Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments

Nicholas M Mohr; Kalyn D Campbell; Morgan B Swanson; Fred Ullrich; Kimberly A Merchant; Marcia M Ward

doi:10.1177/1357633X19896667

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Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments

Journal article

Peer reviewed

Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments

Nicholas M Mohr, Kalyn D Campbell, Morgan B Swanson, Fred Ullrich, Kimberly A Merchant and Marcia M Ward

Journal of telemedicine and telecare, Vol.27(8), pp.518-526

09/2021

DOI: 10.1177/1357633X19896667

PMCID: PMC7335316

PMID: 31903840

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https://www.ncbi.nlm.nih.gov/pmc/articles/7335316View

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Abstract

Introduction Sepsis is a life-threatening emergency. Together, early recognition and intervention decreases mortality. Protocol-based resuscitation in the emergency department (ED) has improved survival in sepsis patients, but guideline-adherent care is less common in low-volume EDs. This study examined the association between provider-to-provider telemedicine and adherence with sepsis bundle components in rural community hospitals. Methods This is a prospective cohort study of adults presenting with sepsis or septic shock in community EDs participating in rural telemedicine networks. The primary outcome was adherence to four sepsis bundle requirements: lactate measurement within 3 hours, blood culture before antibiotics, broad-spectrum antibiotics, and adequate fluid resuscitation. Multivariable generalized estimating equations estimated the association between telemedicine and adherence. Results In this cohort ( n = 655), 5.6% of subjects received ED telemedicine consults. The telemedicine group was more likely to be male and have a higher severity of illness. After adjusting for severity and chief complaint, total sepsis bundle adherence was higher in the telemedicine group compared with the non-telemedicine group (aOR 17.27 [95%CI 6.64–44.90], p < 0.001). Telemedicine consultation was associated with higher adherence with three of the individual bundle components: lactate, antibiotics, and fluid resuscitation. Discussion Telemedicine patients were more likely to receive initial blood lactate measurement, timely broad-spectrum antibiotics, and adequate fluid resuscitation. In rural, community EDs, telemedicine may improve sepsis care and potentially reduce disparities in sepsis outcomes at low-volume facilities. Future work should identify specific components of telemedicine-augmented care that improve performance with sepsis quality indicators.

Details

Title: Subtitle: Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments
Creators: Nicholas M Mohr - Department of Emergency Medicine, College of Medicine, University of Iowa, Iowa City, USA, Department of Anesthesia Division of Critical Care, College of Medicine, University of Iowa, Iowa City, USA, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, USA
Kalyn D Campbell - Department of Emergency Medicine, College of Medicine, University of Iowa, Iowa City, USA
Morgan B Swanson - Department of Emergency Medicine, College of Medicine, University of Iowa, Iowa City, USA, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, USA
Fred Ullrich - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, USA
Kimberly A Merchant - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, USA
Marcia M Ward - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, USA
Resource Type: Journal article
Publication Details: Journal of telemedicine and telecare, Vol.27(8), pp.518-526
DOI: 10.1177/1357633X19896667
PMID: 31903840
PMCID: PMC7335316
NLM abbreviation: J Telemed Telecare
ISSN: 1357-633X
eISSN: 1758-1109
Grant note: DOI: 10.13039/100000133, name: Agency for Healthcare Research and Quality, award: K08 HS025753; DOI: 10.13039/100010001, name: Federal Office of Rural Health Policy, award: Cooperative agreement #UICRH29074, G01RH27868, G01RH27869, G01RH27870, G01RH27871, G01RH27872, G01RH27873
Language: English
Date published: 09/2021
Academic Unit: Rural Telehealth Research Center; Health Management and Policy; Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
Record Identifier: 9984214703702771

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