Abstract

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.

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DRA: Infectious Diseases, Acute and Combat-Related Injury

DRE: Treatment - Implementation, TRL - Applied/Translational

Keywords: Best Practices, Quality of Care

MeSH Terms: None at this time.