Predicting Sepsis Readmissions Using Social Determinants of Health | Exploring “I-TRANSFER”: An Evidence-Based Protocol for Post-Acute Sepsis Care
Session Descriptions:
This activity includes two sessions from Sepsis Alliance Summit to meet the minimum time requirement for nursing CE credits.
Predicting Sepsis Readmissions Using Social Determinants of Health
Patients hospitalized with sepsis experience a high risk of unplanned 30-day readmissions – higher than patients with myocardial infarction, chronic obstructive pulmonary disease, heart failure, or pneumonia. Predicting which patients would benefit from additional resources aimed at preventing readmission can be challenging. Many models designed to predict sepsis patients at high risk of readmission do not take social determinants of health into consideration, which may limit the models' predictive abilities. In this session, learners will review the current literature on sepsis readmissions with an emphasis on the role that social determinants of health can play in predicting outcomes. The presenter will also discuss how such data can be used to improve predictive modeling of 30-day unplanned sepsis readmissions.
Exploring “I-TRANSFER”: An Evidence-Based Protocol for Post-Acute Sepsis Care
Every year, up to one-third of the 1.5 million Americans who survive sepsis transition from acute care to skilled home health care. During this transitional period, survivors experience a heightened likelihood of hospital readmission and 32% of those readmissions occur within the first seven days. In this session, learners will review key components of “I-TRANSFER” (Improving Transitions and Outcomes of Sepsis Survivors), an evidence-based protocol for timely post-acute care of sepsis survivors. The presenter will discuss strategies for overcoming barriers in the implementation of best-practice aftercare protocols of this kind, as well as the need for a new ICD-10 Code for aftercare of sepsis survivors.
Target Audience
Nurses, advanced practice providers, physicians, emergency responders, pharmacists, medical technologists, respiratory therapists, physical/occupational therapists, infection prevention specialists, data/quality specialists, and more.
Learning Objectives
At the end of the session, the learner should be able to:
Predicting Sepsis Readmissions Using Social Determinants of Health
- Identify current approaches to preventing unplanned sepsis readmissions based on the best available evidence;
- Understand why current readmission models may not accurately predict sepsis patients at high risk for readmission;
- Recognize how social determinants of health may improve ability to predict sepsis readmissions.
Exploring “I-TRANSFER”: An Evidence-Based Protocol for Post-Acute Sepsis Care
- State the major study design principles for a Type 1 hybrid implementation science study;
- List the components of I-TRANSFER, an evidence-based protocol for timely post-acute care of sepsis survivors;
- Discuss the need for a new ICD-10 code for aftercare of sepsis survivors;
- Create strategies to overcome the barriers to implementation of I-TRANSFER in acute and home health care.
Gabriel Wardi, MD, MPH
Associate Professor, University of California, San Diego, Department of Emergency Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine
Gabriel Wardi, MD, MPH completed his undergraduate and graduate education in Atlanta. He moved to San Diego for his residency in Emergency Medicine where he served as the Education Chief Resident during his final year of residency. He is the first graduate of the joint Critical Care Medicine fellowship offered by the Division of Pulmonary and Critical Care and Department of Emergency Medicine. Dr. Wardi joined the faculty in July 2017 at UC San Diego, where he is currently an Associate Professor of Clinical Emergency Medicine and attends in both the emergency department and the ICUs. Dr. Wardi’s research interests include sepsis, the ED-ICU interface, resuscitation, cardiac arrest management, and development of novel educational curriculum. He is currently funded by the NIH to study how big data can be used to develop clinically actionable sepsis phenotypes and to reduce sepsis readmissions. He is the Medical Director for Hospital Sepsis at UC San Diego and has been recognized as a "Top Doctor" in Critical Care in San Diego.
Kathy Bowles, PhD, FAAN, FACMI
Professor and van Ameringen Chair in Nursing Excellence, Biobehavioral and Health Sciences, I-TRANSFER, University Of Pennsylvania School of Nursing
Kathy Bowles, PhD, FAAN, FACMI is a Professor of Nursing and the van Ameringen Chair in Nursing Excellence at the University of Pennsylvania School of Nursing. She is the Vice President and Director of the Center for Home Care Policy & Research at Visiting Nurse Service (VNS) Health. Her program of research in clinical decision support and implementation science for discharge planning, transitions in care, and home care with vulnerable older adults has been continuously funded for 25 years.
She has served on many national committees and workgroups to advance the care of older Americans such as the National Quality Forum, the Care Coordination Steering Committee, and the Heath Information Technology Standards Panel (HITSP) Care Coordination Committee. She was an invited expert consultant on the Centers for Medicare Services (CMS) Technical Expert Panel on the Post-Acute Care Assessment instrument (CARE tool) and two other expert panels to develop measures for transitions in care and continuity of care.
Dr. Bowles co-founded RightCare Solutions, a software company based on her team's research on decision support for post-acute care referrals. She was appointed to the National Institute of Nursing Research (NINR) Advisory Council and delivered the 2016 NINR Director's Lecture. She was invited by the National Academy of Medicine and the Office of the National Coordinator for Health Information Technology to discuss optimizing strategies for clinical decision support.
She is a fellow in the American Academy of Nursing and the American College of Medical Informatics, a member of the American Nurses Association (ANA), and Sigma Theta Tau International Honor Society, where she was inducted into the International Nursing Research Hall of Fame.
Provider approved by the California Board of Registered Nursing, Provider Number CEP17068 for 1.4 contact hours.
Other healthcare providers will receive a certificate of attendance for 1.0 contact hours.
Medical Disclaimer
The information on or available through this site is intended for educational purposes only. Sepsis Alliance does not represent or guarantee that information on or available through this site is applicable to any specific patient’s care or treatment. The educational content on or available through this site does not constitute medical advice from a physician and is not to be used as a substitute for treatment or advice from a practicing physician or other healthcare provider. Sepsis Alliance recommends users consult their physician or healthcare provider regarding any questions about whether the information on or available through this site might apply to their individual treatment or care.
Available Credit
- 1.00 Participation
- 1.40 RN CE Contact HoursProvider approved by the California Board of Registered Nursing, Provider Number CEP17068.