Forbes-This Medical Condition Is The Leading Cause Of Unplanned Hospital Readmissions

Forbes, Rory Staunton Foundation, Rory's Regulations, Readmissions, Sepsis, Leading Cause, Unplanned, Robert Glatter MD, unplanned

By
Published by Forbes, January 30, 2017.

Based on a new study evaluating data obtained from the 2013 Nationwide Re-admissions Database, unplanned 30-day readmissions were highest after hospitalizations for sepsis.

Sepsis is a medical condition associated with profound alterations in vital signs, characterized by reduced blood flow to organs, typically triggered by invasive bacterial or viral infections. It is treated aggressively with broad spectrum antibiotics, intravenous fluids, respiratory support, and vasopressors designed to elevate blood pressure when indicated.

But the most unexpected finding from the study was that sepsis represented the leading cause of 30-day readmissions in the U.S. Coupled with this finding, data also indicated that readmissions after treatment for sepsis were also more costly  when compared to readmissions after heart attack, heart failure, pneumonia and COPD.

The study should make hospital administrators and CEOs take a step back to examine this important subgroup of patients when evaluating metrics related to 30-day unplanned hospital readmissions since it accounts for a significant costs related to readmissions.

The Centers for Medicare & Medicaid Services (CMS) has typically evaluated readmissions following index or initial hospitalizations for acute myocardial infarction (AMI) or heart attack, heart failure, COPD, and pneumonia, as part of its pay-for-performance program–but not sepsis.

This study, published as a letter in JAMA online late last week, highlights the importance of examining the proportion and cost of unplanned 30-day readmissions following admission for sepsis.

Dr. Sachin Yende, the lead author from VA Pittsburgh Healthcare System in Pennsylvania, evaluated data from the 2013 Nationwide Readmissions Database.

Data from the study indicated that sepsis accounted for over 12% of more than 1.1 million unplanned 30-day readmissions.  This was significantly more than readmissions after hospitalizations for heart failure (6.7%), or pneumonia (5.0%), COPD (4.6%), and heart attacks (1.3%).

The study also noted that patients with sepsis also carried diagnoses such as pneumonia (7.5%), heart failure (3.4%), COPD (3.3%), and heart attacks (0.7%).

Compared with readmissions following heart attacks, heart failure, COPD, and pneumonia, the length of stay for unplanned readmissions was greater following hospitalizations for sepsis. Also important to note was that the estimated mean cost per readmission was significantly higher for sepsis ($10,070) compared with pneumonia ($9533) heart attacks ($9424), heart failure ($9051) or COPD ($8417).

So, while recent studies do demonstrate that since the hospital readmission reduction program (HRRP) was launched, readmissions for heart failure, COPD, pneumonia, and heart attack have declined, it would be wise to consider adding sepsis readmissions to HRRP. The potential to avoid hospital acquired infections secondary to readmissions for sepsis would likely help improve health care outcomes.

Its also vital that the public be educated about the dangers of sepsis to facilitate not only early diagnosis and treatment, but rapid dispatch of EMS to the closest emergency department.  While sepsis is a medical emergency in patients presenting to the hospital, the more pressing issue is that persons may develop chronic medical issues that can be lifelong or last for years after treatment and discharge.

Patients who survive an initial hospitalization for sepsis require close follow up and must be monitored for development recurrent or worsening kidney failure as well as recurrent infections, recurrent heart failure as well as ongoing lung problems including multidrug resistant pneumonia, CRE, or even aspiration.

One of the pressing issues that emergency and critical care physicians encounter is the difficulty is identifying patients in the early stages of sepsis.  Some patients may have nonspecific symptoms such as nausea or dizziness, before changes in mental status or vital signs develop.

In addition, our aging population is at greater risk for sepsis, especially patients who have cancer and are receiving chemotherapy, as well as those with chronic kidney disease and  those on hemodialysis.

Data indicates that close to 25% of patients who survive their initial hospitalization for sepsis are then readmitted within 30 days suffering from another potentially deadly infection. But the real challenge is communicating with patients to make them aware of this potential for recurrent infection after initial treatment by instructing them to be aware of early warning signs such as rapid breathing, a low blood pressure, along with confusion or a change in mental status.

In the future, anticipating a recurrent infection may be possible by using wearable sensors to alert clinicians and patients to subtle changes in vital signs (drop in blood pressure, core body temperature, or increase in heart rate) that may be the earliest warning signs of sepsis.

One limitation of this study was that the data was derived from a state-specific registry, so patients could be lost to follow-up, thus underestimating readmission rates.

That said, this study still  provides convincing evidence suggesting that sepsis be added to the current list of medical conditions for the existing CMS-derived hospital readmission reduction program (HRRP).

Read the original article here.