What the standard says
A patient who has survived sepsis receives individualised follow-up care to optimise functional outcomes, minimise recurrence, reduce rehospitalisation and manage the ongoing health effects of sepsis. This requires structured, holistic and coordinated post-discharge care and education that involves the patient, their family, carer, general practitioner and other clinicians.
Support and information are provided to the family or carer of a patient who has died from sepsis.
What the quality statement means
nsure that processes are in place to support patients, families and carers after hospital discharge for acute management of sepsis. This can include rehabilitation, access to emotional and social wellbeing supports, and allied health care. Consider using a centralised computer system to coordinate the patient’s post-acute care.
Before discharge, a patient should be referred to their general practitioner (GP), who can coordinate their care after hospital discharge. The GP and any other clinician to whom the patient is referred should be provided with:
- A comprehensive plan on follow-up requirements to optimise functional outcomes, minimise recurrence, reduce rehospitalisation and manage the ongoing health effects of sepsis
- Details of the hospital clinician with expertise in managing sepsis or care coordinator to support the transition of care and facilitate communication between the community and hospital care providers
- Education materials about sepsis and patient care needs.
Discharge summaries should include all the relevant information as described in Quality statement 6 – Transitions of care and clinical communication and the NSQHS Communicating for Safety Standard Action 6.11.
Healthcare services discharging patients on antimicrobial therapy should have systems in place to ensure that the patient can continue antimicrobial therapy post-discharge and address potential barriers to access, including cost. In some cases, antimicrobials may need to be supplied to the patient.
Review the death of any patient due to sepsis in the absence of a pre-existing life-limiting condition, or where death was unexpected. Offer the family an explanation, information and discussion in line with the principles of open disclosure. This may involve a follow‑up appointment at a later date and referral to bereavement care and support services as required. Ensure that all sepsis deaths are documented in a risk management system, reviewed, and reported to and monitored by a governing body (such as a patient safety or deteriorating patient committee, or similar) to identify opportunities for continued improvement.
Equity and Cultural Safety
Ensure that services are in place to support patients after discharge, such as access to Aboriginal medical services, Aboriginal and Torres Strait Islander health workers and liaison officers.
Ensure that information provided to patients is provided in a way that the patient understands and is culturally safe.