Peridischarge Management After Sepsis

Background Sepsis performance initiatives typically focus on early hospital management, but peridischarge care is important to improving recovery from sepsis. Research Question What peridischarge best practices and organizational processes facilitating their implementation differentiate hospitals with higher vs lower postsepsis mortality? Study Design and Methods We conducted a qualitative study using semistructured interviews to examine peridischarge care at 3 higher-performing and 4 lower-performing Veterans Affairs (VA) hospitals based on 90-day risk-adjusted mortality after sepsis. We assessed perspectives of VA staff, veterans, and caregivers on delivery of Surviving Sepsis Guidelines best practices for peridischarge care after sepsis. Results Interviews were conducted with 69 VA staff involved in peridischarge sepsis care, 41 veterans recently hospitalized for sepsis, and 10 caregivers of veterans (median, 18 interviews per site; range, 7-23 interviews per site). Interviews lasted 6 to 90 minutes. We did not find consistent differences in knowledge or perceived use of specific best practices to support recovery from sepsis between higher-performing and lower-performing sites. Instead, we identified 3 organizational domains that impacted the optimal delivery of best practices to enhance recovery from sepsis: staffing and training, teamwork, and information transfer. Although participants at each hospital identified barriers related to these domains, the barriers were less frequent or less substantial at higher-performing sites. Effective use of technology helped to facilitate implementation of best practices and to overcome barriers related to all 3 organizational domains. Few respondents reported sepsis-specific peridischarge management. Interpretation Our results show that knowledge and perceived use of best practices to support recovery from sepsis were similar between higher-performing and lower-performing VA hospitals. System-level organizational domains (staffing and training, teamwork, and information transfer) were perceived as essential determinants of effective care delivery. Additional attention to these organizational domains is warranted and may support improved recovery from sepsis.