Five discharge steps an expert panel prioritised for sepsis survivors

Design

Expert panel using the RAND/UCLA appropriateness method (modified Delphi)

Population

15 experts across sepsis, critical care, hospital and primary care, geriatrics and nursing, with patient representatives

Primary outcome

Ratings of validity, importance and resource intensity for 18 recovery practices

Effect

10 of 18 rated valid; 5 rated high importance with moderate resource needs

Many patients survive sepsis only to be readmitted or die in the months that follow, yet there is little evidence on what to do at discharge. A 15-member panel spanning sepsis, critical care, hospital medicine, primary care, geriatrics and nursing, with patient representatives, used the RAND/UCLA appropriateness method to rate 18 recovery practices.

Ten were rated valid. Five of those were rated both highly important and only moderately resource-intensive, and the panel suggests prioritising them: booking follow-up before the patient leaves; screening for limits in basic and instrumental activities of daily living and for equipment needs; teaching patients the signs of sepsis; warning them about common after-effects such as fatigue, breathlessness and poor concentration; and counselling patients or carers on discharge medicines and why each is taken.

This is expert consensus, not trial evidence, and the panel was drawn mostly from the US Veterans Health Administration with no social work member. But none of the five practices is costly, and each targets a known route back to hospital.

• Book the follow-up appointment before the patient leaves, not as an instruction to arrange it later.
• Check what the patient can now do for themselves, including dressing, bathing, shopping and medicines.
• Tell the patient and family which symptoms mean sepsis may be returning and where to go.
• Warn that fatigue, breathlessness and brain fog are common for weeks to months after sepsis.
• Go through every discharge medicine and its purpose, especially any started or stopped in hospital.

Why it matters

Discharge after sepsis is often treated as the end of the illness when it is the start of a high-risk period.

Don't overread it

These are expert ratings, not tested interventions; they have not been shown to cut readmissions.

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