Intermountain study shows need for sepsis discharge guidelines

According to a to study published Thursday in JAMA Network Open.

Researchers led by Dr. Ithan Peltan from the University of Utah School of Medicine and Salt Lake City-based Intermountain Healthcare looked at the characteristics of people with sepsis discharged from emergency departments, which has not been thoroughly researched before. The team reviewed electronic health record data from four Intermountain Healthcare hospitals in Utah as well as state and federal death records.

“The obvious assumption is that these patients should all be admitted, and we were really, we were concerned that these patients might have poor outcomes,” Peltan said.

The results of the limited study, however, show that discharged patients had lower levels of acuity and did not face worse health outcomes based on mortality.

“Referral to outpatient treatment of patients who met criteria for sepsis in the ED was more common than previously recognized and varied widely between ED physicians, but was not associated with higher mortality compared to hospitalization,” the JAMA article said.

Patients with sepsis who were discharged home were less sick overall and had more mild cases of organ failure than those admitted on average, the researchers determined. Discharged patients also had lower death rates. Any infection can cause sepsis, which can be fatal if not caught quickly. New research indicates that each type of infection presents with different sepsis symptoms and varying degrees of danger.

For example, the likelihood of a discharged patient having a urinary tract infection was four times higher than other infections. These patients had lower levels of septic shock – which cause dangerous drops in blood pressure – and other markers indicating lower risk.

Of more than 12,000 patients admitted to the four hospitals between July 2013 and December 2017, 16% were discharged overall. Some doctors discharged an average of 8% of patients with sepsis while others discharged up to 40% of patients with the disease.

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