The association between interhospital transfer and sepsis guideline adherence among rural emergency department patients

Cole Wymore; Eliezer Santos León; Priyanka Vakkalanka; Uche Okoro; Karisa K Harland; Brian M Fuller; Kalyn Campbell; Morgan B Swanson; Brett Faine; Anne Zepeski; Edith A Parker; Luke J Mack; Amanda Bell; Katie DeJong; Keith Mueller; Elizabeth Chrischilles; Christopher R Carpenter; Kelli Wallace; Michael P Jones; Marcia M Ward; Nicholas M Mohr

doi:10.1371/journal.pone.0351133

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The association between interhospital transfer and sepsis guideline adherence among rural emergency department patients

Journal article

Open access

Peer reviewed

The association between interhospital transfer and sepsis guideline adherence among rural emergency department patients

Cole Wymore, Eliezer Santos León, Priyanka Vakkalanka, Uche Okoro, Karisa K Harland, Brian M Fuller, Kalyn Campbell, Morgan B Swanson, Brett Faine, Anne Zepeski, …

PloS one, Vol.21(7), e0351133

07/01/2026

DOI: 10.1371/journal.pone.0351133

PMID: 42430347

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Abstract

The objective of this study was to assess whether interhospital transfer delays completion of the Surviving Sepsis Campaign (SSC) 3-hour bundle among rural sepsis patients. We conducted a multicenter (n = 23) cohort study among adult rural sepsis patients in an ED-based telemedicine network between August 2016 and June 2019. The primary exposure was interhospital transfer and the primary outcome was completion of the SSC 3-hour bundle. Secondary outcomes included SSC component adherence, ED length-of-stay, and in-hospital mortality. We used a Cox proportional hazards model to evaluate time to bundle completion by transfer status, generalized linear models for dichotomous outcomes, and linear and quantile regression for ED length-of-stay. A total of 1,191 patients were treated in participating hospitals, with 359 (30%) undergoing interhospital transfer. SSC bundle adherence was similar in both groups (difference 2.2%; 95% confidence interval [CI]: - 2.2, 6.5%). Among eligible patients, transfer was associated with a longer ED length-of-stay (3.1 hours vs 2.6 hours; difference 0.6 hours; 95%CI: 0.4, 0.7).

Aged

Emergency Service, Hospital - statistics & numerical data

Female

Guideline Adherence - statistics & numerical data

Hospital Mortality

Humans

Length of Stay - statistics & numerical data

Male

Middle Aged

Patient Transfer - statistics & numerical data

Rural Population

Sepsis - mortality

Sepsis - therapy

Details

Title: Subtitle: The association between interhospital transfer and sepsis guideline adherence among rural emergency department patients
Creators: Cole Wymore - University of Iowa
Eliezer Santos León - University of Iowa
Priyanka Vakkalanka - University of Iowa
Uche Okoro - Merck & Co., Inc., Rahway, NJ, USA (United States)
Karisa K Harland - University of Iowa
Brian M Fuller - Washington University in St. Louis
Kalyn Campbell - University of Iowa
Morgan B Swanson - University of Iowa
Brett Faine - University of Iowa
Anne Zepeski - University of Iowa
Edith A Parker - University of Iowa
Luke J Mack - Sanford Health
Amanda Bell - Avera Health
Katie DeJong - Avera Health
Keith Mueller - University of Iowa
Elizabeth Chrischilles - University of Iowa
Christopher R Carpenter - Mayo Clinic
Kelli Wallace - University of Iowa
Michael P Jones - University of Iowa
Marcia M Ward - University of Iowa
Nicholas M Mohr - University of Iowa
Resource Type: Journal article
Publication Details: PloS one, Vol.21(7), e0351133
DOI: 10.1371/journal.pone.0351133
PMID: 42430347
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: PLoS
Grant note: Agency for Healthcare Research and Quality: K08HS025753 National Institutes of Health: UL1TR002537 Health Resources and Services Administration: U3GRH40003
This study was funded by the Agency for Healthcare Research and Quality (K08HS025753) and the Institute for Clinical and Translational Science at the University of Iowa through a grant from the National Center for Advancing Translational Sciences at the National Institutes of Health (UL1TR002537). Dr. Mohr is additionally supported by funding from the Rural Telehealth Research Center with funding from the Health Resources and Services Administration (U3GRH40003).
Language: English
Date published: 07/01/2026
Academic Unit: Statistics and Actuarial Science; Pharmacy; Public Health Administration; Health Management and Policy; Epidemiology; Emergency Medicine; Biostatistics; Pharmacy Practice and Science; Anesthesia; Injury Prevention Research Center; Community and Behavioral Health; Law Faculty
Record Identifier: 9985180978002771

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