Background. Sepsis—life-threatening organ dysfunction triggered by infection—hospitalizes more than 25,000 Veterans each year, making it the 2nd most common reason for hospitalization in the VA. While most Veterans survive the acute episode, many suffer poor longer term outcomes. Approximately 1 in 3 survivors die in the year following sepsis, 1 in 5 have a potentially preventable rehospitalization, and 1 in 6 experience severe persistent physical or cognitive impairments. The dramatic increase in sepsis from COVID-19 brings new urgency to optimizing sepsis survivorship, but also new opportunity to learn from hospitals implementing recovery-focused practices to address the needs of Veterans surviving viral sepsis from SARS-CoV-2. Significance. Despite the prevalence of long-term morbidity after sepsis, there are no treatment guidelines focused on enhancing recovery from sepsis. OVeR-Sepsis will meet an urgent clinical need in VA, enhancing the recovery of the thousands of Veterans who survive sepsis each year (including viral sepsis from COVID). OVeR-Sepsis will validate best practices for enhancing recovery from sepsis that are responsive to Veteran and caregiver perspectives and identify feasible strategies for implementation. We will make these tools freely available, easy to use, and promote them nationally to encourage their use. Innovation and Impact. OVeR-Sepsis is innovative by studying sepsis survivorship systematically and broadly. We will study survivorship from both COVID and non-COVID sepsis, and consider how innovation in COVID sepsis survivorship practices can inform practice for non-COVID sepsis survivors. Our sequential explanatory mixed methods approach, with video site visits for 4-6 top- and 4-6 bottom- performing sites for sepsis survivorship, will allow us to study of clinical practices and implementation strategies that differentiate top-performing sites. We will then incorporate qualitative findings from our site visits into the evidence synthesis informing a modified Delphi panel to assess best practices for sepsis recovery. Specific Aims. (A1) Identify top- and bottom-performing VA hospitals for 90-day survival and quality of life after sepsis. (A2) Define practices that differentiate top-performing hospitals through electronic health record analysis, surveys, and video site visits. (A3) Prioritize best practices for sepsis recovery based on validity, improvement opportunity, and feasibility. Methodology. We will measure risk-standardized 90-day survival from sepsis across VA hospitals using hierarchical regression models and 2017-2020 CDW data. We will then empanel a cohort of N=600 Veterans from (25 Veterans per hospital, from 12 higher- and 12-lower survival hospitals) to measure quality of life and disability using telephone survey instruments with proxy respondent options. From those, we will select 4-6 top-performing (higher survival, high quality of life) and 4-6 bottom- performing hospitals for 360-degree video site visits. Through quantitative analyses of select practices, survey of current practices, and semi-structured interviews with a diverse set of 12-15 informants (clinicians, administrators, Veterans, caregivers), we will identify “best practices” for sepsis recovery and associated implementation strategies. Using a modified Delphi panel of experts, we will assess the validity, improvement opportunity, and feasibility of these best practices. Next Steps/Implementation. Upon successful completion of this research, we will work with our operational partners—who we have included even in the design stage of this IIR—to implement these best practices.
External Links for this Project
Grant Number: I01HX003304-01A1
- Hechtman RK, Cano J, Whittington T, Hogan CK, Seelye SM, Sussman JB, Prescott HC. A Multi-Hospital Survey of Current Practices for Supporting Recovery From Sepsis. Critical care explorations. 2023 Jun 1; 5(6):e0926. [view]
- Denstaedt SJ, Cano J, Wang XQ, Donnelly JP, Seelye S, Prescott HC. Blood count derangements after sepsis and association with post-hospital outcomes. Frontiers in immunology. 2023 Feb 28; 14:1133351. [view]
- Karlic KJ, Clouse TL, Hogan CK, Garland A, Seelye S, Sussman JB, Prescott HC. Comparison of Administrative versus Electronic Health Record-based Methods for Identifying Sepsis Hospitalizations. Annals of the American Thoracic Society. 2023 Sep 1; 20(9):1309-1315. [view]
- Watson MA, Anderson C, Karlic KJ, Hogan CK, Seelye S, Taylor SP, Prescott HC. Receipt of Recovery-Oriented Care Practices During Hospitalization for Sepsis. Critical care explorations. 2022 Sep 1; 4(9):e0766. [view]
- Wayne MT, Valley TS, Arenberg DA, De Cardenas J, Prescott HC. Temporal Trends and Variation in Bronchoscopy Use for Acute Respiratory Failure in the United States. Chest. 2023 Jan 1; 163(1):128-138. [view]
- Prescott HC, Seelye S, Wang XQ, Hogan CK, Smith JT, Kipnis P, Barreda F, Donnelly JP, Pogue JM, Iwashyna TJ, Jones MM, Liu VX. Temporal Trends in Antimicrobial Prescribing During Hospitalization for Potential Infection and Sepsis. JAMA internal medicine. 2022 Aug 1; 182(8):805-813. [view]
Infectious Diseases, Acute and Combat-Related Injury
Treatment - Implementation, TRL - Applied/Translational
Best Practices, Quality of Care
None at this time.