Hospital Sepsis Program Core Elements Score

Sepsis is a leading cause of hospitalization and hospital mortality,¹ contributing to over a third of all hospital deaths.² In the United States, there are an estimated 1.7 million cases of adult sepsis hospitalization annually, of which 350,000 result in hospital death or discharge to hospice.³ Beyond being a major driver of hospital mortality, sepsis also contributes to incident disability.⁴ Patients who survive hospitalization for sepsis are at increased risk for negative health outcomes including the development of new morbidity, inability to return to work, hospital readmission, and death.^5,6,7

Support from hospital and health system leadership, especially from the chief medical and chief nursing officers, is critical to the success of hospital sepsis programs.^8,9 Barriers to successful hospital sepsis programs include lack of engagement from hospital clinicians and staff and insufficient resources to effectively run the hospital sepsis program (e.g., lack of personnel, lack of analytic support, or insufficient time for sepsis activities). By setting sepsis performance improvement as a priority and allocating necessary resources to the program, hospital leadership can help ensure that sepsis programs have the engagement and resources necessary to accomplish their goals.

There have been some misperceptions that antibiotic stewardship may hinder efforts to improve management of sepsis. However, rather than hindering effective patient care, antibiotic stewardship programs can play an important role in optimizing the use of antibiotics, leading to better patient outcomes. It is possible for hospitals to make simultaneous improvement in sepsis management and antimicrobial stewardship.¹⁰ 

Hospital sepsis programs should have one leader or two co-leaders who are accountable for program management and outcomes within the hospital or healthcare system. We strongly recommend for sepsis programs to be co-led by a physician and a nurse. Effective leadership, management, and communication skills, as well as clinical expertise in sepsis, are essential to success. Programs with co-leaders should have clear delineation of responsibilities and expectations. For health system-wide programs, physician and nurse champions or point-persons should be identified at each hospital, as local champions are consistently identified as key facilitators to successful quality improvement programs.¹¹ 

Sepsis programs require engagement of multidisciplinary partners throughout the hospital, including clinicians and healthcare staff who support the care of patients with sepsis throughout the organization; individuals who facilitate performance evaluation and improvement activities (e.g., data analytics, information technology); and patients, family members, and caregivers who can provide insight into the experience of being hospitalized with and recovering from sepsis.¹⁰ Dedicated sepsis coordinators can greatly increase the effectiveness of the hospital sepsis program by contributing to action, tracking/reporting, and education activities.¹⁰

The development of a multi-disciplinary hospital sepsis program is critical to monitoring and improving the management and outcomes of patients with sepsis. Hospital quality improvement programs focused on sepsis have been associated with reductions in hospital mortality, length of stay, and healthcare costs.^11,12,13 Regardless of the structure of the hospital sepsis program, it should help healthcare staff improve outcomes from sepsis by aiding in the recognition of sepsis, facilitating the implementation of evidence-based management of sepsis, supporting the recovery of patients after sepsis, and monitoring the impact of hospital-based interventions to improve care and outcomes of sepsis.

Sepsis programs should develop and implement structures and processes to facilitate recognition of sepsis, evidence-based management of sepsis, and longer-term recovery from sepsis. When designing and implementing interventions to improve sepsis management, it is important to use structured quality improvement processes and implementation science principles to promote uptake of the intervention.^14,15 Additionally, hospital sepsis programs should monitor use and effectiveness of hospital interventions and refine interventions as needed to optimize treatment and outcomes.

• Implementing a standardized process to screen for sepsis: Early administration of sepsis treatment is lifesaving, so it is important that clinicians recognize sepsis as early as possible.  To this end, hospitals should have a standardized process to screen at-risk patients for sepsis upon presentation to the hospital and throughout their hospitalization.^{16,17,18,19,20}
• Developing and maintaining a hospital guideline or a standardized care pathway for management of sepsis: Hospital guidelines or standardized care pathways can greatly enhance the effectiveness of sepsis programs by establishing clear recommendations for care. ¹⁰ Ideally, guidelines should address management across the continuum of hospital care including screening, clinical evaluation (e.g., recommended/suggested laboratory, microbiology, laboratory, or imaging studies), diagnosis, antimicrobial selection, source control, fluid resuscitation (e.g., indications, contraindications, type, and volume of fluid), indications for treatment escalation (e.g., admission to critical care unit), antimicrobial narrowing, antimicrobial stopping, patient and family/caregiver education on sepsis, and peri-discharge management¹⁰. Recommendations should be based on published guidelines and generally accepted standards of care but also take into consideration the available resources, local epidemiology, and patient population served (e.g., adult, pediatric, obstetric).¹⁰ For example, while international/national guidelines recommend prompt antimicrobials and source control, hospital guidelines can provide guidance on the selection of antimicrobials based on local resistance patterns and antimicrobial formulary options and approaches for source control based on hospital availability of surgical and interventional radiology services.¹⁰ Empiric antimicrobial options should be recommended in conjunction with Antimicrobial Stewardship or Infectious Diseases staff. To ensure viability of hospital guidelines, they should be updated at least biannually and based on existing evidence-based sepsis guidelines.¹⁰
• Hospital order sets for management of sepsis: Templated order sets can further aid in implementation of recommended practices for sepsis evaluation and management, including selection of antimicrobial therapy, timely delivery of the first dose of antimicrobials, clinical evaluation, source control, fluid resuscitation, antimicrobial narrowing, and antimicrobial stopping.¹⁰ Order sets should be tailored to the patient population (e.g., pediatric versus adult patients). ¹⁰ As with hospital screening for sepsis, the content and scope of sepsis order sets may vary across hospitals, but they should always be developed with user-centered design principles.¹⁰
• Structures and processes to facilitate prompt delivery of antimicrobials: Timely delivery of antimicrobial therapy in sepsis is life-saving.^{16,17,18,19,20}  In addition to facilitating prompt recognition of sepsis, hospitals should facilitate the prompt administration of initial antimicrobial therapy after the order for antimicrobial therapy has been placed.²¹ It has been estimated that one-third of the interval from patient presentation to antimicrobial delivery occurs after the antimicrobial order, and that post-order delays are associated with increased mortality.²²
• Structures and processes to support effective hospital hand-offs in patients with sepsis: Transfers between units (e.g., ED-to-ward, ward-to-ICU, and ICU-to-ward transfers), between treating clinicians (e.g., during physician and nursing shift changes), and between hospitals are high-risk times for information loss.¹⁰ Incomplete awareness of a patient's working diagnosis, uncertainty regarding the diagnosis, and/or treatment-to-date contribute to lapses in the delivery of subsequent care.¹⁰ Hospitals should also have processes for safe patient transfer between healthcare facilities to continue the plan of care and facilitate infection control, akin to the inter-facility infection control transfer form.²³ 

Additional examples of action include:

• Rapid response teams trained in sepsis recognition and care: Rapid response teams (also known as medical emergency teams) were first developed in the 1990s to bring needed expertise to the bedside of patients experiencing acute clinical deterioration. Sepsis rapid response teams are rapid response teams specifically focused on managing patients with sepsis.²⁴ The teams are often multi-disciplinary, consisting of nurses, physicians, respiratory therapists, pharmacists, and phlebotomists. Implementation of sepsis-specific rapid response teams and training of general rapid response teams on the management of sepsis have been associated with improved care practices.²⁵
• A "Code Sepsis" protocol: Many hospitals use "Code Sepsis" huddles to hasten sepsis recognition and treatment.^58-60 "Code Sepsis" is activated by clinical staff based on suspicion of sepsis, often in response to vital signs and chief complaint upon presentation to the ED. Code sepsis activation triggers a multi-disciplinary team huddle (e.g., physician or physician assistant, primary nurse, ED pharmacist, and ED charge nurse) at the patient's bedside for evaluation of the clinical scenario and initiation of expedited early sepsis treatment (e.g., cultures, lactate measurement, imaging, antimicrobials, fluid) if indicated. Implementation of a code sepsis protocol has been associated with increased recognition of sepsis and faster delivery of initial treatment.^26,27,28
• Peri-discharge evaluation: Survivors of hospitalization for sepsis may experience new or worsening functional limitations, cognitive impairment, post-traumatic stress disorder/anxiety symptoms, and chronic health conditions.⁶ Up to 40% of patients are re-hospitalized within three months of discharge. Common causes for re-hospitalization include recurrent infection, heart failure exacerbation, chronic obstructive pulmonary disease exacerbation, acute renal failure, and aspiration pneumonitis. Some of these hospitalizations may be preventable with optimal medical management.³¹ 

Tracking of sepsis epidemiology, management, and outcomes is critical for identifying gaps, trends, and improvement opportunities, as well as for understanding the impact of hospital-based sepsis interventions and progress towards hospital sepsis goals.¹⁰ However, tracking requires resources, and no program can measure everything.¹⁰ It is important to prioritize which sepsis metrics to measure, focusing on the processes and outcomes that are most important to patients and anticipated to represent the greatest opportunity for improvement in the hospital. ¹⁰ 

Reporting sepsis treatment and outcomes to relevant staff can help maintain staff engagement, motivate behavior change, and facilitate improvement in sepsis treatment and outcomes. ¹⁰ It is critical that information be provided in a clear and transparent manner. ¹⁰ Reports should explain how data were collected and how measures were calculated.¹⁰ In addition, providing the option to drill down and review data for individual hospitalizations can help facilitate targeted review of cases for performance improvement. ¹⁰ Data that are timely and focused (e.g., to a specific hospital unit or an individual clinician) are often most actionable.³² Reports to hospital leadership and the board can also help raise awareness of and support for sepsis program efforts.

For optimal sepsis treatment and outcomes, it is imperative that hospital staff have strong knowledge of sepsis and understand their role in team-based management of sepsis.  Educational efforts should be focused on all healthcare workers involved in sepsis care, all patient-facing staff, and all trainees for health professions. Knowledge of sepsis is also important to patients, families, and caregivers. Patients hospitalized for sepsis are at increased risk for subsequent episodes of sepsis.^31,33 However, despite the increased risk for recurrent sepsis, many patients are unaware of both their diagnosis of sepsis and their risk for recurrent sepsis.³⁴ In an international survey of sepsis survivors, nearly half reported dissatisfaction with their sepsis education.³⁵ Hospitalization and post-hospital follow-up are key opportunities to educate patients and families on sepsis, when to suspect sepsis, and when to seek evaluation for potential sepsis. The Surviving Sepsis Campaign guidelines suggest offering both verbal and written sepsis education prior to hospital discharge and in the follow-up setting because education may facilitate timely health-seeking behavior in sepsis survivors who experience complications.^36,37

References

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2.           American College of Emergency Physicians. DaRT Guide. Available at https://www.acep.org/patient-care/dart/ (accessed January 23, 2023).

3.           Liu V, Escobar GJ, Greene JD, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. Jul 2 2014;312(1):90-2. doi:10.1001/jama.2014.5804

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6.           Prescott HC, Osterholzer JJ, Langa KM, Angus DC, Iwashyna TJ. Late mortality after sepsis: Propensity matched cohort study. BMJ (Online). 2016;353:i2375. doi:10.1136/bmj.i2375

7.           Carlton EF, Gebremariam A, Maddux AB, et al. New and Progressive Medical Conditions After Pediatric Sepsis Hospitalization Requiring Critical Care. JAMA Pediatr. Nov 1 2022;176(11):e223554. doi:10.1001/jamapediatrics.2022.3554

8.           Weiner BJ, Shortell SM, Alexander J. Promoting clinical involvement in hospital quality improvement efforts: the effects of top management, board, and physician leadership. Health Serv Res. Oct 1997;32(4):491-510.

9.           Zoutman DE, Ford BD. Quality improvement in hospitals: barriers and facilitators. Int J Health Care Qual Assur. Feb 13 2017;30(1):16-24. doi:10.1108/IJHCQA-12-2015-0144

10.        Hospital Sepsis Program Core Elements | Sepsis | CDC

11.        Prescott HC, Seelye S, Wang XQ, et al. Temporal Trends in Antimicrobial Prescribing During Hospitalization for Potential Infection and Sepsis. JAMA Intern Med. Aug 1 2022;182(8):805-813. doi:10.1001/jamainternmed.2022.2291

12.        Zoutman DE, Ford BD. Quality improvement in hospitals: barriers and facilitators. Int J Health Care Qual Assur. Feb 13 2017;30(1):16-24. doi:10.1108/IJHCQA-12-2015-0144

13.        Weiner BJ, Shortell SM, Alexander J. Promoting clinical involvement in hospital quality improvement efforts: the effects of top management, board, and physician leadership. Health Serv Res. Oct 1997;32(4):491-510.

14.        Jones B, Vaux E, Olsson-Brown A. How to get started in quality improvement. BMJ. Jan 17 2019;364:k5408. doi:10.1136/bmj.k5437

15.        Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. Sep 16 2015;3(1):32. doi:10.1186/s40359-015-0089-9

16.        Liu VX, Fielding-Singh V, Greene JD, et al. The Timing of Early Antibiotics and Hospital Mortality in Sepsis. Am J Respir Crit Care Med. Oct 1 2017;196(7):856-863. doi:10.1164/rccm.201609-1848OC

17.        Seymour CW, Gesten F, Prescott HC, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med. Jun 8 2017;376(23):2235-2244. doi:10.1056/NEJMoa1703058

18.        Peltan ID, Brown SM, Bledsoe JR, et al. ED Door-to-Antibiotic Time and Long-term Mortality in Sepsis. Chest. May 2019;155(5):938-946. doi:10.1016/j.chest.2019.02.008

19.        Reitz KM, Kennedy J, Li SR, et al. Association Between Time to Source Control in Sepsis and 90-Day Mortality. JAMA Surg. Sep 1 2022;157(9):817-826. doi:10.1001/jamasurg.2022.2761

20.        Ruddel H, Thomas-Ruddel DO, Reinhart K, et al. Adverse effects of delayed antimicrobial treatment and surgical source control in adults with sepsis: results of a planned secondary analysis of a cluster-randomized controlled trial. Crit Care. Feb 28 2022;26(1):51. doi:10.1186/s13054-022-03901-9

21.        Klompas M, Rhee C. Antibiotic Order-to-Infusion Time for Patients With Septic Shock: A Potential New Quality Metric. Crit Care Med. Oct 2019;47(10):1467-1470. doi:10.1097/CCM.0000000000003940

22.        Kashiouris MG, Zemore Z, Kimball Z, et al. Supply Chain Delays in Antimicrobial Administration After the Initial Clinician Order and Mortality in Patients With Sepsis. Crit Care Med. Oct 2019;47(10):1388-1395. doi:10.1097/CCM.0000000000003921

23.        US Centers for Disease Control and Prevention. Inter-Facility Infection Control Transfer Form for States Establishing HAI Prevention Collaboratives. Available at https://www.cdc.gov/healthcare-associated-infections/media/pdfs/Interfa… Accessed (Accessed December 6, 2024).

24.        Ju T, Al-Mashat M, Rivas L, Sarani B. Sepsis Rapid Response Teams. Crit Care Clin. Apr 2018;34(2):253-258. doi:10.1016/j.ccc.2017.12.004

25.        Dooley K, Guzik W, Rooker G, Beecher L, Hiniker C, Olson A. Improving hospital sepsis care using PAs and NPs on a rapid response team. JAAPA. Oct 1 2022;35(10):43-45. doi:10.1097/01.JAA.0000873808.41684.d3

26.        Currie KE, Barry H, Scanlan JM, Harvey EM. Impact of a multidisciplinary sepsis huddle in the emergency department. Am J Emerg Med. Feb 2023;64:150-154. doi:10.1016/j.ajem.2022.12.006

27.        Delawder JM, Hulton L. An Interdisciplinary Code Sepsis Team to Improve Sepsis-Bundle Compliance: A Quality Improvement Project. J Emerg Nurs. Jan 2020;46(1):91-98. doi:10.1016/j.jen.2019.07.001

28.        Whitfield PL, Ratliff PD, Lockhart LL, et al. Implementation of an adult code sepsis protocol and its impact on SEP-1 core measure perfect score attainment in the ED. Am J Emerg Med. May 2020;38(5):879-882. doi:10.1016/j.ajem.2019.07.002

29.        Kang M, Torriani FJ, Sell RE, Wardi G, Abeles SR. The Impact of an Inpatient Nurse-Triggered Sepsis Alert on Antimicrobial Utilization. Jt Comm J Qual Patient Saf. Mar 2021;47(3):157-164. doi:10.1016/j.jcjq.2020.11.004

30.        Taylor SP, Rozario N, Kowalkowski MA, et al. Trends in False-Positive Code Sepsis Activations in the Emergency Department. Annals of the American Thoracic Society. Apr 2020;17(4):520-522. doi:10.1513/AnnalsATS.201910-757RL

31.        Prescott HC, Langa KM, Iwashyna TJ. Readmission diagnoses after hospitalization for severe sepsis and other acute medical conditions. JAMA. Mar 10 2015;313(10):1055-7. doi:10.1001/jama.2015.1410

32.        McGrath BM, Takamine L, Hogan CK, et al. Interpretability, credibility, and usability of hospital-specific template matching versus regression-based hospital performance assessments; a multiple methods study. BMC Health Serv Res. Jun 3 2022;22(1):739. doi:10.1186/s12913-022-08124-w

33.        Pandolfi F, Brun-Buisson C, Guillemot D, Watier L. One-year hospital readmission for recurrent sepsis: associated risk factors and impact on 1-year mortality-a French nationwide study. Crit Care. Nov 29 2022;26(1):371. doi:10.1186/s13054-022-04212-9

34.        Gallop KH, Kerr CEP, Nixon A, Verdian L, Barney JB, Beale RJ. A qualitative investigation of patients' and caregivers' experiences of severe sepsis*. Critical care medicine. 2015;43(2):296-307. doi:10.1097/CCM.0000000000000613

35.        Huang CY, Daniels R, Lembo A, et al. Life after sepsis: an international survey of survivors to understand the post-sepsis syndrome. Int J Qual Health Care. Jun 19 2018;doi:10.1093/intqhc/mzy137.

36.        Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. Nov 1 2021;49(11):e1063-e1143. doi:10.1097/CCM.0000000000005337

37.        Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. Oct 2 2021;doi:10.1007/s00134-021-06506-y

Below are recommendations from the Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-1247. doi: 10.1007/s00134-021-06506-y. Epub 2021 Oct 2. PMID: 34599691; PMCID: PMC8486643.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock” was first published in 2004 and subsequently revised in 2008, 2012, 2016, and  2021. These guidelines provide recommendations to support clinicians managing hospitalized adult patients with or at risk of developing sepsis or septic shock. 

The GRADE approach was used to identify outcomes that were considered important from a patient’s perspective. For each question, the panel developed a list of relevant outcomes and then electronically voted on the importance of each outcome from a patient’s perspective.  Mean scores were used to select the most critical and important outcomes.

The GRADE system categorizes the quality of evidence into four main levels:

High (Grade 1): 

• The evidence is highly reliable. Further research is unlikely to change our confidence in the estimate of effect.

Moderate (Grade 2): 

• The evidence is moderately reliable. Further research may have an impact on the estimate of effect and may change the confidence in the result.

Low (Grade 3): 

• The evidence is limited. Further research is likely to have a significant impact on the estimate of effect and may alter the confidence in the result.

Very Low (Grade 4): 

The evidence is very limited. Any estimate of effect is very uncertain, and further research is likely to have a major impact on the estimate of effect.

• For hospitals and health systems, we recommend using a performance improvement program for sepsis, including sepsis screening for acutely ill, high-risk patients and standard operating procedures for treatment.

Strong recommendation, moderate quality of evidence for screening.

Strong recommendation, very low-quality evidence for standard operating procedures.

Sepsis performance improvement programs generally consist of sepsis screening, education, measurement of sepsis bundle performance, patient outcome reporting, and actions for identified opportunities. Despite some inconsistency, a meta-analysis of 50 observational studies on the effectiveness of sepsis performance improvement programs showed that these programs were associated with better adherence to sepsis bundles and reductions in mortality (OR, 0.66; 95% CI, 0.61–0.72) among patients with sepsis and septic shock (Damiani). 

Sepsis screening tools are designed to promote early identification of sepsis and consist of manual methods or automated use of the electronic health record (EHR). Screening tools may target patients in various locations, such as in-patient wards, emergency departments, or intensive care units (ICUs).  A pooled analysis of three randomized controlled trials (RCTs) did not demonstrate a mortality benefit of active screening (RR, 0.90; 95% CI, 0.51−1.58) (Downing; Hooper; Shimabukuro). However, while there is wide variation in sensitivity and specificity of sepsis screening tools, these tools are an important component of identifying sepsis early for timely intervention.

Standard operating procedures are sets of practices that specify a preferred response to specific clinical circumstances (Rao).  A large study was conducted to examine the association between implementation of state-mandated sepsis protocols, compliance, and mortality. A retrospective cohort study of 1,012,410 sepsis admissions to 509 hospitals in the United States examined mortality before (27 months) and after (30 months) implementation of New York state sepsis regulations, with a concurrent control population from four other states. In this comparative interrupted time series, mortality was lower in hospitals with higher compliance with sepsis bundles.

Damiani E, Donati A, Serafini G, et al: Effect of performance improvement programs on compliance with sepsis bundles and mortality: A systematic review and meta-analysis of observational

studies. PLoS One 2015; 10:e0125827. 

Downing NL, Rolnick J, Poole SF, et al: Electronic health record-based clinical decision support alert for severe sepsis: A randomised evaluation. BMJ Qual Saf 2019; 28:762–768. 

Hooper MH, Weavind L, Wheeler AP, et al: Randomized trial of automated, electronic monitoring to facilitate early detection of sepsis in the intensive care unit. Crit Care Med 2012; 40:2096–2101

Shimabukuro DW, Barton CW, Feldman MD, et al: Effect of a machine learning-based severe sepsis prediction algorithm on patient survival and hospital length of stay: A randomised clinical

trial. BMJ Open Respir Res 2017; 4:e000234

Rao TS, Radhakrishnan R, Andrade C: Standard operating procedures for clinical practice. Indian J Psychiatry 2011; 53:1–3

Kahn JM, Davis BS, Yabes JG, et al: Association between state-mandated protocolized sepsis care and in-hospital mortality among adults with sepsis. JAMA 2019; 322:240–250

• For adults with possible septic shock or a high likelihood for sepsis, we recommend administering antimicrobials immediately, ideally within 1 hour of recognition. Strong, low quality of evidence (Septic shock)

Early administration of appropriate antimicrobials is one of the most effective interventions to reduce mortality in patients with sepsis (Ferrer; Kalil; Seymour). Delivering antimicrobials to patients with sepsis or septic shock should therefore be treated as an emergency.

Ferrer R, Artigas A, Suarez D, et al; Edusepsis Study Group: Effectiveness of treatments for severe sepsis: A prospective, multicenter, observational study. Am J Respir Crit Care Med 2009; 180:861–866

Kalil AC, Johnson DW, Lisco SJ, et al: Early goal-directed therapy for sepsis: A novel solution for discordant survival outcomes in clinical trials. Crit Care Med 2017; 45:607–614

Seymour CW, Gesten F, Prescott HC, et al: Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med 2017; 376:2235–2244

• For adults with sepsis or septic shock and their families, we suggest offering written and verbal sepsis education (diagnosis, treatment, and post-ICU/post-sepsis syndrome) prior to hospital discharge and in the follow-up setting. Weak, very low quality of Evidence

Almost 40% of sepsis survivors are re-hospitalized within 3 months, often for preventable conditions, contributing to increased healthcare costs (Gruther). Sepsis education may have a role in the timely healthcare-seeking behavior in sepsis survivors who experience complications. In an international survey of sepsis survivors from 41 countries, 45% and 63% reported dissatisfaction with sepsis education at the acute and post-acute phase, respectively (Huang). We identified six RCTs that evaluated educational interventions for critically ill patients and their families (Azoulay; Bench;  Demircelik; Fleischer; Gehrke-Beck; Schmidt). Only one RCT focused on patients with sepsis; this study evaluated a complex intervention that included sepsis education along with primary care follow-up and post-discharge monitoring. 

Gruther W, Pieber K, Steiner I, et al: Can early rehabilitation on the general ward after an intensive care unit stay reduce hospital length of stay in survivors of critical illness?: A randomized controlled trial. Am J Phys Med Rehabil 2017; 96:607–615. 

Huang CY, Daniels R, Lembo A, et al; Sepsis Survivors Engagement Project (SSEP): Life after sepsis: An international survey of survivors to understand the post-sepsis syndrome. Int J Qual Health Care 2019; 31:191–198

Azoulay E, Pochard F, Chevret S, et al: Impact of a family information leaflet on effectiveness of information provided to family members of intensive care unit patients: A multicenter,prospective, randomized, controlled trial. Am J Respir Crit Care Med 2002; 165:438–442

Bench S, Day T, Heelas K, et al: Evaluating the feasibility and effectiveness of a critical care discharge information pack for patients and their families: A pilot cluster randomised

controlled trial. BMJ Open 2015; 5:e006852

Demircelik MB, Cakmak M, Nazli Y, et al: Effects of multimedia nursing education on disease-related depression and anxiety in patients staying in a coronary intensive care unit. Appl Nurs Res 2016; 29:5–8

Fleischer S, Berg A, Behrens J, et al: Does an additional structured information program during the intensive care unit stay reduce anxiety in ICU patients?: A multicenter randomized controlled trial. BMC Anesthesiol 2014; 14:48

Gehrke-Beck S, Bänfer M, Schilling N, et al: The specific needs of patients following sepsis: A nested qualitative interview study. BJGP Open 2017; 1:bjgpopen17X100725

Schmidt K, Worrack S, Von Korff M, et al; SMOOTH Study Group: Effect of a primary care management intervention on mental health-related quality of life among survivors of sepsis: A randomized clinical trial. JAMA 2016; 315:2703–2711