A new paper published online in the Annals of the American Thoracic Society outlines a “significant” rehabilitation program for sepsis patients that may also help post-COVID-19 patients and those who survived other serious illnesses.
“Translating post-sepsis care into post-COVID care: The case for a meaningful rehabilitation program,” Stephanie Parks Taylor, MD, Department of Internal Medicine, Atrium Health, Charlotte, North Carolina , and co-authors describe a model of real-time care that they have successfully developed and implemented for patients who left hospital after being treated for sepsis. They also address ways in which this model of care may help COVID-19 patients who have survived the illness but need ongoing care.
Our first study of health services showed that post-sepsis care practices were inconsistently recommended for sepsis survivors, but the use of these practices was associated with fewer relapses and deaths at 90 days after release. We decided to deploy a multidisciplinary stakeholder group to develop equipment to deliver optimal post-sepsis care. With the challenges many patients face in returning for a face-to-face visit after an emergency illness, the meaningful mobility program emerged as a unique approach that combined quality, heart-care and scalability. “
Dr. Stephanie Parks Taylor, MD, Department of Internal Medicine, Atrium Health, Charlotte, North Carolina
This multidisciplinary sepsis transfusion and rehabilitation program, called “STAR,” is performed almost exclusively by a dedicated nurse specialist, who provides best-practice care for high-grade sepsis survivors. danger after discharge from hospital. The nurse facilitator assists in the delivery of care through low-tech telehealth methods, including electronic health records (EHRs), secure messaging and telephone services. The sepsis nurse nurses monitor and support patients from a centralized, remote location.
“While there is still much to be learned about surviving COVID-19, based on what we currently know we can assume that COVID survivors experience many of the same issues as overcoming sepsis patients, “said Dr Taylor. “The STAR program benefits from a meaningful platform that addresses the challenges of delivering care in a dispersed setting.”
According to Dr Taylor, these challenges include pressures on the health care system due to a rapid increase in survivors and reduced access to traditional primary care as a result. at physical distance.
Dr Taylor and colleagues name a number of factors that have been important to the successful implementation of their program:
- Appropriate human, financial and technological resources. Advance funding and appropriate training for the sailors are crucial for success. Sailors should be trained in a number of areas, such as sepsis education, communication skills and cultural awareness.
- Method for identifying high risk patients. The team developed and used a data-based, EHR-based algorithm and risk models to identify patients at risk of death after discharge or re-hospitalization.
- Robust and efficient operational processes. Additional elements that should be part of the work of the program include: optimization of medication, including frequent reassessments and changing dosages; screening and early intervention for functional, brain, and mental health problems, which are common among sepsis survivors and appear to be even worse for COVID-19 survivors; monitor for symptoms to prevent the occurrence of new infections, and look for signs that other pre-existing conditions are getting worse (such as weight gain for patients with heart failure) or signs of malignancy drug reactions (such as bleeding for patients receiving antipsychotic medication), and establishing care goals, in partnership with patients, and disseminating this information to the patient’s primary care physician . STAR referrers are supported by a hospital-based physician (hospital) who reviews cases and discusses emerging issues.
Dr. Taylor notes that Atrium Health is an integrated health system, and that home health providers or community paramedicine can be used for assessment or treatment in patients’ homes. “Whether the implementation site is a unified health system or not, programs need to establish strong communication channels for effective information exchange between referrers and relevant partners,” she said. “I think a step wrong to implement a transition program that identifies problems among sepsis survivors but does not have an effective process for dealing with those problems effectively. “
In addition, much of the home care and some of the skilled post-hungry nursing facilities are integrated within the health system, but many are not. Dr. Taylor and co-author Marc A. Kowalkowski, PhD, are now exploring how to overcome barriers to additional support for post-traumatic stress care situations, as these patients are particularly vulnerable after discharge from hospital.
The authors add that there are several benefits of a meaningful referral platform for the transition and overcoming of sepsis:
- Better access and persistence. This type of program can help ensure that sepsis survivors receive follow-up care, which is often not prescribed or accessible. It can also reduce rural, socio-economic and disability disparities.
- Frequent review and change of patient care plan. This is made possible by meaningful visits by nurse referrals, which can continue in the long run at short intervals. The STAR referral program continues for 90 days after discharge from hospital, and the most common navigator contact is in patients with persistent challenges.
- Regular “check-ins” from an experienced health professional may have psychological benefits. The nurse referrer can help reduce the stress disorders that are common among sepsis survivors.
- The program is cost effective and scalable. This model of care delivery enables one STAR referrer to accept 20-30 new patients per month and provide 90 days of support.
Dr Taylor concludes, “Because COVID can be considered a form of severe sepsis, COVID patients are admitted to the STAR program if they meet its eligibility criteria. Currently, post-COVID patients receive the same elements of care as sepsis survivors, with a particular focus on respiratory symptoms and related complications.Mart of our research includes assessment to the extent that post-COVID recovery is different from non-COVID sepsis recurrence, so we hope to have data to determine whether there are factors specific to COVID survival. “
Source:
Thoracic Society of America