B27-09 Role-Based Perspectives on Sepsis Care in Short Stay Units: A Rapid Qualitative Analysis of Risk, Resources, and System Fit

Rationale

Short stay units (SSUs) are increasingly used to manage patients requiring brief hospitalization yet their role in sepsis care remains poorly defined. Prior work demonstrates substantial hospital-level variation in use of SSUs for sepsis, with potential implications for quality and safety. Although standardized sepsis protocols and quality measures are widely implemented, less is known about how frontline clinicians conceptualize sepsis risk within SSUs or how role-based perspectives shape judgements about appropriateness, safety, and system fit. We sought to characterize nursing and physician perspectives on sepsis risk and care in SSUs across hospitals participating in a statewide quality initiative.

Methods

From June to August 2025, we conducted 30 semi-structured interviews with nurses and physicians involved in SSU care at 10 hospitals participating in the Michigan Hospital Medicine Safety Consortium Sepsis Initiative. Hospitals were purposively sampled to capture variation in sepsis outcomes and utilization of SSUs. Interviews explored patient selection, sepsis recognition and treatment, workflow, safety considerations, and organizational context. Transcripts were analyzed using rapid qualitative analysis with structured summaries and matrix-based comparison, guided by the Consolidated Framework for Implementation Research.

Results

Interviews were completed with 16 nurses and 14 physicians. Across hospitals, SSUs were consistently described as throughput-oriented environments designed for short stays, with limited tolerance for clinical uncertainty. Nurses and physicians converged in their emphasis on early sepsis recognition, patient safety, and adherence to hospital-wide sepsis protocols. However, perspectives diverged in how “low-risk” sepsis was conceptualized. Physicians generally defined low-risk categorically, emphasizing hemodynamics, comorbidities, and anticipated length of stay. In contrast, nurses characterized sepsis risk as dynamic and context-dependent, incorporating workload, staffing ratios, monitoring intensity, competing demands, and feasibility of sustained vigilance. Nurses described a disconnect between SSU admission decisions, typically made outside the unit, and their accountability for continuous monitoring and early sepsis-related deterioration. Both groups identified EMR tools (alerts, order sets) as facilitating recognition and escalation but noted alert fatigue and limits of protocolized care in high-throughput settings. Clinicians did not describe SSUs as intentionally expanding sepsis care, but rather as settings where early or missed sepsis occasionally surfaced, requiring escalation.

Conclusions

Among these Michigan hospitals, nurses and physicians described complementary yet distinct perspectives on sepsis risk and system fit within SSUs. These findings highlight an implementation challenge: “low-risk” sepsis lacks a shared operational definition that connects clinical risk with unit-level capacity, staffing, and workflow, raising challenges for safe implementation across short stay and inpatient settings.

This abstract is funded by: Michigan Hospital Medicine Safety Consortium (HMS)