Clinical Pearls

More than 19 million cases of sepsis occur each year worldwide. Although the prevalence of sepsis-related deaths has diminished in the past 2 decades, many survivors experience various levels of cognitive, physical, and psychological consequences. In addition, survivors are at risk for deterioration and readmission within 30 days of discharge.Hartley and colleagues examined 30-day readmission rates and types of discharge facilities after a sepsis diagnosis in adult patients. They found About 24% of hospitalizations for sepsis resulted in readmission within 30 days, with 68% due to repeat sepsis and 47% due to infections.Most readmissions (90%) were of patients originally discharged to skilled nursing facilities, home health care, long-term acute care, and home.The comorbidity burden and acuity were similar for patients discharged to any of these 4 types of settings.Although further research is needed to examine best practices for transition to discharge, study findings indicate that sepsis survivors discharged to settings such as skilled nursing facilities and home care are at risk for readmission.See Article, pp 353–363Pressure injuries occur in approximately 4% to 6% of critical care patients and can lead to extended hospital stays and increased costs. With appropriate interventions, hospital-acquired pressure injuries (HAPIs) are considered preventable. Early and accurate assessment enables appropriate preventive measures; however, traditional methods are limited in predictive accuracy.Alderden and colleagues developed an artificial intelligence–based approach to assess HAPIs and implemented a dashboard to aid in clinical decision-making. Using data from patients’ electronic health records, the authors created a model that exhibited good performance in providing insight into patient-specific HAPI predictions. They found that the most important variables for prediction included This artificial intelligence model can be used as a tool to enhance, but not replace, the health care team’s expertise in clinical decision-making. The authors recommend further research to understand the practicality of this technology in real-world settings.See Article, pp 373–381Infants born with congenital heart defects requiring surgical intervention are at risk for neurodevelopmental complications. Family involvement is an important element of family-centered care that can improve infant well-being. Infant holding promotes family attachment and bonding; however, use of this practice in cardiac intensive care units is inconsistent, often depending on the experience level of the health care team.Rachwal and colleagues used high-fidelity simulation training to aid in development of a standardized guideline for infant holding. They found that Although the authors recommend further research to identify best practice, findings show that simulation is a feasible educational training tool that can be used for high-risk technical skills such as holding medically complex infants.See Article, pp 338–346Early mobility interventions can improve physical function and decrease possible complications and length of stay. The Society of Critical Care Medicine includes early mobility interventions in their patient-centered interprofessional ABCDEF bundle, yet adoption of this component is low and variable.Krupp and colleagues examined factors associated with use of early mobility interventions and the impact of those factors in predicting next-day use of early mobility interventions. They found that The study findings show that adherence to guideline-based interventions is associated with early mobility practice. Further research is needed, but the authors recommend adapting early mobility interventions as part of ABCDEF bundle practice.See Article, pp 324–333