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Table 2 Post-Sepsis Guidelines with Sepsis Transition and Recovery (STAR) Program Task

From: Protocol for a two-arm pragmatic stepped-wedge hybrid effectiveness-implementation trial evaluating Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship (ENCOMPASS)

Core component / Evidence Recommendation STAR Task
Screen for new physical, mental, and cognitive deficits after sepsis
 Functional disability: Patients aged ≥65 years develop 1 to 2 new functional limitations -Prescribe structured exercise program
-Referral to Physical/ Cardiac/ Pulmonary rehab as needed
Confirm functional assessment (Physical Therapy). Refer as needed.
 Swallowing impairment: Of patients aged ≥65 years, 1.8% readmitted < 90 days for aspiration pneumonitis -Screen for cough, dysphagia, weak voice
-Referral to speech therapy as needed
Confirm screen and team aware. Refer as needed.
 Mental Health impairment: Prevalence for clinically significant anxiety 32%, depression 29%, and PTSD 44% -Review details of hospital course (e.g., ICU diary)
-Depression screen
-Referral to peer support or Behavioral Health as needed
Mental health screen. Refer as needed.
Review and Adjust Long-term Medications
 Medication errors: Errors of omission and commission occur in up to 25% of patients, depending on medication -Review antibiotic choice, dose, duration.
-Start/continue meds for comorbidities; adjust for BMI, etc.
-Discontinue hospital meds without ongoing indication
Antibiotic Stewardship Medication Reconciliation Vitals/Weight
Anticipate and Mitigate risk for Common and Preventable Causes of Health Deterioration   Routine virtual follow up. Schedule provider visits
 Infection: Of patients aged ≥65 years, 11.9% readmitted < 90 days for infection (6.4% for sepsis) -Patient education about symptoms of sepsis, recurrence
-Appropriate vaccination
-Monitor for symptomatic improvement in index infection
Medication Reconciliation Monitor symptoms
 Heart failure exacerbation: Of patients aged ≥65 years, 5.5% readmitted < 90 days for CHF -Reassess beta-blocker, diuretic, ACE-inhibitor dosing
-Monitor volume status (fluid balance) - recognizing dry weight may be decreased if muscle mass lost
Medication Reconciliation Vitals/Weight
Monitor symptoms
 Acute Renal Failure: Of patients aged ≥65 years, 3.3% readmitted < 90 days for acute renal failure -Monitor renal function; lab testing as needed
-Reassess need and dosages for renally cleared, nephrotoxic agents
Monitor symptoms
Confirm CBC/BMP
Medication Reconciliation
 COPD exacerbation: Of patients aged ≥65 years, 1.9% readmitted < 90 days for COPD exacerbation -Confirm/initiate appropriate controller inhalers
-Appropriate vaccination
-Review use of benzodiazepines/opioids
Monitor symptoms
Medication Reconciliation
Assess appropriateness for palliative care -Palliative Care screen/consult as indicated
-Goals of care. Educate on disease progression/ terminal
Discuss Palliative Care consult. Goals of Care