1188: SEPSIS RECOGNITION IN RURAL EDS IS LOW AND RECOGNITION IS NOT ASSOCIATED WITH TELEMEDICINE USE

Anna Kaldjian; Uche Okoro; Cole Wymore; Nicholas Mohr

doi:10.1097/01.ccm.0000910488.86281.a4

Introduction: Sepsis is a disease with high mortality, yet many sepsis patients are not recognized at the time of initial emergency department (ED) care. Provider-to-provider ED telehealth (tele-ED) has been proposed to improve rural sepsis care. The objectives of this study were to measure the association between sepsis recognition and tele-ED use and to compare concordance of sepsis diagnosis between local EDs and a tele-ED hub. Methods: This analysis was a multicenter (n=23) cohort study of sepsis patients treated in rural EDs that participated in a tele-ED network between August 2016 and June 2019. Included patients had hospital diagnosis codes of sepsis, with SIRS criteria, organ failure, and infection recognized in the ED. The primary exposure was sepsis recognition in the rural ED and the primary outcome was tele-ED use, with secondary outcomes of time to tele-ED and diagnostic concordance between local ED and hub ED. We used multivariable logistic regression to measure the association between sepsis recognition and tele-ED use. Results: Data from 1146 patients were included, of whom 36% (414) had sepsis documented in the rural ED and 71% (810) had sepsis documented by the tele-ED hub. Factors associated with increased recognition of sepsis were: fever, hypotension, tachycardia, elevated lactate level, source of infection, and care by an advanced practice provider with an onsite physician. Sepsis recognition was not associated with higher rates of tele-ED use (adjusted odds ratio [aOR] 1.19, 95% CI 0.8-1.7). Median time to tele-ED use in patients with recognized sepsis was shorter than in those without (87 minutes vs. 107 minutes, 95% CI 3–37 minutes), but this relationship was not significant after adjustment for potentially confounding variables, including interhospital transfer (aHR 0.8, 95% CI 0.6-1.1). Thirty-three percent of sepsis cases were recognized in both local and hub EDs. Among those with sepsis not recognized in the rural ED, 60% (436) were recognized in the hub. Conclusions: Sepsis is under-recognized in rural EDs, potentially limiting the effect of rural tele-ED care. However, recognition of sepsis does not significantly affect rates of tele-ED use or times to tele-ED use. Future work will focus on ways in which tele-ED care can improve recognition of sepsis in rural EDs.

1188: SEPSIS RECOGNITION IN RURAL EDS IS LOW AND RECOGNITION IS NOT ASSOCIATED WITH TELEMEDICINE USE

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