Hallie C. Prescott, MD; Julien Weinstein, MSc; Sarah Seelye, PhD; Jason D. Buxbaum, PhD, MHSA; Steven J. Bernstein, MD, MPH; Megan Cahill, DO, MBA; Megan Heath, PhD; Lama Hsaiky, PharmD, BCPS; Jennifer K. Horowitz, MA; Namita Jayaprakash, MB BcHBAO, MRCEM; Anurag N. Malani, MD; Elizabeth McLaughlin, MS, RN; Lakshmi Swaminathan, MD; Patricia J. Posa, RN, BSN, MSA, CCRN; Q1 Scott A. Flanders, MD; and Andrew M. Ryan, PhD
Abstract. 
Background: Sepsis is a devastating condition with frequent discharge to nonhome settings such as skilled nursing facilities. Bundled payment incentive programs targeting sepsis have tried to encourage lower spending by avoiding discharge to institutional postacute care.
Research question: What is the impact of timely antibiotic delivery and fluid resuscitation on discharge to home after sepsis?
Study design and methods: This was an observational cohort study of adults hospitalized for confirmed community-onset sepsis at 67 hospitals participating in the Michigan Hospital Medicine Safety Consortium Sepsis Initiative (HMS-Sepsis) from 2022 through 2025. Timely antibiotic delivery and fluid resuscitation were assessed via performance measures used for statewide benchmarking. Antibiotic delivery was measured in patients without positive viral testing results. Target administration was ≤ 3 hours of emergency department arrival among patients with hypotension, or else ≤ 5 hours. Fluid resuscitation (≥ 30 mL/kg body weight) was measured in patients with hypotension or elevated lactate. The primary outcome was discharge to home.
Results: Among 38,568 patients with community-onset sepsis (18,941 male patients [49.1%]; median age, 71 years [interquartile range, 61-80 years]), 7,942 patients (20.6%) died in hospital or were discharged to hospice, 9,941 patients (25.8%) were discharged to a postacute care facility, and 20,685 patients (53.6%) were discharged to home. Among 35,025 and 27,393 eligible patients, timely antibiotic delivery and fluid resuscitation occurred in 26,357 patients (75.3%) and 13,561 patients (49.5%), respectively. In multivariable models adjusted for patient characteristics, timely antibiotic administration and fluid resuscitation were associated with a 3.0-absolute percentage point (95% CI, 2.0-4.0 absolute percentage point) and 1.1-absolute percentage point (95% CI, 0.2-2.1) increase in discharge to home, respectively. Findings were robust across sensitivity and subgroup analyses.
Interpretation: Our results show that in this multihospital cohort, timely antibiotic delivery and fluid resuscitation were associated with increased discharge to home after sepsis. This finding suggests that timely treatment of sepsis may reduce downstream morbidity and health care expenditures.
Keywords: benchmarking; health care quality indicator; hospitalization; risk adjustment.
Published by Elsevier Inc.
Conflict of interest statement
Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: H. C. P., J. W., S. J. B., M. H., J. K. H., P. J. P., E. M., S. A. F.) receive salary support from Blue Cross Blue Shield of Michigan for work on HMS. The authors report grant funding and salary support unrelated to this study from the National Institutes of Health (H. C. P.), AHRQ (H. C. P.), the Department of Veterans Affairs (H. C. P., S. J. B.), and the Centers for Disease Control and Prevention (H. C. P., J. K. H.). H. C. P. serves on the Surviving Sepsis Campaign guidelines committee and is a paid scientific consultant to Aurobac Therapeutics. None declared (S. S., J. D. B., M. C., L. H., N. J., A. N. M., L. S., A. M. R.).
