The clinical case study of a patient with advanced COPD who has multiple comorbid
conditions and develops sepsis provides the backdrop for two potential clinical pathways—
sepsis and post-sepsis syndrome—and explores the natural history and indicators of poor prognosis
in both conditions.
The clinical case study of a patient with advanced COPD who has multiple comorbid conditions and develops sepsis provideD the backdrop for two potential clinical pathways—sepsis and post-sepsis syndrome.
This document discusses sepsis, post-sepsis syndrome, and the benefits of early hospice referral. Key points include:
- Sepsis affects millions worldwide each year and is a leading cause of death in hospitals. Survivors often experience post-sepsis syndrome with new physical and cognitive impairments.
- Early identification of sepsis and standardized hospital treatment can improve outcomes, but there is no consensus on best post-acute care. Hospice may be appropriate for some patients.
- Over 40% of sepsis patients who die in the hospital meet hospice eligibility guidelines upon admission due to underlying terminal conditions exacerbated by sepsis. Hospice referral rates for sepsis patients remain low compared to non-
A case study of a 66-year-old patient provides the backdrop for two potential clinical scenarios—sepsis and post-sepsis syndrome—and explores the natural history and indicators of poor prognosis in both conditions.
Sepsis & Hospice Eligibility: Natural History, Prognosis & Role of HospiceVITAS Healthcare
Sepsis can lead to organ dysfunction and death in the hospital setting. Approximately 25-50% of hospital deaths are sepsis-related. Some sepsis patients who do not die in the hospital still have a poor prognosis and increased mortality risk. Up to 40% of sepsis patients meet hospice eligibility guidelines at the time of hospital admission based on their underlying illness and sepsis complications. After hospitalization, sepsis survivors are at risk for post-sepsis syndrome which can include new physical and cognitive limitations that affect quality of life and functional status.
Advanced Lung Disease: Prognostication and Role of HospiceVITASAuthor
The document provides information about a continuing medical education (CME) activity on advanced lung disease presented by VITAS Healthcare Corporation. It includes objectives of defining different types of advanced lung diseases, their impact and symptoms, prognostic factors, hospice eligibility guidelines, and medical management. It also provides information on accreditation and credit designation for physicians, nurses, social workers and other professionals who complete the CME activity.
Enhancing Access, Quality, and Equity for Persons With Advanced IllnessVITASAuthor
This diverse panel examined various facets of healthcare access, equity, and inclusion as it
relates to individuals in underserved communities who are coping with advanced illness. Based on their
decades of experience in end-of-life care, as well as evidence-based data and a compelling case study
of a Filipino-American US Navy Veteran, panel members shared strategies on how to mitigate
current barriers, including ensuring patients are granted timely access to hospice and palliative
services and that appropriate levels of care are provided.
The goal of this webinar was to educate physicians and healthcare professionals about hospice eligibility and the benefits of hospice for patients with advanced cardiac disease (ACD).
The goal of this webinar was to educate physicians and healthcare professionals about hospice eligibility and the benefits of hospice for patients with advanced cardiac disease (ACD). Through evidence-based data and case studies, attendees will understand the advantages of advance care planning, complex modalities for high-acuity patients, and management of symptoms and pain to provide comfort and dignity near the end of life.
The clinical case study of a patient with advanced COPD who has multiple comorbid conditions and develops sepsis provideD the backdrop for two potential clinical pathways—sepsis and post-sepsis syndrome.
This document discusses sepsis, post-sepsis syndrome, and the benefits of early hospice referral. Key points include:
- Sepsis affects millions worldwide each year and is a leading cause of death in hospitals. Survivors often experience post-sepsis syndrome with new physical and cognitive impairments.
- Early identification of sepsis and standardized hospital treatment can improve outcomes, but there is no consensus on best post-acute care. Hospice may be appropriate for some patients.
- Over 40% of sepsis patients who die in the hospital meet hospice eligibility guidelines upon admission due to underlying terminal conditions exacerbated by sepsis. Hospice referral rates for sepsis patients remain low compared to non-
A case study of a 66-year-old patient provides the backdrop for two potential clinical scenarios—sepsis and post-sepsis syndrome—and explores the natural history and indicators of poor prognosis in both conditions.
Sepsis & Hospice Eligibility: Natural History, Prognosis & Role of HospiceVITAS Healthcare
Sepsis can lead to organ dysfunction and death in the hospital setting. Approximately 25-50% of hospital deaths are sepsis-related. Some sepsis patients who do not die in the hospital still have a poor prognosis and increased mortality risk. Up to 40% of sepsis patients meet hospice eligibility guidelines at the time of hospital admission based on their underlying illness and sepsis complications. After hospitalization, sepsis survivors are at risk for post-sepsis syndrome which can include new physical and cognitive limitations that affect quality of life and functional status.
Advanced Lung Disease: Prognostication and Role of HospiceVITASAuthor
The document provides information about a continuing medical education (CME) activity on advanced lung disease presented by VITAS Healthcare Corporation. It includes objectives of defining different types of advanced lung diseases, their impact and symptoms, prognostic factors, hospice eligibility guidelines, and medical management. It also provides information on accreditation and credit designation for physicians, nurses, social workers and other professionals who complete the CME activity.
Enhancing Access, Quality, and Equity for Persons With Advanced IllnessVITASAuthor
This diverse panel examined various facets of healthcare access, equity, and inclusion as it
relates to individuals in underserved communities who are coping with advanced illness. Based on their
decades of experience in end-of-life care, as well as evidence-based data and a compelling case study
of a Filipino-American US Navy Veteran, panel members shared strategies on how to mitigate
current barriers, including ensuring patients are granted timely access to hospice and palliative
services and that appropriate levels of care are provided.
The goal of this webinar was to educate physicians and healthcare professionals about hospice eligibility and the benefits of hospice for patients with advanced cardiac disease (ACD).
The goal of this webinar was to educate physicians and healthcare professionals about hospice eligibility and the benefits of hospice for patients with advanced cardiac disease (ACD). Through evidence-based data and case studies, attendees will understand the advantages of advance care planning, complex modalities for high-acuity patients, and management of symptoms and pain to provide comfort and dignity near the end of life.
The Value Proposition of Hospice | VITASVITASAuthor
The goal of this webinar was to help hospice and healthcare professionals discover the evidence-based benefits of hospice care, while gaining key insights on hospice eligibility guidelines, how hospice differs from other types of care, and how the Medicare Hospice Benefit helps patients facing advanced illness.
Advanced Lung Disease: Prognostication and Role of HospiceVITAS Healthcare
The goal of this webinar was to educate physicians and healthcare professionals about the medical management of advanced lung disease (ALD), the value of advance care planning (ACP) and the benefits of hospice for end-of-life patients.
Palliative Care vs. Curative Care - December 2023VITASAuthor
The goal of this webinar was to educate healthcare professionals about the differences between palliative and curative care while exploring the history and philosophy of the hospice movement.
The document discusses the value of hospice care within the Medicare system. It notes that recent statistical analyses found hospice generated cost savings in a patient's last six months of life and up to a year of hospice enrollment. The document then proposes examining these results from different perspectives within the serious illness care continuum, including from primary care physicians and considering diversity, equity and inclusion. Expert hospice and palliative care clinicians would discuss the importance of earlier access to such care in a patient's disease trajectory, as well as the
Sepsis & Hospice Eligibility: Natural History, Prognosis & Role of HospiceVITAS Healthcare
The goal of this webinar is to educate healthcare clinicians about the history, incidence, impact and identification of sepsis in the acute-care setting. Hospice care is inadequately utilized for patients with sepsis, a serious condition that results in 250,000 US deaths each year and an annual $3.5 billion in hospital readmission costs.
The goal of this webinar was to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
Advanced Lung Disease: Prognostication and Role of HospiceVITAS Healthcare
This document provides an overview of advanced lung disease (ALD) and the role of hospice. It defines different types of ALD including obstructive and restrictive lung diseases. Signs and symptoms of ALD are discussed along with factors associated with poorer prognosis. Guidelines for hospice referral in ALD are reviewed. Trends showing increasing home and hospice deaths for those with lung disease are presented. Pharmacologic management of ALD focuses on symptom control rather than disease modification.
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
This document provides information on continuing education credit for completing an advanced cardiac disease training. It states that learners must complete an evaluation to receive a certificate of completion and participate in the entire activity, as partial credit is not available. It then lists the accredited organizations that provide credit for various specialties, such as physicians, nurses, social workers, and nursing home administrators. Exceptions to credit eligibility for certain specialties are also noted for some states.
The goal of this webinar was to educate healthcare professionals about the differences between palliative and curative care while exploring the history and philosophy of the hospice movement.
A Change in Behavior: Delirium, Terminal Restlessness, or Dementia, A Pragmat...VITAS Healthcare
This webinar leverages evidence-based data to help physicians and healthcare professionals differentiate delirium, terminal restlessness and dementia-related agitation in patients as they near the end of life.
Advanced Lung Disease: Prognostication and Role of HospiceVITAS Healthcare
The goal of this webinar was to educate physicians and healthcare professionals about the medical management of advanced lung disease (ALD) and the value of advance care planning (ACP) for end-of-life patients.
Managing National Health: An Overview of Metrics & OptionsDale Sanders
This is a presentation that I gave at the annual international healthcare conference hosted by the Cayman Islands government. It summarizes the international standards and frameworks for planning and managing the health of a nation. One of the most fun parts of a very fun career was the time that I spent working and living in the Cayman Islands and serving as the CIO of the national health system. The Cayman Islands national health system sat at the intersection of three very influential healthcare ecosystems-- the United States, United Kingdom, and the Pan-American Healthcare Organization. As a result, I was fortunate enough to learn from these international settings and contrast that to the US healthcare system. Other healthcare systems tend to benchmark themselves internationally more so than the United States, where we tend to benchmark ourselves internally. Unfortunately, those internal US benchmarks are the lowest in the developed world by almost every measure of national health.
Determining Prognosis in Cancer and Non-Cancer DiagnosisVITAS Healthcare
The goal of this webinar is to help healthcare professionals identify patients who have advanced illness and are no longer responding to curative care.
Key tools can quickly facilitate goals-of-care (GOC) conversations, advance care planning, and hospice referrals amid the ED’s time constraints and high-acuity challenges.
When Decision-Making Is Imperative: Advance Care Planning for Busy Practice S...VITAS Healthcare
Complex, chronically ill patients present an opportunity to discuss and implement hospice and palliative care. Many elderly patients who present to the ED and other busy practice settings are hospice-eligible because of functional decline and multi-morbidity. Key tools can quickly facilitate goals-of-care (GOC) conversations, advance care planning, and hospice referrals amid time constraints and high-acuity challenges.
A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...VITAS Healthcare
The goal of this webinar was to help physicians and healthcare professionals differentiate delirium, terminal restlessness, and dementia-related agitation and aggression in patients near the end of life.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Webinar: Advanced Cancer and End of LifeVITASAuthor
GOAL: To provide insight and guidance into the challenges of advanced cancer in patients nearing the end of life. A case study provides the foundation to explore functional status and prognosis in advanced cancer, with hospice as the active plan of care. It highlights the value and benefits of hospice care for patients and families, and it identifies missed opportunities that could have supported earlier goals-of-care conversations, advance care planning, and a timelier referral to hospice care.
The Value Proposition of Hospice | VITASVITASAuthor
The goal of this webinar was to help hospice and healthcare professionals discover the evidence-based benefits of hospice care, while gaining key insights on hospice eligibility guidelines, how hospice differs from other types of care, and how the Medicare Hospice Benefit helps patients facing advanced illness.
Advanced Lung Disease: Prognostication and Role of HospiceVITAS Healthcare
The goal of this webinar was to educate physicians and healthcare professionals about the medical management of advanced lung disease (ALD), the value of advance care planning (ACP) and the benefits of hospice for end-of-life patients.
Palliative Care vs. Curative Care - December 2023VITASAuthor
The goal of this webinar was to educate healthcare professionals about the differences between palliative and curative care while exploring the history and philosophy of the hospice movement.
The document discusses the value of hospice care within the Medicare system. It notes that recent statistical analyses found hospice generated cost savings in a patient's last six months of life and up to a year of hospice enrollment. The document then proposes examining these results from different perspectives within the serious illness care continuum, including from primary care physicians and considering diversity, equity and inclusion. Expert hospice and palliative care clinicians would discuss the importance of earlier access to such care in a patient's disease trajectory, as well as the
Sepsis & Hospice Eligibility: Natural History, Prognosis & Role of HospiceVITAS Healthcare
The goal of this webinar is to educate healthcare clinicians about the history, incidence, impact and identification of sepsis in the acute-care setting. Hospice care is inadequately utilized for patients with sepsis, a serious condition that results in 250,000 US deaths each year and an annual $3.5 billion in hospital readmission costs.
The goal of this webinar was to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
Advanced Lung Disease: Prognostication and Role of HospiceVITAS Healthcare
This document provides an overview of advanced lung disease (ALD) and the role of hospice. It defines different types of ALD including obstructive and restrictive lung diseases. Signs and symptoms of ALD are discussed along with factors associated with poorer prognosis. Guidelines for hospice referral in ALD are reviewed. Trends showing increasing home and hospice deaths for those with lung disease are presented. Pharmacologic management of ALD focuses on symptom control rather than disease modification.
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
This document provides information on continuing education credit for completing an advanced cardiac disease training. It states that learners must complete an evaluation to receive a certificate of completion and participate in the entire activity, as partial credit is not available. It then lists the accredited organizations that provide credit for various specialties, such as physicians, nurses, social workers, and nursing home administrators. Exceptions to credit eligibility for certain specialties are also noted for some states.
The goal of this webinar was to educate healthcare professionals about the differences between palliative and curative care while exploring the history and philosophy of the hospice movement.
A Change in Behavior: Delirium, Terminal Restlessness, or Dementia, A Pragmat...VITAS Healthcare
This webinar leverages evidence-based data to help physicians and healthcare professionals differentiate delirium, terminal restlessness and dementia-related agitation in patients as they near the end of life.
Advanced Lung Disease: Prognostication and Role of HospiceVITAS Healthcare
The goal of this webinar was to educate physicians and healthcare professionals about the medical management of advanced lung disease (ALD) and the value of advance care planning (ACP) for end-of-life patients.
Managing National Health: An Overview of Metrics & OptionsDale Sanders
This is a presentation that I gave at the annual international healthcare conference hosted by the Cayman Islands government. It summarizes the international standards and frameworks for planning and managing the health of a nation. One of the most fun parts of a very fun career was the time that I spent working and living in the Cayman Islands and serving as the CIO of the national health system. The Cayman Islands national health system sat at the intersection of three very influential healthcare ecosystems-- the United States, United Kingdom, and the Pan-American Healthcare Organization. As a result, I was fortunate enough to learn from these international settings and contrast that to the US healthcare system. Other healthcare systems tend to benchmark themselves internationally more so than the United States, where we tend to benchmark ourselves internally. Unfortunately, those internal US benchmarks are the lowest in the developed world by almost every measure of national health.
Determining Prognosis in Cancer and Non-Cancer DiagnosisVITAS Healthcare
The goal of this webinar is to help healthcare professionals identify patients who have advanced illness and are no longer responding to curative care.
Key tools can quickly facilitate goals-of-care (GOC) conversations, advance care planning, and hospice referrals amid the ED’s time constraints and high-acuity challenges.
When Decision-Making Is Imperative: Advance Care Planning for Busy Practice S...VITAS Healthcare
Complex, chronically ill patients present an opportunity to discuss and implement hospice and palliative care. Many elderly patients who present to the ED and other busy practice settings are hospice-eligible because of functional decline and multi-morbidity. Key tools can quickly facilitate goals-of-care (GOC) conversations, advance care planning, and hospice referrals amid time constraints and high-acuity challenges.
A Change in Behavior: A Pragmatic Clinical Guide to Delirium, Terminal Restle...VITAS Healthcare
The goal of this webinar was to help physicians and healthcare professionals differentiate delirium, terminal restlessness, and dementia-related agitation and aggression in patients near the end of life.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Webinar: Advanced Cancer and End of LifeVITASAuthor
GOAL: To provide insight and guidance into the challenges of advanced cancer in patients nearing the end of life. A case study provides the foundation to explore functional status and prognosis in advanced cancer, with hospice as the active plan of care. It highlights the value and benefits of hospice care for patients and families, and it identifies missed opportunities that could have supported earlier goals-of-care conversations, advance care planning, and a timelier referral to hospice care.
Advance Directives and Advance Care Planning: Ensuring Patient Voices Are HeardVITASAuthor
GOAL: To educate healthcare professionals about advance directives and advance care planning, including the types and purposes of legal documents that govern patients’ decisions and preferences. The webinar provides resources and guidance on effective conversations with patients and families about their goals, wishes, and values for end-of-life care.
Veterans Nearing the End of Life: Distinct Needs, Specialized CareVITASAuthor
The goal of this webinar was to equip healthcare professionals with an understanding of military veterans’ unique
medical, emotional, and spiritual needs as they near the end of life
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)blessyjannu21
Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
MBC Support Group for Black Women – Insights in Genetic Testing.pdfbkling
Christina Spears, breast cancer genetic counselor at the Ohio State University Comprehensive Cancer Center, joined us for the MBC Support Group for Black Women to discuss the importance of genetic testing in communities of color and answer pressing questions.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
For More Details:
Map: https://cutt.ly/BwCeflYo
Name: Apollo Hospital
Address: Singar Nagar, LDA Colony, Lucknow, Uttar Pradesh 226012
Phone: 08429021957
Opening Hours: 24X7
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
Your mindset is the way you make sense of the world around you. This lens influences the way you think, the way you feel, and how you might behave in certain situations. Let's talk about mindset myths that can get us into trouble and ways to cultivate a mindset to support your cancer survivorship in authentic ways. Let’s Talk About It!
KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
GEMMA Wean has an optimised nutritional balance and physical quality so that it flows more freely and spreads readily on the water surface. The balance of phospholipid classes to- gether with the production technology based on a low temperature extrusion process improve the physical aspect of the pellets while still retaining the high phospholipid content.
GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
Tips for Pet Care in winters How to take care of pets.
Sepsis and Post-Sepsis Syndrome
1. Confidential and Proprietary Content
Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help.
Sepsis and
Post-Sepsis Syndrome
2. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
CME Provider Information
Satisfactory Completion
Learners must complete an evaluation form to receive a certificate of completion. You must participate
in the entire activity as partial credit is not available. If you are seeking continuing education credit for a
specialty not listed below, it is your responsibility to contact your licensing/certification board to determine
course eligibility for your licensing/certification requirement.
Physicians
In support of improving patient care, this activity has been planned and implemented by Amedco LLC and
VITAS®
Healthcare. Amedco LLC is jointly accredited by the Accreditation Council for Continuing Medical
Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses
Credentialing Center (ANCC), to provide continuing education for the healthcare team. Credit Designation
Statement – Amedco LLC designates this live activity for a maximum of 1 AMA PRA Category 1 Credit
TM
.
Physicians should claim only the credit commensurate with the extent of their participation in the activity.
3. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
VITAS Healthcare programs are provided CE credits for their Nurses/Social Workers and Nursing Home Administrators through:
VITAS Healthcare Corporation of Florida, Inc./CE Broker Number: 50-2135. Approved By: Florida Board of Nursing/Florida Board
of Nursing Home Administrators/Florida Board of Clinical Social Workers, Marriage and Family Therapy & Mental Health Counseling.
VITAS Healthcare programs in Illinois are provided CE credit for their Nursing Home Administrators and Respiratory Therapists through:
VITAS Healthcare Corporation of Illinois, Inc./8525 West 183 Street, Tinley Park, IL 60487/NHA CE Provider Number: 139000207/RT CE
Provider Number: 195000028/Approved By the Illinois Division of Profession Regulation for: Licensed Nursing Home Administrators and
Illinois Respiratory Care Practitioner.
VITAS Healthcare, #1222, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB)
Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and
provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing
education credit. VITAS Healthcare maintains responsibility for this course. ACE provider approval period: 06/06/2021 – 06/06/2024.
Social workers completing this course receive 1.0 ethics continuing education credits.
VITAS Healthcare Corporation of California, 310 Commerce, Suite 200, Irvine, CA 92602. Provider approved by the California
Board of Registered Nursing, Provider Number 10517, expiring 01/31/2025.
Exceptions to the above are as follows: AL: No NHAs, DE: No NHAs, DC: No NHAs, GA: No NHAs, KS: No NHAs, NJ: No NHAs,
OH: No NHAs, PA: No NHAs, TX: No NHAs, VA: No NHAs, WI: No NHAs and Nurses are not required – RT only receive CE Credit
in Illinois
CE Provider Information
4. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Goal
• Appreciate the role of hospice in the care of patients
who develop sepsis in acute-care hospital and
post-acute care settings
• Discuss the role of post-sepsis syndrome and
characteristics that support hospice eligibility
5. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Objectives
• Appreciate the identification and
natural history of sepsis
• Describe hospice eligibility for sepsis
– Hospitalization
– Post-acute
• Understand indicators of poor
prognosis in sepsis
• Incorporate a care model for
sepsis in hospice
• Integrate ICD-10 coding for sepsis
6. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
1
US Centers for Disease Control and Prevention. (2020). Data and Reports, retrieved from: https://www.cdc.gov/sepsis/datareports/index.html
2World Health Organization. (2021). WHO calls for global action on sepsis: cause of 1 in 5 deaths worldwide. Retrieved from: https://www.who.int/news/item/08-09-2020-who-calls-for-global-action-on-sepsis---cause-of-1-in-5-deaths-worldwide
3Rhee, C., et al. (2017). Incidence and trends of sepsis in US hospitals using clinical vs claim data, 2009 to 2014. JAMA, 318(13), 1241-1249.
4Thompson, K., et al. (2018). Health-related outcomes of critically ill patients with and without sepsis. Intensive Care Med, 44(8):1249-1257.
• Sepsis affects 1.7 million people
per year in the US and 270,000
die from it1
– 50 million worldwide and
11 million deaths2
• About 1 in 3 patients or more who
die in a hospital have sepsis; many
are hospice-eligible at admission3
• Recommendations exist for
inpatient hospital care
– Standard/rapid identification
and management
• 30% of sepsis survivors suffer
from post-sepsis syndrome4
• No consensus recommendations
exist on best post-acute care
– New symptom burden
– Pain, fatigue, dysphagia, poor
attention, shortness of breath
– Long-term disability:
cognitive and physical function
• Higher risk of hospital readmission and
death compared to other conditions
Background
7. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Who is at Risk?
Centers for Disease Control & Prevention (2022). What is Sepsis? Available at: https://www.cdc.gov/sepsis/what-is-sepsis.html
Anyone can develop sepsis, but some people are at higher risk for sepsis:
People with
chronic medical
conditions, such as
diabetes, lung
disease, cancer, and
kidney disease
People who
survived
sepsis
People with
weakened
immune
systems
People with
recent severe
illness or
hospitalization
Children
younger
than one
Adults 65
or older
8. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Sepsis Incidence in US Hospitals, 2009 to 2014
Rhee, C., et al. (2017). Incidence and trends of sepsis in US hospitals using clinical vs claim data, 2009 to 2014. JAMA, 318(13), 1241-1249.
9. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Sepsis and Healthcare Costs
1Buchman, T., et al. (2020). Sepsis Among Medicare Beneficiaries: 3. The Methods, Models, and Forecasts of Sepsis, 2012-2018. Critical Care Medicine; 48:302-318.
2Hajj, J., et al., The “centrality of sepsis”: a review on incidence, mortality, and cost of care. In Healthcare (Vol. 6, No. 3, p. 90). Multidisciplinary Digital Publishing Institute.
3Gluck, T. (2019). Epidemiology and Costs of Sepsis in the U.S. NEMJ Journal Watch. Retrieved from: https://www.jwatch.org/na48114/2019/01/02/epidemiology-and-costs-sepsis-us.
• The cost of sepsis and post-sepsis
care continues to be a serious
healthcare burden
• Sepsis costs accounted for
$62 billion in 2019 (including
inpatient and skilled nursing
admissions), making it the most
expensive condition treated in
US hospitals1
• The median hospital cost
was $16,0002
– Hospital-acquired: $38,000
– Community-acquired: $7,000
• The comparative cost
of care by disease states:
– Diabetes: $32,000 vs.
non-diabetes: $13,000
• Readmission cost
averaged $25,0003
10. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Case of HS
HPI: 66 y/o female presents to
ED with multiple infected 1st- and
2nd-degree burn wounds to 60%
of TBSA after she slipped/fell
on hot cooking oil 7 days ago
PMHx: COPD with previous
hospitalization for exacerbation and
pneumonia. Worsening SOB with
optimal medical management.
Controlled IDDM, severe PVD,
obesity. Unsteady gait s/p fall,
1/6 ADL dependency
Treatments: Spiriva and Advair,
oxygen-dependent 2L NC with SOB
on minimal exertion
Exam: Poor attention, temp. 104 ºF,
pulse 120 bpm, RR 28/min, BP 90/60,
WBC 15 and 15% bands, lung sounds
with bilateral congestion and wheezing
to bases, grossly infected 1st- and
2nd-degree oil burn wounds
11. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
• Sepsis is a life-threatening illness with host dysregulation
brought on by the body’s response to an infection
• Sepsis can lead to:
– Severe sepsis (acute organ dysfunction secondary
to documented or suspected infection)
– Septic shock (severe sepsis plus hypotension not
reversed with fluid resuscitation)
– Post-sepsis syndrome (immune, inflammatory, and
endocrine changes resulting in cognitive and
physical impairments)
What Is Sepsis?
12. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
• In 1991, SIRS criteria consensus conference
established “Sepsis-1”
• Sepsis-1 diagnosis requires at least 2 of the following:
– Tachycardia (heart rate > 90 beats/min)
– Tachypnea (respiratory rate > 20 breaths/min)
– Fever or hypothermia (temperature > 38ºC or < 36ºC)
– Leukocytosis, leukopenia, or bandemia (white blood cells
> 1,200/mm3, < 4,000/mm3, or bandemia ≥ 10%)
• Sepsis is infection or suspected infection leading to SIRS
SIRS: Systemic Inflammatory Response Syndrome
13. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
SOFA: Sequential Organ Failure Assessment Score
Marik, P., et al. (2017). SIRS, qSOFA and new sepsis definition. Journal of Thoracic Disease, 9(4), 943.
Max SOFA
Score
Mortality,
%
0-6 < 10
7-9 15-20
10-12 40-50
13-14 50-60
15 > 80
15-24 > 90
14. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
qSOFA: quick Sequential Organ Failure Assessment Score
Sepsis Related Organ Failure Assessment: https://qsofa.org/
qSOFA (quick SOFA) Criteria Points
Respiratory rate ≥ 22/min 1
Change in mental status 1
Systolic blood pressure ≤ 100 mmHg 1
17. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
1
US Department of Health and Human Services. (2020). Solving Sepsis: Transforming Health Security. Retrieved from DRIVe.HHS.gov
2Prescott, H., et al. (2018). Enhancing Recovery from Sepsis: A Review. JAMA, 319(1), 62-75.
3Thompson, K., et al. (2018). Health outcomes of critically ill patients with and without sepsis. Intensive Care Medicine, 1249-1257. doi: 10.1007/s00134-018-5274-x.
• Physical location
– 80% community-acquired1
– 26% healthcare-associated
(NH/recent hospital/dialysis)
– 7.5% hospital-acquired2
– 20% of all deaths
are sepsis-related
– 30% of sepsis
survivors experience
post-sepsis syndrome3
• Body location
– Pneumonia (40%)
– Abdominal
– Genitourinary
– Primary bacteremia
– Skin/soft tissue infection
Sepsis Characteristics
18. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Case of HS (cont.)
Day 1 Day 8
Day 5
48 hrs
Hospital
Admission
• 48 hours post-admission, condition worsened
– Mechanical ventilation
initiated for acute
respiratory failure,
secondary to
bilateral pneumonia
– Acute renal failure;
hemodialysis initiated
– IV vasopressors initiated
– Thrombocytopenia
– Hyperlactatemia
• Admitted to ICU from
ED; Sepsis Alert
System activated
– Multiple IV antibiotics
– Volume resuscitation
– Wound care
19. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Rhee, C., et al. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality
in US acute care hospitals. JAMA Network Open, 2(2), e187571-e187571.
• An estimated 25%-50% of hospital deaths are sepsis-related
– Sepsis was present on admission: 93%
– Developed sepsis during hospital stay: 7.5%
• Compared to patients who died in the hospital without sepsis,
hospitalized patients who died of sepsis were more likely to:
– Be admitted from acute rehabilitation or long-term care
– Be admitted to the intensive care unit
– Die in the hospital than on hospice
Sepsis and Hospital Mortality
20. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Rhee, C., et al. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Network Open, 2(2), e187571-e187571.
All Deaths
• 568 patients included in analysis
– 395 (69.5%) died in the hospital
– 173 (30.5%) discharged
to hospice
• Of the 173 patients discharged
to hospice
– 59 (34.1%) died within 1 week
Sepsis vs. Non-Sepsis Deaths
• 19% of sepsis deaths were
referred to hospice
• 43.3% non-sepsis deaths
were referred to hospice
Hospital Deaths, Sepsis, and Hospice
21. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Rhee, C., et al. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Network Open, 2(2), e187571-e187571.
• 40% (121 of 300) of sepsis deaths
met hospice eligibility guidelines at
time of hospital admission
• Most common terminal
conditions are:
– Solid cancer: 20%
– Hematologic cancer: 5.3%
– Advanced cardiac disease: 16%
– Dementia: 5%
– Stroke: 4%
– Advanced lung disease: 4%
Sepsis and Hospice Eligibility: Hospital
22. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Rhee, C., et al. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Network Open, 2(2), e187571-e187571.
• Hospice-eligible, not previously
identified:
– Cancer, solid tumor, and
hematologic
– Advanced cardiac disease
– Advanced lung disease
– Dementia
• Clinical complications of sepsis
associated with death:
– Vasopressors
– Mechanical ventilation
– Hyperlactatemia
– Acute kidney injury
– Hepatic injury
– Thrombocytopenia
Sepsis and Hospice Eligibility: Hospital
23. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Cause of Death in Patients With Sepsis
0 5 10 15 20 25 30 35 40
Sepsis
Progressive Cancer
Heart Failure
Hemorrhage
Cardiac Tamponade
Stroke
Myocardial Infarction
Infection Without Sepsis
Other Pulmonary
Unknown
Aspiration
Other
Immediate Cause of Death in All Patients
All Deaths (Immediate Cause), %
0 5 10 15 20 25
Solid Cancer
Chronic Heart Disease
Hematologic Cancer
Dementia
Chronic Pulmonary Disease
Unknown
Chronic Liver Disease
Chronic Renal Disease
Stroke
Other
Cause of Death in Patients With Sepsis
Rhee, C., et al. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Network Open, 2(2), e187571-e187571.
24. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Factors Associated With Hospital-Related Death
Rhee, C., et al. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Network Open, 2(2), e187571-e187571.
0 10 20 30 40 50 60
Thrombocytopenia
Hepatic injury
Acute kidney injury
Hyperlactatemia
Mechanical
ventilation initiation
Vasopressor
initiation
Organ Dysfunction or Associated Mortality
A greater number
of organs with
dysfunction
increases the
likelihood of hospital
death and the need
for a goals-of-care
conversation.
Organ dysfunction or mortality, %
0 20 40 60 80 100
≥4
≥3
≥2
≥1
Associated Mortality by Number of
Organ Dysfunction Criteria Met
Organ dysfunction or mortality, %
Number
of
criteria
met
Proportion of sepsis cases with organ dysfunction Associated mortality
25. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Pre-hospitalization Conditions:
• Hospice-eligible:
– COPD with optimal
medical management
– SOB with minimal exertion
on 2L NC for SOB
– Hospitalization for COPD
exacerbation and pneumonia
• Functional decline:
– 1 of 6 ADL dependent
– Unsteady gait
– Status-post fall
Sepsis-associated organ dysfunction:
• Vasopressor initiation
• Mechanical ventilation initiation
• Hyperlactatemia
• Acute kidney injury
• Thrombocytopenia
Case of HS: Sepsis Course
26. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Case of HS: Sepsis Course
• 5 days post-admission, condition
has not improved
– Ventilator-dependent
– Palliative care consult to discuss
goals of care (GOC), and
trach and PEG tube placement
– Husband reveals patient’s
specific request for DNR.
Trach and PEG tube deferred
– Referral for VITAS hospice
services with general inpatient
(GIP) level of care
Day 1 Day 8
Day 5
48 hrs
Hospital
Admission
27. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Case of HS: Sepsis Course (cont.)
• 8 days post-admission
– Compassionate extubation
along with admission to
VITAS GIP level of care
for management of
SOB and restlessness
Day 1 Day 8
Day 5
48 hrs
Hospital
Admission
• During the night, HS’ vital signs deteriorate, and she shows
signs of restlessness:
– Hospital nurse calls VITAS Telecare
– VITAS Telecare clinician dispatches VITAS RN to hospital
– VITAS RN confirms that HS is actively dying and
administers medication for symptom management
– VITAS RN notifies on-call psychosocial staff member
to support husband at bedside
– HS responds to medication and is resting comfortably
• 6 hours later, HS passes peacefully with husband at bedside
• Bereavement support provided to family
28. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Pre-hospitalization conditions:
• Hospice-eligible:
– COPD with optimal
medical management
– SOB with minimal exertion
on 2L NC for SOB
– Hospitalization for COPD
exacerbation and pneumonia
• Functional decline:
– 1 of 6 ADL dependent
– Unsteady gait
– Status-post fall
Sepsis-associated organ dysfunction:
• Vasopressor initiation
• Mechanical ventilation initiation
• Hyperlactatemia
• Acute kidney injury
• Thrombocytopenia
Case of HS: Post-Sepsis Syndrome Course
29. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Case of HS: Post-Sepsis Syndrome Course
Day 14
Day 10
Hospital
Admission
• Admitted to ICU from
ED; Sepsis Alert
System activated
– Multiple IV antibiotics
– Volume resuscitation
– Wound care
• 48 hours post-admission, condition worsened
– Mechanical ventilation
initiated for acute
respiratory failure,
secondary to
bilateral pneumonia
– Acute renal failure;
hemodialysis initiated
– IV vasopressors initiated
– Thrombocytopenia
– Hyperlactatemia
Day 1 48 hrs
30. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Case of HS: Post-Sepsis Syndrome Course (cont.)
Day 1 Day 14
• 10 days post-admission:
– HS is weaned off ventilator;
kidney function improves
– Vital signs are stable;
labs normalize
– Mild delirium persists after
HS is discharged home
with home health care
48 hrs
Hospital
Admission
Day 10
31. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Case of HS: Post-Sepsis Syndrome Course (cont.)
• 14 days post-admission
– HS continues to decline,
marked by 20-lb. weight
loss, and functional decline
in 4/6 ADLs
– HS visits PCP for follow-up and
is diagnosed with aspiration
pneumonia; PCP recommends
HS readmit to hospital
– GOC conversation reveals
HS’ request for comfort care
– PCP initiates hospice referral
Day 1 Day 14
48 hrs
Hospital
Admission
Day 10
32. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Post-Sepsis Syndrome
Yende, S., et al. (2019). Long-term Host Immune Response Trajectories Among Hospitalized Patients With Sepsis. JAMA Network Open, August, 2(8), e198686.
• Inflammatory and immune changes persist in many patients
Inflammatory and Immunosuppression Biomarker Values Collected at Each Scheduled Collection Time Point
33. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Prescott, H., et al. (2018). Enhancing Recovery from Sepsis: A Review. JAMA, 319(1), 62-75.
• New functional limitations
– 1-2 new ADL limitations
on average
• Physical weakness
• Myopathy and neuropathy
• Increased cognitive impairment (CI)
– Persistent delirium
– Moderate to severe CI increased
from 6.1% before hospitalization
to 16.7% post-hospitalization
• Difficulty swallowing
– 63% aspiration on fiberoptic
endoscopic evaluation
– Muscular weakness
or damage
Post-Sepsis Syndrome (cont.)
34. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Sepsis Cognitive and Functional Outcomes
Iwashyna, T., et al. (2010). Long-Term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis. JAMA, 304(16), 1797-1794.
35. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Prescott, H., et al. (2018). Enhancing Recovery from Sepsis: A Review. JAMA, 319(1), 62-75.
• Cardiovascular events occurred
in 29.5% of patients in the year
after sepsis
– Persistent myocardial dysfunction
• Increased risk of recurring sepsis
– 9-fold elevated risk
• Increased depression and anxiety
– About 33% prevalent 2-3
months later
• Exacerbation of chronic
medical conditions
– Heart failure, acute renal
failure, and COPD
Post-Sepsis Syndrome (cont.)
36. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Case of HS: Post-Sepsis Syndrome Course (cont.)
Hospice
Admission
• Same-day hospice admission and initial
Plan of Care implemented:
– Medication and treatments ordered and delivered
in coordination with PCP and hospice physician
– Continuous care level of care initiated for symptoms
of pain, SOB, congestion, wound care, and delirium
– Short-acting and long-acting opioids optimized
for pain
• Agitation addressed with pain control plus
Ativan PRN
• Respiratory:
– Oral antibiotics x 10 days for pneumonia
– O2 at 6L (previously 2L)
– Respiratory treatments ATC
– Opioids for SOB
• Wound care:
– TID dressing changes
– Electric hospital bed with low-air-loss mattress
• 4 days later, HS’ symptoms improve; continuous
care is discontinued, and HS returns to routine
level of hospice care
Day 124 Day 127
Day 1 Day 141
Day 4
37. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Sepsis and Post-Acute Care Utilization
Buchman, T., et al. (2020). Sepsis Among Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012–2018. Critical Care Medicine, 48(3), 289.
38. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Sepsis and Readmissions
Jones, T., et al. (2015). Post–acute care use and hospital readmission after sepsis. Annals of the American Thoracic Society, 12(6), 904-913.
0
5
10
15
20
25
30
Cohort (N=112,578) AMI (N=2,597) Heart Failure
(N=19,723)
Pneumonia
(N=4,949)
Sepsis (N=3,620)
7-Day Hospital Readmission 30-Day Hospital Readmission
• Patients who are
readmitted to the
hospital within 30
days of an initial
sepsis episode are
twice as likely to die
or enroll in hospice
as patients not
admitted for sepsis
39. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Riester, M., et al. (2022). Causes and timing of 30-day rehospitalization from skilled nursing facilities after a hospital admission for pneumonia or sepsis. PloS one, 17(1), e0260664.
Daily Risk of 30-Day Unplanned Hospital
Readmission Among Older Adults
0
0.0001
0.0002
0.0003
0.0004
0.0005
0.0006
0 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Infectious Circulatory Respiratory Genitourinary
40. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Case of HS: Post-Sepsis Syndrome Course (cont.)
• Four months later:
– Over a weekend,
HS’ husband notices
increased congestion and
SOB and contacts hospice
provider, who dispatches
after-hours clinician
– Hospice on-call physician
contacted
– Continuous care LOC for
SOB, congestion, fever,
and presumed pneumonia
• Husband indicates
he wants symptom
management only:
ATC Tylenol for fever,
opioids for dyspnea, and
respiratory treatments
to manage SOB
Day 1 Day 141
Day 124 Day 127
Hospice
Admission
Day 4
• 3 days later, HS is
discharged from
continuous care with
return to routine LOC
– Hospice increases
nurse and SW
visits to assist in
LOC transition
41. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Case of RA: Clinical Indicators of Poor Prognosis
• Hospice-eligible, not previously identified
– Cancer, solid tumor, and hematologic
– Advanced cardiac disease
– Advanced lung disease
– Dementia
• Pre-hospital functional ability
– Physical impairment
• 1 of 6 ADL or 1 of 5 IADL
– Cognitive status
• Any degree of dementia
Sepsis and Hospice Guidelines: Hospitals Discharge
42. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Iwashyna, T., Ely, E., Smith, D., & Langa, K. (2010). Long-Term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis. JAMA, 304(16), 1797-1794.
Pre-Sepsis Function and Cognition on
Post-Hospital Survival
• Patients with functional
and cognitive impairment
prior to sepsis who
survive hospitalization
have a high 6-month
mortality that supports
hospice as a relevant
and important post-acute
care option
43. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Case of HS: Post-Sepsis Syndrome Course (cont.)
Inouye, S., et al. (1990). Clarifying Confusion: the Confusion Assessment Method: a New Method for Detection of Delirium. Annals of Internal Medicine, 113(12), 941-948.
• Two weeks later:
– HS continues to decline despite aggressive
respiratory symptom management
– She dies peacefully surrounded by family
Day 1 Day 141
Hospice
Admission
Day 4 Day 127
Day 124
– Hospice RN attends death, prepares
HS’s body for viewing and transport, and
supports her husband in the process
44. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Disease
Group
No
Hospice
Hospice
< 15 Days 15 – 30 31 – 60 61 – 90 91 – 180 181 – 266 > 266
ALL $67,192 4% -5% -9% -12% -14% -10% -12%
Circulatory $66,041 7% -4% -8% -10% -11% -8% -10%
Cancer $76,625 10% -1% -6% -9% -13% -14% -20%
Neuro-
degenerative $61,004 12% -6% -9% -11% -11% -5% -4%
Respiratory $77,892 -2% -11% -14% -17% -19% -18% -22%
CKD/ESRD $82,781 1% -14% -21% -24% -24% -23% -27%
Comparison of Total Cost of Care by Disease Group and
Hospice Episodes in the 12-Month Period Before Death
*To be eligible to elect hospice care under Medicare, an individual must be entitled to Part A of Medicare and be certified as being terminally ill. An individual is considered
to be terminally ill if the medical prognosis is that the individual’s life expectancy is 6 months or less if the illness runs its normal course. Only care provided by (or under
arrangements made by) a Medicare certified hospice is covered under the Medicare hospice benefit. The hospice admits a patient only on the recommendation of the
medical director in consultation with, or with input from, the patient's attending physician (if any).
NORC at the University of Chicago (2023). Value of Hospice in Medicare. Available at: https://www.nhpco.org/wp-content/uploads/Value_Hospice_in_Medicare.pdf
• Hospice care saved Medicare
approximately $3.5 billion for
patients in their last year of life
• Those patients with hospice
stays of ≥ 6 months* yielded
the highest percentage
of savings
– For patients whose hospice
stays were between 181-266
days, total cost of care
was almost $7K less
than non-hospice users
– Hospice patients with stays
of > 266 days spent
approximately $8K less
than non-hospice users
Spending is greater than Spending is less than
non-hospice users non-hospice users
No Difference / Not
Statistically Significant
45. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
The Medicare Hospice Benefit is a 6-Month Benefit: Quality
and Cost Evidence Corroborate the Need for Timely Access*
*To be eligible to elect hospice care under Medicare, an individual must be entitled to Part A of Medicare and be certified as being terminally ill. An individual
is considered to be terminally ill if the medical prognosis is that the individual’s life expectancy is 6 months or less if the illness runs its normal course. Only care
provided by (or under arrangements made by) a Medicare certified hospice is covered under the Medicare hospice benefit. The hospice admits a patient only
on the recommendation of the medical director in consultation with, or with input from, the patient's attending physician (if any).
NORC at the University of Chicago (2023). Value of Hospice in Medicare. Available at: https://www.nhpco.org/wp-content/uploads/Value_Hospice_in_Medicare.pdf
Over the last 12 months
of life, as hospice use
increases, total spending
decreases relative to
non-hospice users
The reduction in costs when
patients across all disease
classes use hospice can
be significant
46. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Benefits of Early Identification of Hospice-Eligible Sepsis
Patients and Alignment With Care Goals
Quality
• Hospital
readmissions
• Advance care
planning
• Symptom
management
• Patient experience
• Hospital mortality
• Medicare spend
per-beneficiary
• Bereavement
HME and Supplies
• Oxygen
• Non-invasive
ventilation
• Hospital bed
• Specialized mattress
• ADL assist devices
• Incontinence
supplies
• Wound care supplies
Complex Modalities
• Antibiotics
• IV hydration
• Parenteral opioids
• Respiratory therapist
• Therapy services:
PT, OT, speech
• Nutritional counseling
• Goals-of-care
conversations
High-Acuity Care
• Telecare
• Intensive
Comfort Care®
• General
inpatient care
• Visits after
hours and on
weekends/holidays
• Visit frequency
• Physician support
Levels of Care
• Home/routine
• Respite
• Continuous
• Inpatient
47. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Datta, R., et al. (2019). Increased Length of Stay Associated with Antibiotic Use in Older Adults with Advanced Cancer Transitioned to Comfort
Measures. American Journal of Hospice and Palliative Medicine, 37(1): 27-33. doi: 10.1177/1049909119855617
Infections and Symptoms
• Erythema
• Malodor
• Fever
• Pain
• Frequency
• Dysuria
• Agitation
• Confusion
• Fever
• Short of breath
• Cough
• Chest/back pain
• Agitation
• Fever
• Fatigue
• Cough
• Sneeze
• Sore throat
• Fatigue
• Sinus pressure
• Fever
Skin
Upper
Respiratory
Lower
Respiratory
UTI
48. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Infections and Management Consideration
• Symptom assessment
• Pharmacologic and
non-pharmacologic considerations
• Time of onset and duration of action
– Nebs/opioids vs. antibiotics
for SOB
• Adverse effects, including allergies
• Feasibility (ability to swallow,
route available, cost)
• Treatment schedule
– Scheduled vs. as-needed
• Prognosis
• Care goals
49. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Goals of Care (GOC) Conversation
Develop
a collaborative plan
Understand
what patient and
caregiver know
Listen
to goals and
expectations
Inform
of evidence-based
information
Build
trust and respect
Post-Centric
Care
50. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
ICD-10 Coding for Sepsis, SIRS, and Post-Sepsis Syndrome
(Acute Causes of Death Only)
ICD-10 Description
A41.9 Sepsis, unspecified organism
A41.52 Sepsis due to pseudomonas
J69.0
Pneumonitis due to inhalation
of food and vomit
ICD-10 Description
R65.20
Severe sepsis without
septic shock
R65.21
Severe sepsis with septic
shock
R65.11
Systemic inflammatory
response syndrome (SIRS)
of non-infectious origin with
acute organ dysfunction
ICD-10 Description
J96.00
Acute respiratory failure,
unspecified
I50.9 Heart failure, unspecified
K72.00
Acute and subacute
hepatic failure
N17.9
Acute renal failure,
unspecified
G93.40 Encephalopathy, unspecified
Underlying Infection Sepsis/SIRS Organ Dysfunction
51. Confidential and Proprietary Content
Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help.
Questions
52. Additional Hospice Resources
The VITAS mobile app includes helpful
tools and information:
• Interactive Palliative Performance
Scale (PPS)
• Body-Mass Index (BMI) calculator
• Opioid converter
• Disease-specific hospice
eligibility guidelines
• Hospice care discussion guides
We look forward to having you attend
some of our future webinars!
Scan now to
download the
VITAS app.
53. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Adapted from Prescott, H. & Angus, D. (2018). Enhancing recovery from sepsis: a review. JAMA, 319(1), 62-75.
Buchman, T., et al. (2020). Sepsis among Medicare beneficiaries: 3. The methods, Models, and Forecasts of Sepsis, 2012-2018.
Critical Care Medicine; 48:302-318.
US Centers for Disease Control and Prevention. (2020). Data and Reports, Available at:
https://www.cdc.gov/sepsis/datareports/index.html
US Centers for Disease Control and Prevention (2022). What is Sepsis? Available at: https://www.cdc.gov/sepsis/what-is-sepsis.html
Datta, R., et al. (2019). Increased Length of Stay Associated with Antibiotic Use in Older Adults with Advanced Cancer Transitioned
to Comfort Measures. American Journal of Hospice and Palliative Medicine, 37(1): 27-33. doi: 10.1177/1049909119855617
Gluck, T. (2019). Epidemiology and Costs of Sepsis in the U.S. NEMJ Journal Watch. Retrieved from:
https://www.jwatch.org/na48114/2019/01/02/epidemiology-and-costs-sepsis-us
Hajj, J., et al. (2018). The “centrality of sepsis”: a review on incidence, mortality, and cost of care. In Healthcare (Vol. 6, No. 3, p. 90).
Multidisciplinary Digital Publishing Institute.
Iwashyna, T., Ely, E., Smith, D., & Langa, K. (2010). Long-term cognitive impairment and functional disability among survivors
of severe sepsis. JAMA, 304(16), 1797-1794.
Jones, T., et al. (2015). Post–acute care use and hospital readmission after sepsis. Annals of the American Thoracic Society,
12(6), 904-913.
Marik, P., et al. (2017). SIRS, qSOFA and new sepsis definition. Journal of Thoracic Disease, 9(4), 943.
NORC at the University of Chicago (2023). Value of Hospice in Medicare. Available at: https://www.nhpco.org/wp-
content/uploads/Value_Hospice_in_Medicare.pdf
References
54. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
Prescott, H. & Angus, D. (2018). Enhancing recovery from sepsis: a review. JAMA, 319(1), 62-75.
Rhee, C., et al. (2017). Incidence and trends of sepsis in US hospitals using clinical vs claim data, 2009 to 2014. JAMA, 318(13), 1241-1249.
Rhee, C., et al. (2019). Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals.
JAMA Network Open, 2(2), e187571-e187571.
Riester, M., et al. (2022) “Causes and timing of 30-day rehospitalization from skilled nursing facilities after a hospital admission for
pneumonia or sepsis.” PloS one vol. 17,1 e0260664.
Thompson, K., et al. (2018). Health-related outcomes of critically ill patients with and without sepsis. Intensive Care Med. 44(8):1249-1257.
US Centers for Disease Control and Prevention. (2020). Data and Reports, retrieved from: https://www.cdc.gov/sepsis/datareports/index.html
US Department of Health and Human Services. (2020). Solving Sepsis: Transforming Health Security. Retrieved from DRIVe.HHS.gov
World Health Organization. 2021. WHO calls for global action on sepsis: cause of 1 in 5 deaths worldwide. Retrieved from:
https://www.who.int/news/item/08-09-2020-who-calls-for-global-action-on-sepsis---cause-of-1-in-5-deaths-worldwide
Yende, S., et al. (2019). Long-term Host Immune Response Trajectories Among Hospitalized Patients With Sepsis. JAMA Network
Open, August, 2(8), e198686.
References
55. Sepsis and Post-Sepsis Syndrome Is your patient hospice-eligible? VITAS can help. Confidential and Proprietary Content
This document contains confidential and proprietary business information
and may not be further distributed in any way, including but not limited to
email. This presentation is designed for clinicians. While it cannot replace
professional clinical judgment, it is intended to guide clinicians and
healthcare professionals in establishing hospice eligibility for patients
with advanced Alzheimer's and dementia. It is provided for general
educational and informational purposes only, without a guarantee of the
correctness or completeness of the material presented.