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

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.

Concept review of regionalized systems of acute care: Is regionalization the next frontier in sepsis care?

“…Sepsis is one example of an acute care condition for which regional care should be considered, and several small‐scale examples of regional sepsis networks have been developed. 119 , 120 , 121 , 122 Is regionalization the next frontier in sepsis quality?…”

Outcomes Associated with Rural Emergency Department Provider-to-Provider Telehealth for Sepsis Care: A Multicenter Cohort Study

“…23 In small pilot studies, tele-ED has been associated with improved sepsis guideline adherence, possibly attributable both to direct care recommendations and durable training for local medical staff. [24][25][26][27][28] In addition to tele-ED applications, telehealth has also been used to supplement sepsis care during prehospital care, hospitalization, and post-discharge recovery. [29][30][31][32][33]…”

HRSA’s evidence-based tele-emergency network grant program: Multi-site prospective cohort analysis across six rural emergency department telemedicine networks

“…Very few analyses of telehealth interventions have pooled data from multiple networks, and a systematic review of teleED implementation papers did not identify any multi-network studies [12]. The goal of the EB TNGP program was to pool heterogeneous networks that have expanded to scale to better estimate how teleED might reshape rural health care if it were expanded beyond the networks that pioneered its use [32][33][34][35]. Observing the variation between networks in their application and use increases confidence in how teleED might perform at scale, and it allows for better prediction of the impact of systematic telehealth expansion into new health systems.…”