Structured proactive care coordination versus usual care for Improving Morbidity during Post-Acute Care Transitions for Sepsis (IMPACTS): a pragmatic randomized controlled trial

摘要

Patient flow diagram for participation in THE IMPACTS trial. The study population includes adults presenting to the Emergency Department (ED) who meet the following inclusion criteria: ≥ 18 years of age; oral or parenteral antibiotic or bacterial culture order within 24 h of ED presentation and either culture drawn first, antibiotics ordered within 48 h or antibiotics ordered first, culture ordered within 48 h; not discharged from the hospital at the time the daily list of eligible patients is generated each weekday morning; and deemed high risk for either 30-day readmission or mortality using risk-scoring models applied daily to real-time clinical data on acute and chronic factors. Patients are excluded based on receipt of prophylactic antibiotics only, hospital transfers, “do not resuscitate” or “do not intubate” (DNR/DNI) code status, distance of residence from treating hospital, and prior study randomization. Patients who have infection ruled out prior to hospital discharge are also excluded. Improving Morbidity during Post-Acute Care Transitions for Sepsis, Sepsis Transition and Recovery