J: Clinical Practice Issues
Oral Abstract Submission
Severe sepsis is associated with high mortality and readmission rates. Infectious diseases (ID) consultations (IDC) improve clinical outcomes in patients with severe infections. In March 2016, a mandatory ID consultation (MIDC) policy for this patient population was implemented. This study’s goal was to determine the impact of MIDC on clinical outcomes.
In efforts to reduce mortality and complications from sepsis at our institution, multidisciplinary intervention led to a policy for MIDC for patients with sepsis. This intervention was monitored daily by the clinical initiatives team to ensure compliance. We conducted a retrospective chart review of patients with severe sepsis from all sources in Pre-MIDC group from January 2015 to February 2016 and Post-MIDC group from March 2016 to December 2017. Primary endpoint of the study was to evaluate the impact of MIDC on all-cause inpatient mortality (ACIM) and 30-day readmission in patients with severe sepsis. Secondary endpoint focused on impact of MIDC on time to IDC and patient seen by ID physician. Subgroup analysis evaluated the impact of early vs late IDC on ACIM.
There were total of 511 patients in Pre-MIDC and 635 patients in Post-MIDC groups. No differences were seen in the demographics between the groups. Overall a difference was not seen in ACIM between the two groups (9.2% vs 8%, P=0.52), however, Post-MIDC group had lower rates of 30-day readmission due to sepsis/infection (12.1% vs 4.9%, P=0.01) and shorter length of stay (8.5 vs 6.7 days, P=0.001). We did observe an association with early IDC from admission to a decrease in ACIM compared to late IDC (7.8% vs 9.4%, P=0.03). Times to IDC from admission (33.5 hrs vs 16.75 hrs, P=0.001) and patient seen by ID physician from time of IDC order (23 hrs vs 8.75hrs, P=0.0001) was faster in Post-MIDC group. A decline was observed in sepsis mortality by 16% since MIDC implementation compared to Pre-MIDC.
Implementation of MIDC led to faster time to IDC and patients seen by ID physicians which was directly associated with decrease in ACIM. MIDC didn't show a difference in overall ACIM however, it decreased 30-day readmission due to sepsis/infection and shorter LOS. We also observed consistent decline in overall sepsis mortality through this intervention.