Central Venous Access Capability and Critical Care Telemedicine Decreases Inter-Hospital Transfer Among Severe Sepsis Patients: A Mixed Methods Design

Steven A Ilko; J Priyanka Vakkalanka; Azeemuddin Ahmed; Karisa K Harland; Nicholas M Mohr

doi:10.1097/CCM.0000000000003686

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Central Venous Access Capability and Critical Care Telemedicine Decreases Inter-Hospital Transfer Among Severe Sepsis Patients: A Mixed Methods Design

Journal article

Peer reviewed

Central Venous Access Capability and Critical Care Telemedicine Decreases Inter-Hospital Transfer Among Severe Sepsis Patients: A Mixed Methods Design

Steven A Ilko, J Priyanka Vakkalanka, Azeemuddin Ahmed, Karisa K Harland and Nicholas M Mohr

Critical care medicine, Vol.47(5), pp.659-667

05/2019

DOI: 10.1097/CCM.0000000000003686

PMCID: PMC6465097

PMID: 30730442

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Abstract

Severe sepsis is a complex, resource intensive, and potentially lethal condition and rural patients have worse outcomes than urban patients. Early identification and treatment are important to improving outcomes. The objective of this study was to identify hospital-specific factors associated with inter-hospital transfer. Mixed method study integrating data from a telephone survey and retrospective cohort study of state administrative claims. Survey of Iowa emergency department administrators between May 2017 and June 2017 and cohort of adults seen in Iowa emergency departments for severe sepsis and septic shock between January 2005 and December 2013. None. Multivariable logistic regression was used to identify independent predictors of inter-hospital transfer. We included 114 institutions that provided data (response rate = 99%), and responses were linked to a total of 150,845 visits for severe sepsis/septic shock. In our adjusted model, having the capability to place central venous catheters or having a subscription to a tele-ICU service was independently associated with lower odds of inter-hospital transfer (adjusted odds ratio, 0.69; 95% CI, 0.54-0.86 and adjusted odds ratio, 0.69; 95% CI, 0.54-0.88, respectively). A facility's participation in a sepsis-specific quality improvement initiative was associated with 62% higher odds of transfer (adjusted odds ratio, 1.62; 95% CI, 1.10-2.39). The insertion of central venous catheters and access to a critical care physician during sepsis treatment are important capabilities in hospitals that transfer fewer sepsis patients. In the future, hospital-specific capabilities may be used to identify institutions as regional sepsis centers.

Catheterization, Central Venous - statistics & numerical data

Critical Care - organization & administration

Telemedicine - organization & administration

Humans

Middle Aged

Catheterization, Central Venous - methods

Sepsis - epidemiology

Male

Shock, Septic - therapy

Health Care Costs

Iowa

Emergency Service, Hospital - organization & administration

Sepsis - therapy

Adult

Female

Aged

Patient Transfer - statistics & numerical data

Retrospective Studies

Length of Stay - statistics & numerical data

Details

Title: Subtitle: Central Venous Access Capability and Critical Care Telemedicine Decreases Inter-Hospital Transfer Among Severe Sepsis Patients: A Mixed Methods Design
Creators: Steven A Ilko - Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
J Priyanka Vakkalanka - Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
Azeemuddin Ahmed - Department of Management and Organizations, University of Iowa Tippie College of Business, Iowa City, IA
Karisa K Harland - Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
Nicholas M Mohr - Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
Resource Type: Journal article
Publication Details: Critical care medicine, Vol.47(5), pp.659-667
DOI: 10.1097/CCM.0000000000003686
PMID: 30730442
PMCID: PMC6465097
NLM abbreviation: Crit Care Med
ISSN: 0090-3493
eISSN: 1530-0293
Publisher: United States
Grant note: T35 HL007485 / NHLBI NIH HHS
Language: English
Date published: 05/2019
Academic Unit: Management and Entrepreneurship ; Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center; Public Policy Center (Archive); Law Faculty
Record Identifier: 9984024522102771

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