Prevalence, Characteristics, and Outcomes of Sepsis Patients Admitted to Observation Versus Inpatient Status
Recommended Citation
Taylor SP, Paje D, Heath M, Horowitz J, McLaughlin E, Kaatz S, Creutz E, Flanders S, Posa P, Younas M, and Prescott HC. Prevalence, Characteristics, and Outcomes of Sepsis Patients Admitted to Observation Versus Inpatient Status. Am J Respir Crit Care Med 2024; 209.
Document Type
Conference Proceeding
Publication Date
5-20-2024
Publication Title
Am J Respir Crit Care Med
Abstract
Rationale: Patients presenting early in their clinical course are often placed in observation status for further evaluation while discerning the need for inpatient admission. Given the frequent initial diagnostic uncertainty in sepsis, patients with sepsis may be initially hospitalized under observation status rather than inpatient status. Little is known about the prevalence, characteristics and clinical outcomes of patients with sepsis who are initially admitted under observation care.
Methods: We conducted a retrospective cohort study of sepsis admissions (2020 to 2023) at 53 hospitals participating in the Michigan Hospital Medicine Safety Consortium. We ascertained sepsis cases consistent with CDC surveillance criteria. We excluded patients initially admitted to the intensive care (ICU) or moderate care units. Patient data were collected by trained abstractors at each hospital. The primary outcome was hospital mortality. Secondary outcomes were hospital length of stay (LOS), transfer to ICU , and intravenous (IV) antibiotic days. Mixed effects logistic regression models, with hospital included as a random effect, were used to adjust for age, Charlson comorbidity index, and organ dysfunctions at presentation.
Results: Among 5,715 sepsis patients, 701 (12%) were initially admitted under observation status. The proportion of sepsis patients admitted under observation status varied from 1% to 83% across hospitals. Patients admitted under observation status were similar in age, comorbidity status, and predicted mortality risk compared to those admitted to inpatient status. Compared to patients admitted to inpatient status, fewer patients admitted under observation status received timely antibiotics (56% vs 74%) or full SEP-1 bundle compliant care (22% vs 34%). Adjusting for confounding variables, patients admitted under observation status had similar in-hospital mortality (OR, 0.96 [95%CI,0.62-1.48]), LOS (OR, 1.07 [95%CI,0.96-1.19]), and IV antibiotic days (OR, 1.03 [95%CI,0.97-1.09]) compared to those admitted as inpatients. Patients admitted under observation status had greater ICU transfer rates (OR, 1.54 [95%CI,1.09-2.18]) after adjustment for patient and hospital-level variation. This finding was not significant when removing the hospital-level effect.
Conclusion: The use of observation status for sepsis varies widely across hospitals. Patients with sepsis admitted under observation status had similar frequency of hospital mortality, length of hospital stay and days of IV antibiotic treatment as those admitted under inpatient status. After adjusting for patient and hospital-level effects, admission under observation status was associated with higher rates of ICU transfer. This association is not significant when hospital-level effects are removed from the model, suggesting hospital-specific opportunities to improve the quality of sepsis care under observation status.
Volume
209
First Page
A4767
