Sepsis Treatment Through Outpatient Follow-Up Yields Positive Outcomes in Some Patients

When patients are diagnosed with sepsis in the emergency department, they are usually admitted to the hospital as the swiftest course of action to treat the life-threatening condition. Investigators on a new study have found, however, that a small subset of patients who are diagnosed with sepsis in the emergency department are discharged after initial treatment, and then seen through outpatient follow-up without a negative impact on patient outcomes.

According to the study, which was presented at the 2018 American Thoracic Society Conference, May 18-23, 2018 in San Diego, California, and conducted by investigators from Intermountain Medical Center in Salt Lake City, Utah, about 16% of patients diagnosed with sepsis in the emergency department are released for outpatient management. Principal investigator Ithan Peltan, MD, MSc, a pulmonary and critical care medicine specialist and researcher from Intermountain Medical Center in Salt Lake City, remarked on this in a news release on the study, stating, “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.”

For the study, the investigators reviewed clinical data from the Intermountain Healthcare's Enterprise Data Warehouse on patients seen at 4 hospitals between July 2013 and January 2017. A total of 15,832 adult patients were identified as meeting the clinical criteria for sepsis. The investigators then filtered out patients who had repeated visits to the emergency department, those who left the emergency department against medical advice, those on hospice, or those who had died, the team of investigators was left with a total of 12,002 eligible patients.

The investigators acknowledge that although patients who were discharged were much less ill than those who were admitted; however, their 30-day mortality rate was about the same as admitted patients when accounting for severity of illness and other factors.

A total of 65% of those patients who were discharged were women. According to the news release, the investigators, “plan to examine this and other potential disparities more closely in their next study. An initial hypothesis is that women may come to the emergency department earlier in their illness, meaning they're less sick.”

According to the investigators, it would seem that the physicians are doing a good job deciding which patients can be discharged and which should be admitted. “Physicians seem to do a good job of knowing who can be discharged," said Dr. Peltan in the new release. "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."

"Outpatient management of sepsis is likely not automatically 'wrong’,” he continued. “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.”