Home-care nurses often have no idea their patients were hospitalized for sepsis. Penn nurses want to change that.

University of Pennsylvania nursing researchers are helping solve an age-old hospital discharge problem: How to ensure that patients treated for sepsis, a life-threatening infection, get the ongoing care they need at home.

By analyzing patient records, researchers identified a communications gap. After a patient left the hospital, home-care providers often did not know they had been treated for sepsis, which requires prompt treatment and close monitoring. The condition can lead to organ failure, nervous system dysfunction and disrupt brain activity.

Their findings laid the groundwork for a solution that rolled out nationally Oct. 1.

The Centers for Disease Control and Prevention has approved a new code for posthospital sepsis care in the International Classification of Diseases (ICD) system, the standardized system for describing diseases, injuries and other health information in patient records and medical billing systems.

Hospitals choose from a menu of thousands of ICD codes to communicate what patients were treated for and bill insurers for their services. But until now, there was no ICD code to indicate a patient was a sepsis survivor.

That meant nursing facilities and home care workers were often unaware their patients had been treated for sepsis during their hospital stay.

“It has a lot of potential to help,” Steven Simpson, a professor of medicine at the University of Kansas and chair of the board of the Sepsis Alliance, said of the new code. Simpson was not involved in the research by Penn and VNS Health, a New York-based home-care organization.

» READ MORE: Sepsis: A stealthy, sudden killer

Even after a sepsis infection is treated and patients are able to leave the hospital, they need ongoing attention. They may become disoriented, experience kidney or liver dysfunction, or go into respiratory distress. Up to 30% of sepsis patients are readmitted to the hospital for another sepsis infection within 30 days.

But key information about their initial sepsis diagnosis is rarely relayed from hospital to home, according to a published in the Journal of the American Medical Directors Association in 2020.

Researchers analyzed more than 165,000 sepsis patient records and found that sepsis was noted just 7% of the time when they were admitted to home care.

At the hospital, sepsis is typically marked as “resolved” in a patient’s medical record before the patient is sent home.

The code falls to the “history” section of their medical record, where it easily missed by new, at-home care teams, said, Kathryn Bowles, a nursing professor at Penn and director of the VNS Health Center for Home Care Policy & Research.

“It is critically important to communicate sepsis survivorship across transitions in care,” Bowles said.

The new ICD code (z51A) is an important step toward better medical handoffs of sepsis patients, Bowles and Simpson said.

The CDC has not yet released formal guidance on how to use the code, such as whether patients must meet certain criteria.

It’s also unclear whether Medicare and private insurers will recognize and accept the code for billing purposes, and what rate they may pay providers who use it.

The code could also be beneficial to patients who want to apply for disability insurance, if they’re unable to work because of sepsis complications after returning home, Simpson said.