Title: Culture Positive vs. Negative Sepsis: Uncovering Distinct Patterns in 30-Day Hospital Readmissions

Authors: David Pinto, BS, Erika Nguyen, BS, Russell Kerbel, MD, MBA, Kenneth Shitara, MBA, BSN, RN, CNOR, CPHQ, Patricia D. Alberto, MPH, BSN, RN, CPHQ

Area of Concentration (Petal): Medical Education Leadership & Scholarship

Specialty: Internal Medicine

Keywords: Sepsis, Readmissions, Quality Improvement

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Background:
Sepsis is a major cause of hospitalization and is associated with high rates of 30-day readmissions, which can result in increased morbidity, healthcare utilization, and costs. Despite existing treatment protocols, many patients return to the hospital shortly after discharge, suggesting that unaddressed clinical, social, or systemic factors may be contributing to avoidable readmissions.

Current Condition(s):
At UCLA Ronald Reagan and Santa Monica hospitals, there is a lack of comprehensive data on the drivers of 30-day readmissions among adult patients discharged with a diagnosis of sepsis. The variability in patient presentations and discharge planning makes it challenging to identify consistent patterns contributing to these readmissions.

Target Condition(s):
This project aims to reduce sepsis-related 30-day readmissions by identifying underlying clinical and social factors contributing to readmissions, stratifying patients based on culture positivity, and ultimately informing targeted interventions for high-risk populations.

Gap Analysis:
The absence of stratified data differentiating culture-positive from culture-negative sepsis cases, limited exploration into the appropriateness of antibiotic duration or adequacy of source control, and insufficient assessment of social determinants of health have all hindered the ability to design informed QI interventions. Additionally, retrospective reviews have not yet been leveraged to systematically assess modifiable risk factors.

Countermeasures:
We performed a literature review to identify known contributors to sepsis readmissions and are conducting a retrospective chart review of patients ≥18 years discharged to home or home health with ICD-10 codes for sepsis. Patients will be divided into “culture-positive” and “culture-negative” groups to compare 30-day readmission rates. Sampled cases will be reviewed for key contributing factors such as duration of antibiotics, source control, resistant organisms, comorbidities, and social/socioeconomic factors. Methodological support, including power calculations, will be provided by DOM STATs.

Action Plan:

1. Conduct literature review to establish existing knowledge base.

2. Extract relevant retrospective patient data from UCLA RR and SM.

3. Stratify cases by culture status and readmission outcomes.

4. Review sample charts to identify root causes and modifiable contributors.

5. Partner with DOM STATs to refine analysis plan and ensure statistical rigor.

6. Use findings to propose specific interventions aimed at high-risk populations.

Next Steps:
Upon completion of the retrospective review and data analysis, findings will be shared with hospitalist teams and QI leadership to guide pilot interventions. Future directions include developing targeted discharge protocols, addressing barriers to care, and exploring system-level strategies to reduce preventable readmissions among sepsis patients.