Critical Care: Original Research
Association of Timely Antibiotics and Fluid Resuscitation With Increased Discharge to Home After Sepsis
Hallie C. Prescott, Julien Weinstein, Sarah Seelye, et al
Chest 2026 Available online 13 March 2026
https://doi.org/10.1016/j.chest.2026.03.002
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.
Table 2. Adjusted Outcomes (Discharge to Home) Among Patients Who Received vs Did Not Receive Timely Sepsis Management
| Early Sepsis Management Practice | Adjusted Proportion Discharged to Home | Adjusted OR for Discharge to Home (95% CI) | Adjusted Difference in Discharge to Home (95% CI) | |
|---|---|---|---|---|
| Received the Practice | Did Not Receive the Practice | |||
| Antibiotic delivered within target time frame | 54.4 (54.0-54.9) | 51.5 (50.6-52.3) | 1.21 (1.13-1.29) | 3.0 (2.0-4.0) |
| Antibiotic delivered within 3 h (among hypotensive) | 40.1 (39.0-41.1) | 37.3 (35.8-38.7) | 1.20 (1.06-1.35) | 2.8 (1.0-4.6) |
| Antibiotic delivered within 5 h (among normotensive) | 59.0 (58.5-59.6) | 55.9 (54.8-56.9) | 1.22 (1.13-1.31) | 3.2 (2.0-4.3) |
| Fluid resuscitation of ≥ 30 mL/kg (among patients with absolute indication) | 43.1 (42.2-44.0) | 42.2 (41.0-43.4) | 1.06 (0.96-1.17) | 0.9 (-0.6-2.4) |
| Fluid resuscitation of ≥ 30 mL/kg (among expanded population) | 52.0 (51.3-52.7) | 50.9 (50.2-51.5) | 1.08 (1.01-1.15) | 1.1 (0.2-2.1) |
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.
Key Words
benchmarking
health care quality indicator
hospitalization
risk adjustment
