retrieved from: https://www.who.int/sepsis/en/ Yende, S., Kellum, J. A., Talisa, V. B., Palmer, O. M. P., Chang, C. C. H., Filbin, M. R., ... & Hawkins, K. (2019). Long-term Host Immune Response Trajectories Among Hospitalized Patients With Sepsis. JAMA Network Open, August, 2(8), e198686. References
- 47. This document containsconfidential and proprietary business information and may not be further distributed in any way, including but not limited to email. This presentation is designed for clinicians and healthcare professionals. While it cannot replace professional clinical judgment, it is intended to guide clinicians and healthcare professionals in establishing hospice eligibility for patients through evaluation and management of sepsis and post-sepsis syndrome. It is provided for general educational and informational purposes only, without a guarantee of the correctness or completeness of the material presented.