Usefulness of a Discharge Diagnosis of Sepsis in Detecting Iatrogenic Infection and Quality of Care Problems

To address the question of how often a diagnosis of sepsis in the discharge summary represents a condi tion present on hospital admission as opposed to an acquired condition, medical records from Veterans Affairs medical centers were reviewed. A random sample of discharged summaries coded for sepsis were obtained from five different hospitals. One hundred forty-one summaries involving 128 patients from 1989 were evaluated. Twenty-seven (18.7%) of the summaries were judged to be improperly coded. Of the remaining 114 summaries, 61 (53.5%) contained information supporting sepsis as an admission con dition. Comparison of other clinical attributes of these summaries indicates that patients with sepsis on ad mission have some characteristics that are different from those of patients who acquire sepsis during care. These attributes include a history of chemotherapy, an overall shorter length of stay, and a lower death rate. Sepsis, as a discharge diagnosis, cannot be as sumed to represent an iatrogenic condition or to be the result of poor care since more than half of the cases reviewed indicated that the condition was pres ent at admission.