Context and determinants for implementing a sepsis survivor care transition intervention reported from five health systems and home health agencies
The interviews produced actionable insights for leaders, clinicians, providers, and policy makers regarding identifying sepsis through clear definitions, using the problem list and ICD-10 coding. Scheduling outpatient care, communicating to the next level of care, and providing timely follow-up and care coordination necessitates attention to staffing, tools for scheduling and quality measurement, and EHR integration for information transfer. Patient education is critical for awareness of risk and informed decision-making regarding follow-up after discharge.
Authors
- Jiyoun Song (ORCID: https://orcid.org/0000-0003-0362-0670)
- Karen B. Hirschman (ORCID: https://orcid.org/0000-0003-4886-7765)
- Patrik Garren (ORCID: https://orcid.org/0000-0003-3080-4379)
- Kathryn H. Bowles (ORCID: https://orcid.org/0000-0001-7740-5725)
- Elaine Sang (ORCID: https://orcid.org/0000-0002-0002-9570)
- Melissa O’Connor (ORCID: https://orcid.org/0000-0002-2550-3590)
- Michael A. Stawnychy (ORCID: https://orcid.org/0000-0003-0710-7639)
- Sang Bin You (ORCID: https://orcid.org/0000-0002-1424-4140)
- Charlotte Weiss (ORCID: https://orcid.org/0000-0001-8353-8698)
- Mark E. Mikkelsen
- Nancy Hodgson (ORCID: https://orcid.org/0000-0001-8862-9986)
- Sungho Oh (ORCID: https://orcid.org/0000-0002-1221-2305)
- Katherine S Pitcher
- Barbara Newman
Institutions
- University of the Sciences (US)
- VNS Health (US)
- Hunter College (US)
- Neurobehavioral Systems (US)
- University of Colorado Anschutz Medical Campus (US)
- University of Pennsylvania (US)
Publication Details
- Journal
- Frontiers in Medicine
- Published
- 2025-12-01
- DOI
- https://doi.org/10.3389/fmed.2025.1632083
- Primary Topic
- Sepsis Diagnosis and Treatment
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute
- National Institute of Nursing Research