Goals of Care Assessment during Hospitalization for Sepsis

Area of Science:

• Critical Care Medicine
• Health Services Research
• Palliative Care

Background:

• Sepsis is a leading cause of hospital mortality and morbidity.
• Clinical guidelines advocate for goals of care (GoC) assessments during sepsis hospitalization to ensure patient-centered care.
• Inconsistent assessment of GoC can lead to care that does not align with patient values.

Purpose of the Study:

• To evaluate the frequency of GoC assessment in routine practice for adult patients hospitalized with community-onset sepsis.
• To identify patient subgroups and factors associated with GoC discussion and assessment.
• To quantify the variation in GoC assessment practices across different hospitals.

Main Methods:

• A multi-hospital cohort study involving 18,711 adult patients with community-onset sepsis (2020-2023).
• Data collected from the Michigan Hospital Medicine Safety Consortium's sepsis initiative (HMS-sepsis).
• Primary outcomes included documented GoC discussion and inferred GoC assessment based on specific clinical indicators; multilevel logistic regression used to analyze factors and variation.

Main Results:

• GoC discussion and assessment occurred in 35.7% and 45.3% of sepsis hospitalizations, respectively.
• Only 23.8% of patients had GoC discussion within three days of presentation.
• Factors associated with GoC assessment included advanced age, race, chronic conditions, cognitive/functional impairment, ICU admission, and life support receipt; substantial cross-hospital variation was observed (Median Odds Ratios 2.30 and 2.09).

Conclusions:

• Goals of care assessment is not consistently performed during sepsis hospitalizations, even in high-risk populations.
• Significant practice variation exists across hospitals, indicating a need for standardized approaches.
• Further research is required to identify drivers of high-performance GoC assessment to improve care quality.