771. A Quality Improvement Initiative to Reduce 30-days Sepsis-Related Readmissions by Internal Medicine Residents

Abstract

Abstract Background Early readmissions after sepsis treatment are associated with an increased cost of care and poor outcome. Based on nationwide Medicare data, one-third of sepsis survivors get readmitted and wide variation exists between hospitals. Internal medicine residents aimed to determine the most common factors associated with readmission after hospitalization for sepsis at Rochester General Hospital and Unity Hospital in Rochester, New York. Methods This quality improvement (QI) project involved a retrospective chart review of 30 days sepsis-related readmissions from January to July 2017. We used Rochester General Hospital and Unity Hospital electronic database of the admitted patients with ICD 9/ICD 10 diagnoses for sepsis at admission or during the hospital course. This data were used for interpreting predominant risk factors for readmission. Based on the specific determinants, a “readmission alert” is being implemented in the electronic medical record to address the specific area of concern with relevant interventions. In the next phase of the performance improvement, six-monthly follow-up retrospective chart review will be carried out to look for the outcome. Results Of 2,221 patients admitted with a sepsis diagnosis from January to July 2017, 462 (20.8%) were readmitted within 30 days of discharge of which the majority were older than 65 years (66.4%). 66 (16.6%) patients had a septic shock on readmission and 19.3% died within 30-days of discharge after readmission. In 39.7% of cases, there was no primary care provider(PCP) communication at discharge. In 137 (65.5%) cases, Infectious disease(ID) consults service was not involved in care on initial admission. 242 (60.8%) readmitted patients had a follow-up clinic appointment more than a week after discharge. 12.5% of patients were discharged with IV antibiotics on initial admission, whereas 32.9% of the readmitted patients were not provided visiting nursing services after initial discharge. Conclusion Reducing sepsis-related readmission requires a multidisciplinary collaboration of primary care providers, visiting nursing services and infectious disease consult team. This pilot QI project results indicate that early follow-ups are important for reducing readmission. Disclosures All authors: No reported disclosures.