Managing Septic Patients: Advantages of Long-Term Acute Care Hospitals

Dean French, MD, EVP and CMO, of ScionHealth, parent company of Kindred Hospitals, and Saleem Alinur, VP of Managed Care, offer insight into the benefits of transferring septic patients to long-term acute care hospitals as soon as possible, which include lowering costs, reducing readmissions, and improving patient outcomes.

Read the full transcript:

Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network, where we combine expert commentary and exclusive insight into key issues in population health management and more.

Today we're going to be talking about managing septic patients. Our two guests today come from Kindred Hospitals. Gentlemen, why don't you please introduce yourselves.

Dean French, MD: Hi, I'm Dr Dean French. I'm the executive vice president and chief medical officer of ScionHealth. We operate 18 community hospitals in 76 long-term acute care hospitals under the Kindred Hospitals' name.

Saleem Alinur: I'm Saleem Alinur, vice president of managed care at ScionHealth, which includes Kindred Hospitals.

Thank you both so much for joining today. First off, Saleem, why is the managed care community concerned with sepsis?

Mr Alinur: The managed care community is concerned with sepsis due to some of the following reasons. Sepsis is the highest cause of inpatient mortality. Cost is a big issue. Sepsis is the costliest inpatient condition and the most frequent diagnosis. Readmissions is another big problem—admitting condition with the highest number of 30-day readmissions. And then finally, length of stay. The average length of stay is about 75% higher for septic patients than for others.

So what are payers and managed care organizations looking for in terms of solutions?

Mr Alinur: I believe that managed care organizations are looking for partners that have a systematic clinical approach to sepsis that solves length of stay, mortality, and readmission frequency.

And what role do long-term acute care hospitals like Kindred play in mitigating the sepsis challenge?

Mr Alinur: Long-term acute care hospitals or LTACHs specialize in treating complex patients. The data has shown that patients that are septic and have complex medical conditions really benefit from transitioning into an LTACH as soon as possible. 

In fact, many of our managed care partners have specifically asked us to work collaboratively with short-term acute care hospitals and physicians to identify these patients early and to get them transitioned to Kindred as soon as possible.

Thank you, Saleem. Dr. French, can you tell us about the clinical programs at Kindred specifically that have helped improve outcomes for septic patients?

Dr French: At Kindred, we've been able to reduce our readmission rates for sepsis patients, especially where those patients require mechanical ventilation. In fact, according to the Centers for Medicare & Medicaid Services, Kindred's readmission rate for sepsis or severe sepsis on mechanical ventilation for more than 96 hours is 9%, which is 4% less than LTACHs nationally and 23% less than skilled nursing facilities nationally. 

We've been able to achieve that through a few different clinical strategies. All of our Kindred specialty hospitals either have disease specific certification in sepsis and/or respiratory failure or are actively pursuing these certifications from The Joint Commission. This focus on high reliability results in consistent disease-specific care that is borne out in our outcomes that I discussed earlier.

One of our high reliability strategies is a nurse-driven screening protocol for sepsis and order sets that are integrated into our electronic medical record.

Our EMR prompts nurses to look for three criteria at admission, systemic inflammatory response, histories or signs suggestive of a new infection, or signs of hypoperfusion. Based on selections and alert populates that will prompt the nurse to activate a sepsis protocol or a septic shock protocol. The sepsis protocol consists of a series of tests and treatments that follow the guidelines of the surviving sepsis campaign. 

We also have an interdisciplinary team of clinical nurse specialists, respiratory therapists, wound care specialists, clinical pharmacists, and registered dieticians working with our multidisciplinary medical staff to assure a robust approach to complex patients who have sepsis. This approach is one of the differentiators of care our patients benefit from when receiving care at a Kindred specialty hospital.

Thank you, Dr French. And thank you both for joining us today to talk about this important subject.

Dr French: Thanks. It was great to be here.

Mr Alinur: Thanks for having me here.

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