More patients diagnosed with sepsis are being treated on an outpatient basis in the emergency room than ever before, and this treatment protocol has been associated with good patient outcomes according to researchers at Intermountain Medical Center in Salt Lake City. The team says that 16 percent of all sepsis patients are now treated in the emergency room, despite the fact that national guidelines suggest all sepsis patients should be admitted to hospital.
“We found that many more emergency department patients with sepsis are discharged from the [emergency room] than previously recognized, but by and large these patients had fairly good outcomes,” said principal investigator Dr. Ithan Peltan, a pulmonary and critical care medicine specialist and researcher from Intermountain Medical Center in Salt Lake City.
Sepsis occurs when the body responds to an infection in an extreme manner. The resulting inflammatory response can damage tissues and organs, potentially causing vital processes to fail and, if left untreated, can be fatal.
“Sepsis is a common and deadly problem among patients who come to the emergency department,” said Peltan. “While widely-accepted guidelines assume all sepsis patients will be admitted to the hospital, we found that about 16 percent are in fact discharged from the [emergency room] for outpatient management. Our research looked at sepsis patients who were discharged and investigated their outcomes.”
Physicians are often cautious when it comes to treating patients diagnosed with sepsis due to the serious nature of the condition and the fact that the treatment options can be complicated based on the severity of the disease. As such, guidelines recommend these patients be admitted to hospital for the most comprehensive care, however the researchers believe tools could be used to help physicians better identify those patients who have the best chance of a positive outcome with outpatient management.
“Outpatient management of sepsis is likely not automatically ‘wrong,’” said Peltan. “But wide variation in care provided by different physicians suggests there’s room to identify criteria and develop and test tools clinicians can use to guide and optimize sepsis triage decisions.”
Using the Intermountain Healthcare’s Enterprise Data Warehouse, a large clinical data depository in the US, Peltan and his team studied the treatment and outcomes of almost 16,000 patients diagnosed with sepsis. The researchers presented their findings at the recent American Thoracic Society’s annual international conference in San Diego.
Out of the total 15,832 sepsis patients identified in the database, the research team excluded those who repeatedly visited the emergency room, patients who left the hospital against medical advice, and those that died in the emergency room, among others. This left the researchers with just over 12,000 patients for their study.
As a general trend. Peltan and his team found that sepsis patients who were discharged with outpatient follow-up had a less severe form of the disease compared to those who were admitted. Interestingly, patients admitted to hospital were just as likely to die in the 30 days following diagnosis as those that were discharged, when the researchers controlled for variables such as illness severity.
Physician behaviour when treating sepsis also varied. While some hospital doctors admitted all of the patients they saw who had been diagnosed with sepsis, others discharged their patients nearly 40 percent of the time.
Gender differences in patient admittance were also identified through the study; 65 percent of women treated for sepsis in the emergency room were discharged while 35 percent of male patients were admitted to hospital. According to the researchers, one hypothesis to explain this difference is that women may be more likely to visit the hospital before their illness becomes too severe, however more investigation into this trend will need to be done to test this theory.
“Physicians seem to do a good job of knowing who can be discharged,” said Peltan. “However, there was quite a bit of variation between physicians regarding how many of their patients get discharged, which suggests it may be important to give clinicians guidance to ensure patients who need it are admitted to the hospital, and to identify patients who can be considered for outpatient management and potentially avoid the inconvenience, expense, and risks of hospitalization.”