Five discharge steps an expert panel ranks first for sepsis survivors

The edition in brief

Sepsis survivors are readmitted often and many die in the months after discharge. A 15-member multidisciplinary panel using the RAND/UCLA appropriateness method rated 18 recovery practices and picked five as high importance and only moderately resource-intensive: booking follow-up before discharge, screening daily-living function and equipment needs, teaching the warning signs of sepsis, explaining common after-effects such as fatigue and brain fog, and going through discharge medicines and why each is prescribed. This is expert consensus, not trial evidence, but each step is cheap and within a ward team's control. In CTEPH-DETECT, a quasi-cluster randomised trial of 400 outpatients with past pulmonary embolism and ongoing symptoms, an electronic alert raised echocardiography orders from 17.5% to 32.5% and doubled detection of pulmonary hypertension (10.5% vs 5.0%), though no new chronic thromboembolic pulmonary hypertension was diagnosed. A target-trial emulation in 12,922 ICU stays found that above-median overnight care contacts were associated with a 43% higher hazard of delirium, mostly driven by vital-sign charting and blood draws; reverse causation remains possible. A Canadian collaborative of 157 hospitals shows which routine inpatient tests are most often low value. The pearl covers when to recheck inpatient bloods.