The Latest in Critical Care: October 15, 2025
ENCOMPASS trial (telehealth post sepsis); Ambient AI scribes to reduce burnout; BRICK trial (ischemic preconditioning before cardiac cath)
Extra post-discharge support after sepsis admissions (ENCOMPASS trial)
Patients with a diagnosis of sepsis often make less than robust recoveries and remain at high risk for readmission, disability, and death.
Could this be mitigated by routine telephone follow-ups after patients’ initial recovery from life-threatening illness?
And would it help if the overall effort got its own inspiring acronym, like STAR (Sepsis Transition And Recovery)?
A prior randomized trial at three hospitals (at Atrium Health in North Carolina) suggested that a nurse calling ~350 sepsis patients within 30 days after discharge to identify new impairments or undertreated comorbidities, address medication issues, or offer palliative care could reduce readmissions and mortality by 7% at one year of follow-up, compared to ~350 patients not getting the phone calls.
The promise of the STAR program led Atrium to expand it in the ENCOMPASS trial, in which seven Atrium hospitals implemented STAR at random intervals (in a stepped-wedge cluster-randomized design). Nurses in ENCOMPASS called patients for up to three months post-discharge, with a total of 3,548 patients enrolled.
At 90 days, the composite of all-cause readmission or mortality was statistically near-identical between groups (48%). The composite outcome obscured the interesting findings in its components, though: patients receiving telehealth calls had lower mortality (17% vs 20%, statistically significant), but more readmissions (36% vs 33.5%).
This raises the possibility that the phone calls successfully identified patients who needed to be readmitted, and were, saving some of their lives (with a number needed to treat of ~32). Longer-term follow-up data will presumably be reported later.
Atrium Health gained notoriety for suing record numbers of its patients for unpaid medical bills in North Carolina between 2017 and 2022, charging them 8% interest compounded over years. In 2021, Atrium and its merger partner together collected $1.7 billion in profit, after accepting $632 million in taxpayer-funded Covid relief, according to a state report.
Republican state treasurer Dale Folwell criticized Atrium in a public report for its opaque and excessive executive pay, saying it “prioritized the paychecks of its top executives over its charitable mission.”
Atrium then merged with Advocate Aurora Health, which faces an ongoing antitrust class-action lawsuit for alleged monopolistic behavior, and reportedly paid its own executives $927 million over a nine-year period.
None of that invalidates any research conducted there, but it felt like information worth sharing.
Atrium Health and UPenn test pressuring doctors to offer more comfort care
Academics from the University of Pennsylvania have been teaming up with Big Hospitals to perform research on clinical operations.
Ambient AI scribe “reduces burnout” (i.e., docs like it)
AI scribes can now listen in the background and write your notes for you with a high degree of quality and fidelity. Numerous health systems are providing the service in the hope of improving physician retention (and productivity), and Doximity rolled out its own free HIPAA-compliant scribe that any physician can use while on that social platform.
Among 451 clinicians who started using one vendor’s AI scribe in various clinics, the rate of self-reported burnout symptoms declined from 52% to 39% of respondents in just 30 days. They also reported an increased ability to provide their undivided attention and a decreased time documenting after hours.
Did the tool really reduce “burnout”? The users likely understood their survey responses would be used to evaluate the product. Those who wanted to continue to use it had a strong incentive to report reduced burnout symptoms. The results might be better interpreted as a customer satisfaction survey rather than as a burnout intervention. Two of the authors had financial ties to the AI scribe developer.
AI scribes have been one of the best use cases of generative AI in healthcare thus far. They solve a major pain point for clinic-based physicians. They genuinely could reduce burnout. It’s hard not to see AI scribes being widely and rapidly adopted, and then becoming indispensable.
As they do, though, they will quietly evolve from a novel tool to improve a clinician’s workday to a standard feature of the EMR that one must use to meet minimum productivity expectations.
In the current study, the decreased time spent documenting meant additional patients could be seen each day—but only if “urgently needed,” the authors were quick to emphasize. These tools would never be used to insidiously ratchet up physician workload as their efficiency increases—how dare you even suggest that?
Remote ischemic preconditioning dramatically improves outcomes after cardiac cath? (BRICK trial)
The premise of remote ischemic preconditioning is that inducing temporary, nonharmful ischemia in a localized tissue bed (like an arm during several minutes of sustained blood pressure cuff compression) somehow “preconditions” the body to better withstand ischemic-hypoxic or other stress elsewhere later during a planned procedure (e.g., cardiac surgery with bypass).
Numerous small randomized trials have suggested that RIPC prevents acute kidney injury or other organ failure after major surgery or cardiac catheterization:
Does squeezing an arm really hard improve outcomes after cardiac surgery?
Cardiopulmonary bypass (CPB) for cardiac surgery induces ischemic injury throughout the body, but especially in the kidneys. Acute kidney injury occurs in up to a third of patients undergoing CPB.
Most recently, we have the BRICK trial, conducted on 109 patients undergoing cardiac catheterization for acute coronary syndrome who were at high risk for AKI, at a single academic institution (University of Pittsburgh).
Those randomized to RIPC (squeezing an arm with a blood pressure cuff for 5 minutes x 3 within four hours before cath) had far better outcomes than those receiving sham RIPC (both statistically significant):
Less acute renal failure (14.8% vs 29.1%), without reducing the need for long-term dialysis
Fewer major cardiovascular events at 6 months (16.7% vs 36.4%)
One might find these benefits to be implausibly large; chance or unmeasured bias are potential contributors in this relatively small sample size.
The positive findings from BRICK and its brethren contrast with the higher-powered, multicenter PRINCE trial (Circulation 2025). Among 1,213 patients in eight countries undergoing noncardiac surgery, RIPC did not reduce rates of postoperative myocardial infarction, acute kidney injury, or any other adverse outcome.
Other RCTs are in process testing RIPC to prevent complications from noncardiac surgery and cardiac cath, including RIP-HIGH (n=250), NCT05733208 (n=766, in China), and numerous smaller studies (which are likewise vulnerable to bias and underpowering).
Olafiranye et al. Remote Ischemic Preconditioning Prevents Acute Kidney Injury Following Coronary Angiography: The BRICK Randomized Clinical Trial | JACC: Advances 2025