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Table 2 Post-Sepsis Guidelines with Sepsis Transition and Recovery (STAR) Program Task

From: Protocol for a two-arm pragmatic stepped-wedge hybrid effectiveness-implementation trial evaluating Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship (ENCOMPASS)

Core component / Evidence

Recommendation

STAR Task

Screen for new physical, mental, and cognitive deficits after sepsis

 Functional disability: Patients aged ≥65 years develop 1 to 2 new functional limitations

-Prescribe structured exercise program

-Referral to Physical/ Cardiac/ Pulmonary rehab as needed

Confirm functional assessment (Physical Therapy). Refer as needed.

 Swallowing impairment: Of patients aged ≥65 years, 1.8% readmitted < 90 days for aspiration pneumonitis

-Screen for cough, dysphagia, weak voice

-Referral to speech therapy as needed

Confirm screen and team aware. Refer as needed.

 Mental Health impairment: Prevalence for clinically significant anxiety 32%, depression 29%, and PTSD 44%

-Review details of hospital course (e.g., ICU diary)

-Depression screen

-Referral to peer support or Behavioral Health as needed

Mental health screen. Refer as needed.

Review and Adjust Long-term Medications

 Medication errors: Errors of omission and commission occur in up to 25% of patients, depending on medication

-Review antibiotic choice, dose, duration.

-Start/continue meds for comorbidities; adjust for BMI, etc.

-Discontinue hospital meds without ongoing indication

Antibiotic Stewardship Medication Reconciliation Vitals/Weight

Anticipate and Mitigate risk for Common and Preventable Causes of Health Deterioration

 

Routine virtual follow up. Schedule provider visits

 Infection: Of patients aged ≥65 years, 11.9% readmitted < 90 days for infection (6.4% for sepsis)

-Patient education about symptoms of sepsis, recurrence

-Appropriate vaccination

-Monitor for symptomatic improvement in index infection

Education

Medication Reconciliation Monitor symptoms

 Heart failure exacerbation: Of patients aged ≥65 years, 5.5% readmitted < 90 days for CHF

-Reassess beta-blocker, diuretic, ACE-inhibitor dosing

-Monitor volume status (fluid balance) - recognizing dry weight may be decreased if muscle mass lost

Medication Reconciliation Vitals/Weight

Monitor symptoms

 Acute Renal Failure: Of patients aged ≥65 years, 3.3% readmitted < 90 days for acute renal failure

-Monitor renal function; lab testing as needed

-Reassess need and dosages for renally cleared, nephrotoxic agents

Monitor symptoms

Confirm CBC/BMP

Medication Reconciliation

 COPD exacerbation: Of patients aged ≥65 years, 1.9% readmitted < 90 days for COPD exacerbation

-Confirm/initiate appropriate controller inhalers

-Appropriate vaccination

-Review use of benzodiazepines/opioids

Monitor symptoms

Medication Reconciliation

Assess appropriateness for palliative care

-Palliative Care screen/consult as indicated

-Goals of care. Educate on disease progression/ terminal

Discuss Palliative Care consult. Goals of Care