Hospice Provides Post-Discharge Support That Sepsis Patients Need
VITAS Healthcare - Pittsburgh
For more information about the author, click to view their website: https://www.vitas.com/locations-search/pittsburgh/cranberry-township-hospice-office
Mar 24, 2025
Pennsylvania - Greater Pittsburgh Area
By Faith Protsman, MD, Regional Medical
Director, VITAS Healthcare
Two recent studies highlight how sepsis’ impact often
extends well beyond the acute event that led to a patient’s hospitalization.
The studies emphasize two particular points that should inform physicians and
clinicians as they consider referring these patients to specialized care:
- Medicare
patient data gathered between 2012-2017 shows that sepsis
patients face considerably poorer health outcomes following hospital
discharge when compared to non-sepsis patients, including
elevated risk for death and increased use of advanced healthcare services.
- Sepsis
survivors exhibit strong indicators of persistent inflammation and
immunosuppression for up to a year after hospital discharge,
increasing their risk of readmission or death.
Both studies indicate a significantly elevated risk of death
among sepsis patients after they have been discharged and ostensibly “cured.”
Of course, sepsis patients–particularly those of the Medicare cohort, who are
largely of advanced age–rarely leave the hospital in better condition than they
entered.
The
Yende study, in particular, shows that neuroendocrine and inflammatory
responses to sepsis can continue long after the patient survives a septic
episode. For patients with advanced or chronic diseases—as was the case with
nearly 78% of participants in the study—these biomarkers are associated with
decline.
Post-sepsis Discharge: A Critical Juncture
In many cases, these individuals’ life expectancies upon
discharge will be less than six months. This is a critical juncture: While
comfort-focused hospice care could provide an ideal source of support for the
eligible patient, their family, and their caregiver(s), most sepsis patients
are simply sent home without even a
discussion about palliative end-of-life care and its benefits.
Frankly, such an oversight is a disservice to everyone
involved. The sepsis patient is left with physical and/or cognitive
dysfunction, often without significant options for symptom management. Their
partner or family will either need to assume caregiving duties or turn to
costly private services. And the physician and hospital staff will likely see
the patient again following another acute event, a readmission that impacts
performance scores, strains resources, and unnecessarily fills beds.
By no means do I intend to lay the blame for these
unfortunate circumstances on physicians. Timely hospice referrals require
ongoing education about end-of-life care, and open, ongoing communication
between hospice providers and referral sources.
More
Help: How to Talk About Hospice Care >
Those of us in hospice are working hard to bridge the gap,
but even as our healthcare system transitions to a value-based model, the
mentality of fee-for-service still permeates our nation’s acute-care
facilities, and many hospitalists see a discharge home as a success.
Hospice: A New Way Of Judging Success
In hospice, we judge our successes on the patient’s quality
of life and the fulfillment of their goals and wishes near life’s end. Usually,
that means going home with 24/7 support from an interdisciplinary
hospice team. Whether home is a traditional residence, an assisted
living facility, or nursing home, the hospice team will assist caregivers
(and/or facility staff) with direct clinical care and education, integrative
services, bereavement support, and delivery of medication, equipment, and
supplies.
In other cases, improving quality of life means remaining in
a general inpatient setting with hospice support, taking the burden off
hospital staff until the patient is able to transition home or until the
patient dies. Hospice offers complex modalities in any setting, so patients who
would otherwise be confined to an ICU can usually return home to be among loved
ones.
With support from hospice, a sepsis patient and their family
are more likely to report higher satisfaction of care and greater quality of
life. The patient’s emotional
and spiritual needs can be met alongside their physical needs,
thanks to care from chaplains, social workers, music and massage therapists,
and other integrative specialists. Finally, the patient is more likely to die
at home, surrounded by loved ones, rather than in the hospital.
Because sepsis is most common in patients with advanced or chronic diseases that indicate hospice eligibility, acute incidences of sepsis should always trigger a hospice eligibility assessment. We owe it to our patients, their loved ones, and our colleagues in healthcare, all of whom can benefit from the support that timely end-of-life care offers.
- To view the original version of this article visit www.vitas.com/for-healthcare-professionals/making-the-rounds/2020/july/hospice-provides-postdischarge-support-that-sepsis-patients-need
- Seniors Blue Book was not involved in the creation of this content.
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Foley "My Deepest Sympathies: Meaningful Sentiments for Condolence Notes and Conversations, Plus a Guide to Eulogies" by Florence Isaacs "Remembering Well: Rituals for Celebrating Life and Mourning Death" by Sarah York "Readings for Remembrance: A Collection for Funerals and Memorial Services" by Eleanor C. Munro (introduction) "Remembrances and Celebrations: A Book of Eulogies, Elegies, Letters, and Epitaphs" by Jill Werman Harris (editor)
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