Bridging the Gap in Sepsis Recovery: A Scoping Review of Post-Discharge Care Interventions

Abstract

Background

Sepsis affects an estimated 166 million people annually. Short-term survival has been the primary focus of research to date, yet individuals who survive acute sepsis face substantial long-term challenges, including chronic illness, physical disability, cognitive impairment, chronic organ dysfunction, cardiovascular events, and psychological disorders. These complications contribute to personal economic hardship, high healthcare utilization, frequent rehospitalization, and significant mortality rates.

Objectives

We aimed to identify and summarize key interventions for sepsis survivors’ post-hospital discharge – including physical rehabilitation, psychological care, provider assessments, monitoring, medication, and education – and to identify gaps in current evidence to elucidate future research priorities.

Methods

A systematic scoping review was completed across five databases, supplemented with hand searching. Two reviewers independently screened and extracted data. Eligible studies focused on adult survivors of sepsis, where interventions were implemented after discharge from acute care, and included any research design.

Results

Thirteen studies with four follow-up papers were included. Five reported on the impact of simultaneous intervention protocols, four on physical rehabilitation alone, and two on provider assessment and follow-up. The final two focused on psychological care, and pharmacotherapy. Mortality and readmission rates were the most common outcomes measured; satisfaction with care services, mental health outcomes, and cardiovascular event incidence were also evaluated. Qualitative study data was limited. Four studies mentioned intervention costs, but none completed a cost-benefit analysis. Based on a limited pool of evidence, protocolized multi-intervention approaches, provider assessment and follow-up, and physical rehabilitation show some promise in reducing hospital readmissions and improving long-term survival from sepsis. No interventions positively impacted sepsis survivors’ mental health. Further, no studies evaluating educational interventions alone were identified.

Conclusions

This review highlights the need for more comprehensive, multidisciplinary post-sepsis care interventions. Future research should focus on patient education, mental health support, and cost-effectiveness analyses to inform evidence-based post-sepsis care strategies.

Keywords

sepsis post-Sepsis syndrome follow-up care post-acute care sepsis rehabilitation care transitions

Introduction

Sepsis is the disease caused by a dysregulated host response to infection that can lead to life-threatening organ dysfunction.¹ It is estimated that 166 million people each year experience sepsis, with this condition accounting for 31.5% of all global deaths.² Unfortunately, surviving sepsis does not guarantee recovery – despite advancements in preventive care and acute medical management, sepsis remains a major cause of long-term health loss worldwide.³

Over the last several years, there has been increasing recognition of the long-term sequelae of sepsis, often referred to as post-sepsis syndrome.⁴ This entails a range of cognitive, physical, and psychological symptoms,⁵ with persistent weakness, neuromuscular disorders,^6–9 and impaired cognitive functioning^10–12 contributing to decreased independence among sepsis survivors.⁶ The incidence of depression, anxiety, and post-traumatic stress disorder (PTSD) are also elevated.^10,13–15 While these symptoms overlap considerably with those characterized in post-intensive care syndrome, common among those who received intensive care treatment,¹⁶ it is important to recognize that even those sepsis survivors treated outside of the ICU experience post-sepsis syndrome.^17,18 Survivors of sepsis must additionally contend with recurring critical illness including persistent organ dysfunction,^10,19 elevated risk of thrombotic events,^20–22 and recurrent infection.^23,24 Unfortunately, these sequalae, which can persist for years,⁵ are common with nearly 75% of survivors receiving at least one new clinical diagnosis within a year of discharge.²⁵ Such impairments leave approximately one in four individuals unable to return to work, introducing financial risk.^26,27 Survivors of sepsis report a significant need for health and social support,^28,29 however, the post-acute care they receive often falls short of meeting their complex health needs. Provided services often lack important elements – psychological counseling, education, social support – or, in the case of nearly one third of survivors, are absent altogether.¹⁹ The unmet healthcare needs of survivors are reflected in their elevated usage of healthcare resources,^4,30–32 considerable rates of hospital readmission,^33,34 and in their high long-term mortality rates – surpassing 50% at just 5 years.⁴

Evidence to support the long-term recovery from sepsis care has been identified as a research priority by several national and international sepsis organizations.^35–38 While some evidence describing expert consensus,³⁸ exploring post-sepsis intervention efficacy,³⁹ and focused on specific facets of recovery, like rehabilitation⁴⁰ exists, the extent and scope of evidence available to guide post-discharge care of this population remains unclear. Aligned with priorities and seeking to fill this critical evidence gap, we conducted a scoping review guided by following research question: What evidence exists on interventions seeking to improve the outcomes of adult sepsis survivors following their discharge from hospital to any post-acute setting? We sought to summarize key interventions for adult sepsis survivors’ post-hospital discharge, including physical rehabilitation, psychological care, provider assessments, monitoring, medication, and education. Further, we aimed to identify any gaps in current evidence to elucidate future research priorities.

Methods

Design

This scoping review followed the framework by Arksey and O’Malley,⁴¹ further advanced by Levac et al,⁴² and Colquhoun et al.⁴³ The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines⁴⁴ (Supplemental Material 1 PRISMA-SCR Checklist) were followed to ensure methodological rigor, clarity, and transparent reporting. Scoping review methodology was selected for this review as it is ideally suited towards exploring and summarizing available evidence, and to inform future research priorities. This is particularly useful in emerging research areas⁴⁵ like sepsis survivorship and post-discharge care needs.

Search Strategy

A comprehensive search strategy was developed in consultation with a health sciences librarian to identify relevant literature and executed on December 11, 2024, with an update completed on January 22nd, 2026. Five databases were searched: EMBASE, CINAHL, Web of Science, MEDLINE, and EMCARE, supplemented by hand searching of citations. The search strategy for MEDLINE has been included in the Supplemental material (Supplemental Material 2 Search Strategy). Searches were limited to those published in English, focused on adult populations, and from peer-reviewed sources. Grey literature was excluded due to current limitations in the quality and accuracy in existing sepsis-focused grey literature, as well as practical constraints related to team capacity. During study screening, papers related to post-acute sepsis care were flagged for hand searching. The references of flagged papers were reviewed, and relevant papers were manually added to the citation screening pool.

Study Selection

Covidence software⁴⁶ was used for screening and extraction of papers. Citations were imported into Covidence and then independently screened in duplicate by RH, CW, LV, & JS. Discrepancies between reviewers during screening phases were resolved by RH, with oversight and guidance from CW.

Eligible papers were included if they focused on adults (>18 years of age) who had experienced any form of sepsis, and described any treatment, intervention, or protocol administered during or following discharge from hospital, seeking to improve post-acute care or recovery in any way. Papers including mixed samples of sepsis and non-sepsis populations were eligible if findings for the sepsis population were reported separately. In-patient interventions were only included if administered in a post-acute setting – for instance rehabilitation, long-term care, or skilled nursing facility – or if they were administered during discharge from acute care. All research designs were eligible, so long as they were peer-reviewed. Reviews, guidelines, opinion pieces, incomplete trials, grey literature, and non-English papers were excluded. No date restrictions were applied. In keeping with research objectives and scoping review methodology, these criteria were left intentionally broad enabling us to explore the breadth and extent of literature available and to capture the diversity of interventions studied in survivors of sepsis.

Data Extraction

Data were extracted by RH or CW and then confirmed by a second reviewer (RH, CW, or LV). To ensure consistent and complete extraction, a standardized template was followed during this process. Any conflicts between initial extraction and second review were discussed and then resolved by RH and CW by consensus. Data extracted included characteristics of included studies, intervention details, primary outcomes, and suggestions for practice, education, and research priorities described by authors. Guided by the Template for Intervention Description and Replication (TIDieR),⁴⁷ extraction of intervention components included who delivered them, processes followed, their timing, setting, tailoring, and frequency.

Critical Appraisal of Individual Evidence Sources

A critical appraisal was completed on each included study to better understand the strengths and limitations of included evidence. Owing to the diversity of study designs used by included papers, multiple appraisal tools were used including relevant tools from the Critical Appraisal Skills Program (CASP) checklists (eg, randomized controlled trials, cohort studies, qualitative research) and the Joanna Briggs Institute (JBI) Appraisal Checklists for case reports and quasi-experimental studies. The quality of each included paper was considered when reporting data, however, aligning with our research objectives and the purpose of scoping reviews, all papers were included in the final report regardless of quality.

Synthesis of Results

Studies were grouped based on the type of intervention they described – physical rehabilitation, psychological care, provider assessments, monitoring, medication, or education – and whether they were delivered independently or if they occurred as a part of a multi-intervention protocol.

Results

A total of 3912 papers were identified, 3909 through database searches (Embase n = 1041, CINAHL n = 995, Web of Science n = 779, MEDLINE n = 622, Emcare n = 472) and three through citation hand searching. All citations were uploaded into Covidence for screening. After deduplication, 3016 titles and abstracts were screened, excluding an additional 2977, and leaving 38 papers for full-text review. Thirteen unique studies were deemed eligible for inclusion with an additional four identified as follow-up papers linked to included studies^30,48–50 (see Figure 1- PRISMA flow diagram).

Figure 1.

PRISMA flow diagram.

Study Characteristics

Included studies (n = 13) discussed interventions or protocols seeking to improve post-acute sepsis recovery. Studies were published between 2014-2026 and were conducted in the United States (n = 6, 46%), Germany (n = 5, 39%), and Taiwan (n = 2, 15%) (See Table 1 – Characteristics of Included Studies). Many used retrospective cohort (n = 7, 54%) or randomized controlled trial (RCT) designs (n = 3, 23%), however mixed method (n = 1, 8%), case report (n = 1, 8%), and quasi-experimental feasibility (n = 1, 8%) approaches were also identified. Sample sizes varied greatly from 1 up to 170,571. Most studies had less than 1000 participants (n = 6; 62%), however three had between 1000 and 10 000 (23%), and four followed over 10 000 (30%).

Table 1.

Characteristics of Included Studies.

Author, Year	Country	Study Design	Sample Size (n)	Target Population	Type of Intervention (s)	Primary Outcome Measured	Benefit Seen?	Limitations	Quality Rating
Born, 2023	Germany	Mixed-Methods Cohort	287	Adult sepsis survivors who received ICU care	Physical	Utilization and patient satisfaction with inpatient and outpatient rehabilitation	Yes	Lack of qualitative study design; Unclear qualitative analysis methods; Use of unvalidated measures (satisfaction); Specific to German context	Low
Chao, 2014	Taiwan	Retrospective Cohort	114 059	Adult sepsis survivors who received ICU care and antibiotics	Physical	1-, 3-, 5-, & 10-year mortality	Yes	Generalizability – limited to the Taiwanese rehabilitation system; Retrospective	High
Deb, 2019	United States	Retrospective Cohort	170 571	Adult sepsis survivors	Provider Assessment	30-day hospital readmission	Yes	Retrospective; Broad definitions for provider visits	High
Gawlytta, 2022	Germany	RCT	100 (50 dyads)	Dyads of adult sepsis survivors who received ICU care & spouses	Psychological	PTSD symptom severity	No	Unable to blind participants to intervention; High dropout rate; Small sample size	Moderate
Ou, 2021	Taiwan	Retrospective Cohort	9188	Adult sepsis survivors	Medication	Risk of mortality and incidence of major adverse cardiovascular events	Yes	Unclear recruitment methods; Presence of RAASis based on prescription receipt -adherence, dose, frequency not measured	Moderate
Paulson, 2023	United States	Case Report	1	Adult sepsis survivor who received ICU care, & was a high healthcare user	Physical; Provider Assessment; Medication	Feasibility of an advanced care at home program	Yes	Single case significantly limiting generalizability; no comparator; descriptive only	High
Pruitt, 2026	United States	Quality Improvement Study (Quasi-Experimental Feasibility)	26	Adult sepsis survivors	Provider Assessment; Medication; Education	30-day hospital readmission	No	Poor intervention adherence; Poorly defined pre-intervention comparison	Low
Rahmel, 2020	Germany	Retrospective Cohort	83 974	Adult sepsis and severe infection survivors	Physical	5-year mortality	Yes	Lacked any description of rehabilitation intervention; Specific to German context	Moderate
Taylor, 2020	United States	Retrospective Cohort	189	Adult sepsis survivors	Physical; Psychological; Provider Assessment; Medication; Education	90-day mortality and hospital readmission	Yes	Potential for screener subjectivity bias in determining intervention receipt; Retrospective	High
Taylor, 2022	United States	RCT	691	Adult sepsis survivors with high rehospitalization or mortality risk	Physical; Psychological; Provider Assessment; Medication; Education	30-day composite mortality and hospital readmission	Yes	Unable to blind participants to intervention; no discussion of investigator/adjudicator blinding	High
Taylor, 2025*	United States	RCT Multi-center expansion of Taylor, 2022	3548	Adult sepsis survivors with high rehospitalization or mortality risk	Physical; Psychological; Provider Assessment; Medication; Education	90-day composite mortality and hospital readmission	No	Unable to blind participants to intervention; No blinding of investigator or data analyst	High
Colucciello, 2023*	United States	Post-Hoc Analysis Data from Taylor (2022)	175	Adult sepsis survivors with high rehospitalization or mortality risk, discharged to skilled nursing facilities	Physical; Psychological; Provider Assessment; Medication; Education	Mortality and readmission	Yes	Unable to blind participants to intervention; no discussion of investigator/adjudicator blinding; limited statistical power, due to sample size/data availability	Moderate
Kowalkowski 2022*	United States	RCT 12- month follow-up Taylor 2022	691	Adult sepsis survivors with high rehospitalization or mortality risk	Physical; Psychological; Provider Assessment; Medication; Education	12-month composite mortality and readmission	Yes	Unable to blind participants to intervention; no discussion of investigator/adjudicator blinding	High
Schmidt, 2016	Germany	RCT	291	Adult sepsis survivors who received ICU care	Provider Assessment; Education;	Mental health related QOL at 6-, 12-, & 24-months	No	Unable to blind participants to intervention; Outcome assessment was nonblinded	Moderate
Schmidt 2020*	Germany	RCT 12- and 24- month follow-up to Schmidt, 2016	291	Adult sepsis survivors	Psychological; Provider Assessment; Education	Mental health related QOL at 12-, & 24-months	No	Unable to blind participants to intervention; Outcome assessment was nonblinded	Moderate
Winkler, 2023	Germany	Retrospective Cohort	41 918	Adult sepsis survivors	Physical	7-12- & 13–36-month mortality	Yes	Generalizability – limited to non-employed individuals within the German context; Retrospective	High
You, 2025	United States	Retrospective Cohort	6822	Older sepsis survivors transitioning from hospital to home	Provider Assessment	Characteristics and risk factors for 30-day readmission	No	Generalizability – single hospital and United States context; Retrospective, with data as old as 2008; potential confounding	Moderate

ICU = Intensive Care Unit; PTSD = Post Traumatic Stress Disorder; QOL = Quality of Life; RCT = Randomized Controlled trial; * studies linked to another included study. Taylor, 2025, Colucciello, 2023, and Kowalkowski 2022 are linked to Taylor, 2022. Schmidt 2020 linked to Schmidt 2016.

Participants were older (mean 55-76.8 years) and, where reported, were majority male.^51–58 Only three studies (23%) reported race, all identifying a predominantly white population.^53,54,58 Sepsis-related inclusion criteria were most often based on International Classification of Diseases codes, or on the presence of clinical features such as suspected infection, ordered blood cultures, or evidence of organ dysfunction. Three papers lacked a formal definition of sepsis.^52,59,60 Two studies (15%) reported on source of sepsis, both identifying respiratory infections as the most common.^53,56 Six studies (46%) reported medical complexity – high Charlson Comorbidity Index (CCI) or multiple comorbid conditions – in the majority or near majority of their participants.^{51,53,55,56,59,61} Finally, six (46%) studies focused exclusively on survivors of sepsis that were admitted to ICU^{51,52,55–57,59} with the six (46%) that included non-ICU populations reporting 30.3% to 52% of participants having received ICU level care.^{53,54,58,61–63} A single study (8%) excluded ICU patients entirely.⁶⁰

Critical Appraisal of Evidence

A majority of included studies had clear research questions, appropriate recruitment, well described methodologies, and controls in place for confounding variables.^{51–56,59,61–63} None of the studies made changes or modifications over the course of their study. With two exceptions,^52,60 sample size was appropriate for respective methodologies. Due to the nature of the interventions being studied, none of the RCTs were able to blind participants. Descriptions of blinding for data collectors and adjudicators were lacking. Not all included studies clearly justified methodological decisions or strategies to promote credibility and rigor, including Born et al⁵⁷ which did not report a specific qualitative research design. Finally, data from each study should be viewed recognizing the unique context of each setting as many were conducted within single health systems or countries, each with unique care models and availability of post-acute care services, limiting generalizability. Individual study quality appraisal and limitations are outlined in Table 1.

Intervention Type and Delivery

Reflecting the complexity of care needs following sepsis, a limited but diverse array of interventions were identified. The targeted goals, timing and methods of delivery, and providers involved in each varied (See Table 2 – Description of Interventions). Interventions began during the discharge process,^53,60,61 immediately following discharge,^51,54,58 or broadly within 0-6 months post-discharge.^56,62 A single intervention had a minimum initiation date of one-month post-discharge.⁵² Durations ranged from seven days⁵⁴ to 12 months,⁵¹ however most interventions occurred within three to thirteen months.^{52,53,57,59,61} Interventions were delivered individually with a single exception – Gawlytta et al⁵²– who evaluated a dyadic intervention. Most (n = 8, 62%) were delivered in-person^{51,54–57,61,62} or used a hybrid in-person/remote approach (n = 3, 23%).^53,59,60 One (8%) was delivered fully remotely.⁵² Settings varied, with three conducted in patients’ homes (23%),^52,58,59 two in non-acute inpatient settings (23%),^55,62 and seven occurring across multiple settings (54%).^{51,53,54,56,57,60,61} One study⁶³ did not report on delivery or setting. A diverse array of intervention type and strategies were identified.

Table 2.

Description of Interventions.

Author, Year	Goal of Intervention(s)	Description of Intervention(s)	Frequency of Intervention(s)	Healthcare Providers	Delivery Method & Setting	Primary Outcomes
Born, 2023	Improvement in physical, cognitive, & psychological symptoms	Post-acute care in- and outpatient rehabilitation delivered in Germany	Varying frequencies and durations	SLP, PT, & OT	In-person; inpatient and outpatient rehabilitation	Moderate satisfaction with rehabilitation therapies (mean 3.2 [SD 1.1] to 3.4 [SD 1.0] on a scale from 1 [negative] to 4 [positive]), with reported deficits in timeliness, accessibility, and specificity of therapies
Chao, 2014	Reduction in long-term mortality	Post-discharge, outpatient rehabilitation following individualized exercise regimens. Primarily focused on strength and movement, activities of daily living, cardiovascular capacity, functional ability, occupational therapy, and communication	A minimum of rehabilitation course, consisting of six 30-60-min sessions in a 1-month period. Additional courses prescribed as needed	Physiatrists and PT, OT, SLP, Social Workers, and/or athletic trainers	In-Person; outpatient rehabilitation clinics & home	10-year mortality was lower among those who received rehabilitation than not (aHR 0.94, 95% CI 0.92-0.97, p = 0.001)
Deb, 2019	Reduction in 30-day hospital readmission	Early follow-up provided by a home-health nurse and/or any physician within the first week of discharge	At least two visits from a home health nurse plus one physician encounter.	MD & Home Health Nurse	In-Person; home & outpatient clinics	Receipt of both nurse and physician follow-up protocols reduced 30-day readmission rates (ARR 0.07; P = 0.006; 95% CI 2-12); neither nurse or physician follow-up alone was significant
Gawlytta, 2022	Reduction in PTSD symptoms	Internet-based cognitive behavioral writing therapy consisting of biographical reconstruction of the participants life, in sensu trauma exposure, and cognitive reconstruction	2 × 50 min sessions per week over a 5-week period	Therapist	Virtual; home	No significant difference between the experimental group and the waitlist control group in reducing PTSD symptoms measured by PCL-5 scores (95% CI 5.88-3.97; p = 0.703)
Ou, 2021	Reduction in mortality and incidence of major cardiovascular events	Receipt of a prescription for a RAASi, either an ACEi or ARB	-	-	-	Compared with RAASi nonusers, RAASi users had lower risks of all-cause mortality (HR 0.68; 95% CI 0.62-0.75) and MACEs (HR 0.87; 95% CI 0.81-0.94)
Paulson, 2023	Providing high-acuity inpatient care in a home setting	A virtual hybrid hospital-at-home program dictated by a remote medical team supplemented with in-person paramedic and RN visits providing high level care and monitoring in a home setting	Daily and as needed	PT, OT, RN, Paramedics, & MD	In-person & virtual; home setting	The program was able to provide acute care in a home setting without any ER or hospital readmissions within the 21-day study period
Pruitt, 2026	Reduction in 30-day hospital readmission	A nurse discharge navigator providing pre-discharge structured sepsis education and referral to a post-discharge transition clinic, offering provider follow-up, medication review, social work support, and access to a mobile integrated paramedic team for community medical support	One in-hospital education session followed by a clinic appointment within the first 7 days of discharge and additional appointments every 4-6 weeks until patient stabilization	Nurse discharge navigator, medical provider, Social Worker, and Paramedics	In-person & virtual	19% of participants receiving partial intervention (n = 5) and 25% receiving the full intervention (n = 4) were readmitted within 30 days compared to 13.3% readmission rate seen pre-implementation
Schmidt, 2016 & Schmidt, 2020	Improvement in short and long-term mental health related QOL	A primary care approach consisting of case management, proactive symptom monitoring, clinical decision support for primary care providers, and sepsis specific training for patients and their primary care providers	One 60-min training session, followed by monthly telephone contact for 6 months, then once every 3 months for 6 months	RN case managers with ICU experience, PCPs, and experienced Physician consultation	In-person & telephone; outpatient clinic & home	No significant difference between groups in mental health related QOL measured by SF-36 MCS at 6-, 12-, and 24-months
Taylor, 2020	Reduction in 90-day mortality and hospital readmission	Four interventions were evaluated: 1. optimization of medications, 2. early identification and management of common impairments after sepsis, 3. close monitoring for preventable causes of health deterioration, and 4. Alignment of treatment with patient preference, including palliative care when appropriate	-	Providers varied. Primarily PT, palliative care providers, and MDs.	In-person; inpatient acute care & outpatient clinic.	Receipt of two (OR 0.26, 95% CI 0.10-0.69), three (OR 0.28, 95% CI 0.11-0.72), or four interventions (OR 0.12, 95% CI 0.03-0.50) was associated with significantly lower odds of 90-day readmission or mortality compared to receipt of zero or one
Taylor, 2022; Kowalkowski, 2022; & Colucciello, 2023; Taylor, 2025	Reduction in short- and long-term mortality and readmission rates	A nurse navigator-led transitional care program providing screening for new impairments, symptom monitoring and treatment, education, discharge medication review, and as needed provider consultations, including palliative care	30 days in initial study; expanded to 90 days in the final multi-center trial	RN, MD, and as needed referrals to specialized providers	In-person, virtual, & telephone; multiple settings – home, LTC, other acute care hospitals	The intervention group showed lower composite mortality and hospital readmission at 30-days (OR 0.80; 95% CI 0.58-1.11) and 12-months (OR 0.72; 95% CI 0.52-0.99), with similar non-significant trends in the SNF subgroup; the expanded trial found no difference in 90-day composite outcomes (aOR 1.05; 95% CI 0.9-1.24), but did reduce 90-day mortality alone (OR 0.88; 95% CI 9.7-0.99)
Rahmel, 2020	Reduction in long-term mortality	Discharge to in-patient rehabilitation facilities	-		In-person; inpatient rehabilitation	5-year survival after sepsis or septic shock was higher in those treated in rehabilitation facilities (aHR 0.81, 95% CI 0.77-0.85, p < 0.001) compared to those discharged home or to self-care
Winkler 2023	Reduction in short and long-term mortality, nursing care dependency, healthcare usage, and cost	Rehabilitation, either directly following discharge or within the first 6- months of index hospital discharge	Standard inpatient rehabilitation in this population lasts 3-4 weeks(mean, 28.4 days)	PT & OT	In-Person; inpatient rehabilitation	Long-term survival rate was higher among survivors receiving rehabilitation than without (13-36-months: OR 1.2, 95% CI 1.1-1.3; p 0.003)
You, 2025	Reduction in 30-day hospital readmission	Discharged home with a referral to home healthcare services	-	-	Home	Home health care was associated with higher odds of all-cause 30-day readmission even after adjusting for predisposing, enabling, and illness-specific factors (aOR 1.14; 95% CI: 1.02-1.027)

ACEi = Angiotensin Converting Enzyme Inhibitor; ARB = Angiotensin-ii- Receptor Blocker; aHR = Adjusted Hazard Ratio; CI = Confidence Interval; ER = Emergency Room; MACE = Major Adverse Cardiovascular Event; MD = Medical Doctor; NR = Not Reported; OR = Odd Ratio; OT = Occupational Therapist; PCL-5 = Post Traumatic Stress Disorder Checklist for DSM-5; PCP = Primary Care Provider; PT = Physical Therapist; PTSD = Post-Traumatic Stress Disorder; QOL = Quality of Life; RAASi = Renin-Angiotensin-Aldosterone System Inhibitors; RN = Registered Nurse; SD = Standard Deviation; SF-36 MCS = Short Form 36 Question Mental Health Component Score; SLP = Speech Language Pathologist.

Multi-Intervention Approaches

Many studies reported on the impact of multiple simultaneous interventions (n = 5, 38%).^{51,53,59–61} While the approaches to deliver or evaluate simultaneous interventions varied, across protocols there were several care elements that were consistently present. Each included study described methods for monitoring individuals for preventable causes of deterioration, achieved by educating participants on signs of health decline,^60,61 reviewing medication records for errors,^53,60,61 proactively monitoring for new symptoms,^51,59 and through pre-scheduled follow-up with healthcare professionals.^{51,53,59–61} Screening for common impairments was present in three identified papers – either incorporated in provider follow-up appointments,^51,53 or done in-hospital prior to discharge.⁶¹ While included protocols focused predominantly on the roles of a nurse and/or a physician in the provision of post-acute sepsis care, referral to specialized providers, such as physical therapists or speech language pathologists were frequently utilized for the treatment of identified impairments.^51,53,59,61 Specialists were additionally used to support providers in making care decisions,⁵¹ and to aid in the provision of palliative care where indicated.^53,61 Finally, the three papers describing protocolized post-discharge care programs centered on care coordination, referral, and patient support delivered by experienced nurses, with training and experience in either critical care or sepsis.^51,53,60

Physical Rehabilitation

A similar proportion of included studies (n = 4, 31%) evaluated the impact of physical rehabilitation on sepsis survivorship.^55–57,62 Three focused primarily on inpatient rehabilitation services delivered in Germany,^55,57,62 while one evaluated outpatient programs delivered through Taiwan's national health insurance program.⁵⁶ Despite each study focusing on survivors of sepsis, no sepsis-specific rehabilitation regimens were identified. Rather, more generalized treatment in rehabilitation centers specialized in neurological, cardiac, orthopedic care, or other conditions, were described.^57,62 Despite a lack of sepsis-specific care, each identified rehabilitation regimen discussed tailoring programs to the specific needs of individuals.^56,57,62 The provision of home exercises and educational worksheets was described in one study.⁵⁶ A single study did not describe any specific rehabilitation interventions or services.⁵⁵

Psychological Interventions

One study focusing on psychological interventions alone was identified. Gawlytta⁵² described an internet based cognitive behavioral writing therapy program delivered to patients and their spouses seeking to reduce patient and partner post-traumatic stress symptom (PTSD) severity. The program, which included biographical reconstruction, in sensu trauma exposure, and cognitive reconstruction, was administered by a therapist who would asynchronously provide individual feedback and follow-up to participants.

Pharmacotherapy

Renin-Angiotensin-Aldosterone System Inhibitor (RAASI) use was the only medication intervention identified in this review. Using a retrospective cohort design, Ou et al⁶³ broadly evaluated whether the presence of a prescription for either an Angiotensin-Converting Enzyme inhibitor (ACEi) or an Angiotensin II Receptor Blocker (ARB) on hospital discharge was associated with a reduction in major cardiovascular events. Specific medications and drug regimens were not reported.

Provider Assessment and Follow-up

Two studies focused on provider follow-up. You et al⁵⁸ broadly compared readmission rates among those discharged with versus without home healthcare services. Similarly, Deb et al⁵⁴ evaluated the presence of early nurse and/or early physician follow-up on readmission, however, unlike You et al, Deb et al provided explicit definitions for the follow-up care being evaluated. Early nurse follow-up was classified as at least two home visits in the first post-hospital week, with one occurring within two days of hospital discharge. Physician follow-up was defined as one medical encounter within the first week of discharge. Neither study discussed the specific focus of the follow-up care provided.

Measured Outcomes

Mortality (n = 4, 31%), readmission (n = 4, 31%), or a composite score of the two (n = 2, 15%) were primary outcomes reported in most studies. Satisfaction with the extent and quality of rehabilitation services (n = 1, 8%), PTSD symptom severity (n = 1, 8%), mental health related quality of life (n = 1, 8%), and the risk of major cardiovascular events (n = 1, 8%) were also reported on. Most, but not all interventions, had a beneficial effect on survivors of sepsis (n = 9, 61%). Physical rehabilitation, RAASi use, early-provider follow-up, and two of multi-intervention approaches – both primarily measuring mortality and readmission rates – positively impacted recipients. In contrast, no interventions designed to improve the mental health of sepsis survivors – such as the internet-based CBT described by Gawlytta et al,⁵² or the multi-intervention primary care provider support program implemented by Schmidt et al⁵¹– identified benefit. Only a single study utilized qualitative data to evaluate interventions. Reporting a mixed-methods approach, quantitative data from this paper, obtained using 4-point Likert-style survey questions, reported moderate satisfaction with suitability, extent and outcome of rehabilitation services (mean 3.2 [SD 1.1] to 3.4 [SD 1.0]), contrasting their qualitative data which reported deficits in timeliness, accessibility, and specificity of therapies.⁵⁷ Finally, while four studies mentioned general cost of interventions, none completed a cost-benefit analysis.

Discussion

This review describes interventions to enhance post-discharge sepsis survivorship. The 13 studies identify a range of interventions offered either during or directly following acute care discharge. Many of these interventions – particularly physical rehabilitation, protocolized multi-intervention approaches, and multidisciplinary follow-up care – show early potential to improve the long-term outcomes of sepsis survivors, each demonstrating reductions in short- and long-term mortality, readmission rates, or a composite of the two.

Despite being based largely on retrospective data, post-discharge physical rehabilitation is perhaps one of the more promising interventions that can be delivered to survivors, showing benefits in short and long-term mortality across included studies.^55,56,62 These benefits are unsurprising given the considerable proportion of sepsis survivors who experience physical weakness and disability following sepsis⁶ and the well-established associations between poor physical functioning and mortality.^64,65 A recent scoping review on physical rehabilitation in sepsis identified several in-hospital physical therapy interventions that have been implemented during treatment – many of which have demonstrated safety and efficacy.⁴⁰ However, it is noteworthy that all interventions have been confined to hospital settings, with less than 5% incorporating any component of community-based care.⁴⁰ This aligns with the findings of our review identifying no post-discharge physical therapy regimens specific to sepsis have been evaluated. Nonetheless, this gap is increasing in recognition, with new evidence beginning to emerge. Smith-Turchyn et al⁶⁶ for instance, recently examined the rehabilitation needs and preferences of sepsis survivors, describing several elements needed to ensure accessible and effective rehabilitation in this population.

Beyond physical rehabilitation, there is evidence for multidisciplinary protocolized approaches in survivors of sepsis. While the outcomes with general provider follow-up are mixed,^54,58 support from an experienced critical care or sepsis knowledgeable nurse navigator in conjunction with protocolized care elements – medication review, screening for impairments, alignment with goals of care, among others – has some evidence to support short-term mortality reductions,^53,61 though its impact on readmission rates remains unclear.⁴⁸ Survivors of sepsis have complex needs, requiring considerable support on discharge from hospital.^4,31 Barriers related to care coordination, low health literacy and educational gaps, and access to care are common in this population.⁶⁷ Case management, provided by sepsis-knowledgeable clinicians, and provider visits offer opportunities for proactive identification and management of emerging concerns, potentially preventing costly delays in care. The use of protocolized approaches or bundles to guide post-sepsis care may enable more structured and routine access to care elements tailored to the needs of sepsis survivors.

There are critical gaps in the evidence available to support survivors of sepsis following discharge from acute care. Available evidence is limited largely to retrospective analyses and is concentrated on physical outcomes of survivors. Additionally, the difference in outcomes between ICU and non-ICU populations remains unclear, with current evidence still largely focused on ICU populations. Given the overlap between post-sepsis and post-ICU syndromes, differentiating outcomes is an important avenue for future research to explore. Importantly, there are several areas of care relevant to the needs of sepsis survivors lacking any evidence-based interventions altogether. Mental health is one such area.

Sepsis poses a considerable risk for PTSD, anxiety, and depression.^13,68,69 These sequelae are not isolated to the survivors themselves, frequently occurring in family members as well.^13,68,69 This is perhaps unsurprising given the many psychological stressors individuals are exposed to during acute hospitalization, which among others includes loss of autonomy, exposure to invasive medical procedures, and uncertainty surrounding course of illness. Two post-discharge interventions developed to improve the psychological sequala faced by survivors of sepsis were identified, yet neither found any impact.^51,52 This stresses the importance of preventative measures taken during the provision of acute and intensive care to minimize psychological stressors, such as prioritizing mental health and psychological wellness throughout the hospital stay, incorporating the principles of trauma-and violence-informed care,⁷⁰ and interventions assisting patients and their families to better understand the course of their illness, such as ICU journalling.^71,72 There is a critical need for research to support post-acute mental health interventions in survivors of sepsis. One potential avenue to explore may be incorporating dedicated mental health professional follow-up into existing recovery programs.⁷³ Inpatient virtual reality education and exposure interventions, such as those described by Vlake et al,⁷⁴ too warrant expansion and evaluation in outpatient settings.

Interestingly, we found that educational interventions were largely absent from the existing literature. This is particularly concerning given the new and often complex health needs survivors must learn to manage once discharged. High quality discharge education is of further importance given the poor understanding of sepsis in the general population⁷⁵ and the variation in quality and accessibility of online sepsis-focused materials.⁷⁶ The provision of sepsis education to survivors of sepsis has been recommended by the Surviving Sepsis Campaign as a low-cost, and low-risk intervention,⁷⁷ yet there is little to no evidence available to guide the delivery of such education.

Finally, none of the identified papers included a cost-benefit analysis of interventions. Such analyses are critical for determining whether potentially resource-intensive services provide sufficient benefit to justify their implementation within increasingly resource-constrained healthcare systems. This consideration is of further importance given that burden of sepsis is greatest in low- and middle-income countries.³ Future research should therefore prioritize the identification of interventions that are not only effective but are also feasible and adaptable in resource-limited settings.

Limitations

This review had several limitations. Our search was limited to peer-reviewed, English language papers, published prior to January 2026. The exclusion of grey literature may have resulted in the exclusion of real-world practices with potential efficacy, emerging practices, and limited non-academic perspectives. Further, the exclusion of non-English language publication may have resulted in the omission of relevant research, particularly excluding that most applicable to non-English speaking regions and cultural contexts, limiting the generalizability of the findings. Likewise, this may have contributed to the narrow representation of countries in identified evidence including only three countries across the 13 included studies. Additionally, limiting our focus to interventions delivered during or post-discharge, is likely to have omitted early in-hospital interventions that could play a critical role in promoting the long-term recovery of sepsis survivors. Further, the conclusions drawn in this review are based on a limited pool of evidence, comprising of only 13 studies. Finally, our search strategy was designed to broadly identify post-discharge interventions and did not use outcome-specific search terms. This may have contributed to the limited range of outcome measures identified. The near exclusive use of two measures – mortality and hospital readmission – and overall underrepresentation of qualitative experiential data limits this review's ability to holistically represent what makes an intervention effective and meaningful, lacking data reflective of participant perspectives and experience.

Conclusions

This review highlights the research available to support survivors of sepsis following discharge from acute care. There is some early evidence to suggest benefits with comprehensive post-sepsis protocols, multi-disciplinary provider follow-up, and rehabilitation. However, there is a critical need for further research to better inform evidence-based post-sepsis care strategies. In particular, research focusing on mental health supports and post-sepsis education is needed. The effect of interventions on outcomes beyond mortality and readmission, such as cost-analyses and those measures capturing more experiential variables, too will be necessary to inform comprehensive post-sepsis care strategies.

Supplemental Material

sj-docx-1-jic-10.1177_08850666261451779 - Supplemental material for Bridging the Gap in Sepsis Recovery: A Scoping Review of Post-Discharge Care Interventions

Supplemental material, sj-docx-1-jic-10.1177_08850666261451779 for Bridging the Gap in Sepsis Recovery: A Scoping Review of Post-Discharge Care Interventions by Rheya Hanning, Layla Van Meggelen, Jordan Soares, Alison Fox-Robichaud, Robin Enns, Michael McGillion, Carly Whitmore and in Journal of Intensive Care Medicine

Supplemental Material

sj-docx-2-jic-10.1177_08850666261451779 - Supplemental material for Bridging the Gap in Sepsis Recovery: A Scoping Review of Post-Discharge Care Interventions

Supplemental material, sj-docx-2-jic-10.1177_08850666261451779 for Bridging the Gap in Sepsis Recovery: A Scoping Review of Post-Discharge Care Interventions by Rheya Hanning, Layla Van Meggelen, Jordan Soares, Alison Fox-Robichaud, Robin Enns, Michael McGillion, Carly Whitmore and in Journal of Intensive Care Medicine

Supplemental Material

sj-docx-3-jic-10.1177_08850666261451779 - Supplemental material for Bridging the Gap in Sepsis Recovery: A Scoping Review of Post-Discharge Care Interventions

Supplemental material, sj-docx-3-jic-10.1177_08850666261451779 for Bridging the Gap in Sepsis Recovery: A Scoping Review of Post-Discharge Care Interventions by Rheya Hanning, Layla Van Meggelen, Jordan Soares, Alison Fox-Robichaud, Robin Enns, Michael McGillion, Carly Whitmore and in Journal of Intensive Care Medicine

Footnotes

Acknowledgements

We would like to acknowledge Sarah Cairns, a McMaster University Health Sciences Librarian, for her invaluable assistance in the development and refinement of the search strategy used in this review. We would also like to thank Dr's Jenna Smith-Turchyn and Gordon Boyd for their thoughtful review of this work on behalf of the Sepsis Canada Grants and Manuscripts Committee.

ORCID iDs

Rheya Hanning

Layla Van Meggelen

Jordan Soares

Alison Fox-Robichaud

Robin Enns

Michael McGillion

Carly Whitmore

Ethical Considerations

All study activities were conducted in accordance with research ethics, policies, and legislation. Ethics approval was not sought for this scoping review as analysis only involved the use of publicly available, previously published data and did not include primary data collection from human participants.

Author Contributions

Rheya Hanning: Conceptualization, Methodology, Validation, Formal Analysis, Investigation, Data Curation, Writing - Original Draft, Writing - Review & Editing, Visualization, and Project Administration. Layla Van Meggelen: Validation, Formal analysis, Investigation, Data Curation, and Writing - Review & Editing. Jordan Soares: Investigation, and Writing - Review & Editing. Alison Fox-Robichaud: Conceptualization, Writing – Reviewing and Editing, Visualization, and Supervision. Robin Enns: Conceptualization, Writing – Reviewing and Editing, and Supervision. Michael McGillion: Conceptualization, Writing – Reviewing and Editing, and Supervision. Carly Whitmore: Conceptualization, Methodology, Validation, Formal Analysis, Investigation, Data Curation, Writing - Review & Editing, Visualization, Supervision, and Project Administration.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

References

Singer

Deutschman

Seymour

, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287

Gray

Chung

Hsu

, et al. Global, regional, and national sepsis incidence and mortality, 1990–2021: A systematic analysis. Lancet Glob Health. 2025;13(12):e2013-e2026. doi:10.1016/S2214-109X(25)00356-0

Rudd

Johnson

Agesa

, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: Analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200-211. doi:10.1016/S0140-6736(19)32989-7

Farrah

McIntyre

Doig

, et al. Sepsis-Associated mortality, resource use, and healthcare costs: A propensity-matched cohort study. Crit Care Med. 2021;49(2):215-227. doi:10.1097/CCM.0000000000004777

Mostel

Perl

Marck

, et al. Post-sepsis syndrome – an evolving entity that afflicts survivors of sepsis. Mol Med. 2020;26(1). doi:10.1186/s10020-019-0132-z

Fleischmann-Struzek

Born

Kesselmeier

, et al. Functional dependence following intensive care unit-treated sepsis: Three-year follow-up results from the prospective Mid-German Sepsis Cohort (MSC). Lancet Reg Health Eur. 2024;46:101066. doi:10.1016/j.lanepe.2024.101066

Al Khalaf

Al Ehnidi

Al-Dorzi

, et al. Determinants of functional status among survivors of severe sepsis and septic shock: One-year follow-up. Ann Thorac Med. 2015;10(2):132–136.

Zha

Tanaka

, et al. Post-discharge functional outcomes in older patients with sepsis. Crit Care. 2024;28(1). doi:10.1186/s13054-024-05080-1

Mankowski

Anton

Ghita

, et al. Older sepsis survivors suffer persistent disability burden and poor long-term survival. J Am Geriatr Soc. 2020;68(9):1962-1969. doi:10.1111/jgs.16435

10.

Andersen

Herridge

Fiest

. Recovery from sepsis: Management beyond acute care. Semin Respir Crit Care Med. 2024;45(04):523-532. doi:10.1055/s-0044-1787993

11.

Ehlenbach

Gilmore-Bykovskyi

Repplinger

, et al. Sepsis survivors admitted to skilled nursing facilities: Cognitive impairment, activities of daily living dependence, and survival*. Crit Care Med. 2018;46(1):37-44. doi:10.1097/ccm.0000000000002755

12.

Semmler

Widmann

Okulla

, et al. Persistent cognitive impairment, hippocampal atrophy and EEG changes in sepsis survivors. J Neurol Neurosurg Psychiatry. 2013;84(1):62-69. doi:10.1136/jnnp-2012-302883

13.

Calsavara

Costa

Nobre

Teixeira

. Prevalence and risk factors for post-traumatic stress, anxiety, and depression in sepsis survivors after ICU discharge. Braz J Psychiatry. 2021;43(3):269-276. doi:10.1590/1516-4446-2020-0986

14.

Park

Song

I-A

. Depression and long-term survival among South Korean sepsis survivors: A nationwide cohort study from 2011 to 2014. Crit Care Med. 2021;49(9). doi:10.1097/CCM.0000000000005030

15.

Wintermann

G-B

Brunkhorst

Petrowski

, et al. Stress disorders following prolonged critical illness in survivors of severe sepsis. Crit Care Med. 2015;43(6):1213-1222. doi:10.1097/ccm.0000000000000936

16.

Ayenew

Gete

Gedfew

, et al. Prevalence of post-intensive care syndrome among intensive care unit-survivors and its association with intensive care unit length of stay: Systematic review and meta-analysis. PLoS One. 2025;20(5):e0323311. doi:10.1371/journal.pone.0323311

17.

Skov

Østervang

Brabrand

Lassen

Nielsen

. How do sepsis survivors experience life after sepsis? A Danish qualitative study exploring factors of importance. BMJ Open. 2024;14(2):e081558. doi:10.1136/bmjopen-2023-081558

18.

Iwashyna

Ely

Smith

Langa

. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304(16):1787-1794. doi:10.1001/jama.2010.1553

19.

Huang

Daniels

Lembo

, et al. Life after sepsis: An international survey of survivors to understand the post-sepsis syndrome. International Journal of Quality in Health Care. 2019;31(3):191-198. doi:10.1093/intqhc/mzy137

20.

Angriman

Rosella

Lawler

, et al. Risk factors for Major cardiovascular events in adult sepsis survivors: A population-based cohort study. Crit Care Med. 2023;51(4):471-483. doi:10.1097/ccm.0000000000005793

21.

Kosyakovsky

Angriman

Katz

, et al. Association between sepsis survivorship and long-term cardiovascular outcomes in adults: A systematic review and meta-analysis. Intensive Care Med. 2021;47(9):931-942. doi:10.1007/s00134-021-06479-y

22.

S-M

Chu

Chao

P-W

, et al. Long-Term mortality and Major adverse cardiovascular events in sepsis survivors. A nationwide population-based study. Am J Respir Crit Care Med. 2016;194(2):209-217. doi:10.1164/rccm.201510-2023OC

23.

DeMerle

Prescott

Royer

Mikkelsen

. Readmissions for recurrent sepsis: New or relapsed infection? Crit Care Med. 2017;45(10):1702-1708. doi:10.1097/CCM.0000000000002626

24.

Shen

H-N

C-L

Yang

H-H

. Risk of recurrence after surviving severe sepsis: A matched cohort study. Crit Care Med. 2016;44(10):1833-1841. doi:10.1097/ccm.0000000000001824

25.

Fleischmann-Struzek

Rose

Freytag

, et al. Epidemiology and costs of postsepsis morbidity, nursing care dependency, and mortality in Germany, 2013 to 2017. JAMA Netw. Open. 2021;4(11):e2134290. doi:10.1001/jamanetworkopen.2021.34290

26.

Fleischmann-Struzek

Ditscheid

Rose

, et al. Return to work after sepsis—a German population-based health claims study. Front Med (Lausanne). 2023;10. doi:10.3389/fmed.2023.1187809

27.

Skei

Moe

Nilsen

TIL

, et al. Return to work after hospitalization for sepsis: a nationwide, registry-based cohort study. Crit Care. 2023;27(1). doi:10.1186/s13054-023-04737-7

28.

Gallop

Kerr

CEP

Nixon

Verdian

Barney

Beale

. A qualitative investigation of Patients’ and Caregivers’ experiences of severe sepsis. Crit Care Med. 2015;43(2):296-307. doi:10.1097/ccm.0000000000000613

29.

Umberger

Thomas

. Survivor but not fully recovered: The lived experience after 1 year of surviving sepsis. Dimens Crit Care Nurs. 2019;38(6):317-327. doi:10.1097/DCC.0000000000000381

30.

Schmidt

KFR

Huelle

Reinhold

, et al. Healthcare utilization and costs in sepsis survivors in Germany–secondary analysis of a prospective cohort study. J Clin Med. 2022;11(4):1142. doi:10.3390/jcm11041142

31.

Barrett

Sheikh

Chechulina

, et al. High-cost users after sepsis: a population-based observational cohort study. Crit Care. 2024;28(1). doi:10.1186/s13054-024-05108-6

32.

Chechulina

Sheikh

Lóser

Englesakis

Barrett

. Healthcare costs after sepsis: a systematic review. Crit Care. 2025;29(1). doi:10.1186/s13054-025-05600-7

33.

Shankar-Hari

Saha

Wilson

, et al. Rate and risk factors for rehospitalisation in sepsis survivors: Systematic review and meta-analysis. Intensive Care Med. 2020;46(4):619-636. doi:10.1007/s00134-019-05908-3

34.

Pandolfi

Brun-Buisson

Guillemot

Watier

. One-year hospital readmission for recurrent sepsis: Associated risk factors and impact on 1-year mortality-a French nationwide study. Crit Care. 2022;26(1):1-12. doi:10.1186/s13054-022-04212-9

35.

The 2030 global agenda for sepsis. Global Sepsis Alliance. Accessed October 4, 2025. https://globalsepsisalliance.org/2030-global-agenda-for-sepsis

36.

Sepsis Canada research: Focus areas and research objectives. Sepsis Canada. Accessed October 4, 2025. https://www.sepsiscanada.ca/sepsis-canada-research

37.

James Lind Alliance. Sepsis: Top 10 Priorities. James Lind Alliance. Accessed October 4, 2025. https://www.jla.nihr.ac.uk/priority-setting-partnerships/sepsis/sepsis.htm#tab-28281

38.

Prescott

Iwashyna

Blackwood

, et al. Understanding and enhancing sepsis survivorship. Priorities for research and practice. Am J Respir Crit Care Med. 2019;200(8):972-981. doi:10.1164/rccm.201812-2383cp

39.

Bircak-Kuchtova

Rose

Geis

, et al. Effectiveness of targeted post-acute interventions and follow-up services for sepsis survivors: A systematic review. Crit Care. 2025;29(1):351. doi:10.1186/s13054-025-05585-3

40.

Smith-Turchyn

Farley

Hvizd

, et al. Exploring the use of physical rehabilitation for sepsis survivors: A scoping review. BMJ Open. 2025;15(7):e097125. doi:10.1136/bmjopen-2024-097125

41.

Arksey

O'Malley

. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. doi:10.1080/1364557032000119616

42.

Levac

Colquhoun

'Brien

. Scoping studies: Advancing the methodology. Implement Sci. 2010;5(1):69. doi:10.1186/1748-5908-5-69

43.

Colquhoun

Levac

O'Brien

, et al. Scoping reviews: Time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67(12):1291-1294. doi:10.1016/j.jclinepi.2014.03.013

44.

Tricco

Lillie

Zarin

, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. Oct 2 2018;169(7):467-473. doi:10.7326/m18-0850

45.

Tricco

Lillie

Zarin

, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2016;16(1). doi:10.1186/s12874-016-0116-4

46.

Veritas Health Innovaion. Covidence systematic review software. www.covidence.org

47.

Hoffmann

Glasziou

Boutron

, et al. Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. Br Med J. 2014;348(mar07 3):g1687-g1687. doi:10.1136/bmj.g1687

48.

Taylor

Eaton

Rios

, et al. Proactive telehealth-based sepsis transition and recovery support, hospital readmission, and mortality: A randomized clinical trial. JAMA Intern Med. 2025;185(10):1238–1246. doi:10.1001/jamainternmed.2025.3699

49.

Colucciello

Kowalkowski

Kooken

Wardi

Taylor

. Passing the SNF test: A secondary analysis of a sepsis transition intervention trial among patients discharged to post-acute care. J Am Med Dir Assoc. 2023;24(5):742–746.e1. doi:10.1016/j.jamda.2023.02.009

50.

Kowalkowski

Rios

McSweeney

, et al. Effect of a transitional care intervention on rehospitalization and mortality after sepsis: A 12-month follow-up of a randomized clinical trial. Am J of Respir and Crit Care Medicine. 2022;206(6):783–786. doi:10.1164/rccm.202203-0590LE

51.

Schmidt

Worrack

Von Korff

, et al. Effect of a primary care management intervention on mental health–related quality of life among survivors of sepsis: A randomized clinical trial. JAMA. 2016;315(24):2703-2711. doi:10.1001/jama.2016.7207

52.

Gawlytta

Kesselmeier

Scherag

, et al. Internet-based cognitive-behavioural writing therapy for reducing post-traumatic stress after severe sepsis in patients and their spouses (REPAIR): Results of a randomised-controlled trial. BMJ Open. 2022;12(3):e050305. doi:10.1136/bmjopen-2021-050305

53.

Taylor

Murphy

Rios

, et al. Effect of a multicomponent sepsis transition and recovery program on mortality and readmissions after sepsis: The improving morbidity during post-acute care transitions for sepsis randomized clinical trial. Crit Care Med. 2022;50(3):469-479. doi:10.1097/ccm.0000000000005300

54.

Deb

Murtaugh

Bowles

, et al.

Does early follow-up improve the outcomes of sepsis survivors discharged to home health care?

Med Care. 2019;57(8):633-640. doi:10.1097/MLR.0000000000001152

55.

Rahmel

Schmitz

Nowak

, et al. Long-term mortality and outcome in hospital survivors of septic shock, sepsis, and severe infections: The importance of aftercare. PLoS One. 2020;15(2):e0228952. doi:10.1371/journal.pone.0228952

56.

Chao

Shih

Lee

, et al. Association of postdischarge rehabilitation with mortality in intensive care unit survivors of sepsis. Observational study. Am J Respir Crit Care Med. 2014;190(9):1003-1011. doi:10.1164/rccm.201406-1170OC

57.

Born

Matthäus-Krämer

Bichmann

, et al. Sepsis survivors and caregivers perspectives on post–acute rehabilitation and aftercare in the first year after sepsis in Germany. Front Med (Lausanne). 2023;10. doi:10.3389/fmed.2023.1137027

58.

You

Song

Hsu

Bowles

. Characteristics and readmission risks following sepsis discharges to home. Med Care. 2025;63(2):89-97. doi:10.1097/MLR.0000000000002091

59.

Paulson

Torres-Guzman

Matcha

, et al. Treatment of a high healthcare utilizer with sepsis in a virtual hybrid hospital-at-home program. Clin Case Rep. 2023;11(1). doi:10.1002/ccr3.6806

60.

Pruitt

Matusik

Patel

Kreider

. Utilizing a nurse discharge navigator to reduce readmissions for hospitalized patients with sepsis: A quality improvement feasibility study. Prof Case Manag. 2026;31(1):27-34. doi:10.1097/NCM.0000000000000823

61.

Taylor

Chou

S-H

Sierra

, et al. Association between adherence to recommended care and outcomes for adult survivors of sepsis. Ann Am Thorac Soc. 2020;17(1):89-97. doi:10.1513/annalsats.201907-514oc

62.

Winkler

Rose

Freytag

, et al. The effects of postacute rehabilitation on mortality, chronic care dependency, health care use, and costs in sepsis survivors. Ann Am Thorac Soc. 2023;20(2):279-288. doi:10.1513/AnnalsATS.202203-195OC

63.

Lee

, et al. Effects of Renin-Angiotensin–Aldosterone System Inhibitors on Long-Term Major Adverse Cardiovascular Events in Sepsis Survivors. J Am Heart Assoc. 2021;10(23). doi:10.1161/jaha.121.022870

64.

Cooper

Kuh

Hardy

. Objectively measured physical capability levels and mortality: Systematic review and meta-analysis. Br Med J. Sep 9 2010;341:c4467. doi:10.1136/bmj.c4467

65.

Kojima

Iliffe

Walters

. Frailty index as a predictor of mortality: A systematic review and meta-analysis. Age Ageing. 2017;47(2):193-200. doi:10.1093/ageing/afx162

66.

Smith-Turchyn

Alborzi

Hong

, et al. Rehabilitation needs, preferences, barriers, and facilitators of individuals with sepsis: A qualitative study. Int J Nurs Stud Adv. 2025;8:100339. doi:10.1016/j.ijnsa.2025.100339

67.

Sang

Hirschman

Stawnychy

, et al. Patient-level barriers, related facilitators, and proposed strategies for timely home health care and outpatient appointments for sepsis survivors: Perspectives from healthcare system and home health care informants. Patient Educ Couns. 2025;138:109207. 10.1016/j.pec.2025.109207

68.

Rosendahl

Brunkhorst

Jaenichen

Strauss

. Physical and mental health in patients and spouses after intensive care of severe sepsis: A dyadic perspective on long-term sequelae testing the actor–partner interdependence model. Crit Care Med. 2013;41(1):69-75. doi:10.1097/CCM.0b013e31826766b0

69.

Jaenichen

Brunkhorst

Strauss

Rosendahl

. Physical and mental long-term sequelae following intensive care of severe sepsis in patients and relatives. Psychother Psychosom Med Psychol. 2012;62(9-10):335-343. doi:10.1055/s-0032-1306354

70.

Wathen

Varcoe

. Implementing trauma-and violence-informed care: A handbook. University of Toronto Press; 2023.

71.

McIlroy

King

Garrouste-Orgeas

Tabah

Ramanan

. The effect of ICU diaries on psychological outcomes and quality of life of survivors of critical illness and their relatives: A systematic review and meta-analysis. Crit Care Med. 2019;47(2):273-279. doi:10.1097/CCM.0000000000003547

72.

Renner

Jeitziner

M-M

Albert

, et al. Guideline on multimodal rehabilitation for patients with post-intensive care syndrome. Crit Care. 2023;27(1):301. doi:10.1186/s13054-023-04569-5

73.

Hussain

Jones

Hosey

, et al. Patient-psychologist telemedicine interactions in an intensive care unit recovery clinic: Qualitative secondary analysis. Intensive Crit Care Nurs. 2025;87:103886. 10.1016/j.iccn.2024.103886

74.

Vlake

Van Bommel

Wils

E-J

, et al. Virtual reality to improve sequelae of the postintensive care syndrome: A multicenter, randomized controlled feasibility study. Crit Care Explor. 2021;3(9):e0538. doi:10.1097/CCE.0000000000000538

75.

Parsons Leigh

Brundin-Mather

Moss

, et al. Public awareness and knowledge of sepsis: a cross-sectional survey of adults in Canada. Crit Care. 2022;26(1). doi:10.1186/s13054-022-04215-6

76.

Oermann

McInerney

. An evaluation of sepsis Web sites for patient and family education. Plast Aesthetic Nurs. 2007;27(4):192--196. doi:10.1097/01.PSN.0000306184.95812.8a

77.

Evans

Rhodes

Alhazzani

, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49(11):e1063-e1143. doi:10.1007/s00134-021-06506-y

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