43-Effect of a Navigator-Led Transition and Recovery Program on Mortality and Readmission After Sepsis
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Sepsis, Quality and Patient Safety, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Stephanie Parks Taylor

Introduction/Hypothesis: Sepsis survivors experience high mortality and morbidity following hospital discharge. We hypothesized that a nurse navigator-led, telehealth-focused Sepsis Transition and Recovery (STAR) program would reduce 30-day mortality and readmission rates among high-risk sepsis survivors.

Methods: We conducted a pragmatic randomized trial from January 2019 to March 2020 at three urban academic hospitals in a single healthcare system. Adults who presented with suspected sepsis and deemed high risk for readmission or death by previously developed risk-stratification models were randomized 1:1 to either usual care (UC) or STAR. The STAR program comprised a nurse navigator using proactive follow-up to facilitate best-practice post-sepsis care strategies. STAR support began during index hospitalization and continued through 30 days after discharge. Navigators reviewed medications, assessed for new impairments or symptoms, monitored existing comorbidities, and prompted palliative care referral as needed. Protocols guided escalation of support for identified problems. The primary outcome was a composite of all-cause hospital readmission or mortality within 30 days of discharge. Logistic regression models were constructed to evaluate marginal and conditional odds ratios (adjusted for prespecified covariates: age, comorbidity, and organ dysfunction at enrollment).

Results: We enrolled 691 patients with mean age of 63.7 years. 359 (52%) were female, and 448 (65%) were white. Among 349 patients randomized to STAR, 100 (28.7%) experienced the composite outcome of mortality or hospital readmission within 30 days, compared to 114 of 342 (33.3%) randomized to UC (difference: 4.6%; marginal odds ratio [OR]: 0.80, 95% confidence interval [CI] 0.58-1.11; conditional OR: 0.80, 95%CI: 0.64-0.98 p=0.03). There were 74 deaths (STAR: 33 [9.5%] vs UC: 41 [12.0%] and 155 rehospitalizations (STAR: 71 [20.3%] vs UC: 84 [24.6%]).

Conclusions: Among high-risk sepsis survivors, the use of a nurse navigator-led telehealth–focused intervention, compared with usual care, reduced mortality and readmissions within 30 days after discharge when adjusting for covariates known a priori to be associated with the outcomes. Further research is needed to clarify contextual factors associated with successful implementation of this approach.


Meta Tag
Content Type Presentation
Knowledge Area Sepsis
Knowledge Area Quality and Patient Safety
Knowledge Level Advanced
Membership Level Select
Tag Mortality
Tag Length of Stay
Year 2021
IMPACTS clinical trial
nurse-navigator-led sepsis transition program
sepsis survivors
hospital readmissions
outpatient setting


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