761. Sepsis Readmissions and Coding in Two Community Hospitals

Abstract

BackgroundAn estimated 1.7 million adults in the United States develop sepsis and nearly 270,000 Americans die because of sepsis annually. A diagnosis of sepsis increases hospitalization costs, antibiotic usage, and mortality. Admissions for sepsis account for a high proportion of 30-day readmissions, creating a major financial burden for the healthcare system. However, reliable measurement of sepsis incidence remains challenging given increasing clinical awareness, changes in diagnosis/coding practices and changing definitions. We thus sought to evaluate sepsis readmissions and coding practices at 2 community hospitals (226, 99 beds).MethodsA total of 997 hospitalizations occurred at both institutions with a primary diagnosis of sepsis from January 30, 2018–December 31, 2018; out of which 130 were readmitted within 30 days.An Infectious Disease trained physician reviewed all 130 index admissions and readmissions. Sepsis was defined as per the Centers for Medicare and Medicaid Services (CMS) sepsis-1 mandate: 2 of 4 SIRS criteria + suspected infection.ResultsAll 130/130 (100%) index hospital admissions had a primary discharge diagnosis of sepsis, out of which only 85/130 (65%) met criteria for sepsis. While coded as sepsis, in 45/130 (35%) cases no infectious etiology was found. Among 130 readmissions 51 (39%) truly met criteria for sepsis. The infectious etiologies of index admissions included urinary tract infections (UTI) (18), pneumonia (16), bacteremia (16), abscess (9), Clostridium difficile infection (CDI) (8), cellulitis (5), neutropenic fever (5), cholecystitis (4), meningoencephalitis (1), candidemia (1). Readmissions that met criteria for sepsis included pneumonia (10), UTI (8), abscess (7), CDI (5), bacteremia (5), osteomyelitis (4), cellulitis (4), neutropenic fever (3), candidemia (2), and cholecystitis (2).ConclusionShockingly 35% of the index admission cases were misdiagnosed as sepsis and as high as 61% on re-admissions. Increasing clinical awareness and compliance with CMS may have led to overdiagnosis and treatment of sepsis. Given the significant treatment and prevention initiatives that are being undertaken; reliable sepsis definition and coding is warranted for accurate surveillance purposes.Disclosures All authors: No reported disclosures.