Nicholas Mohr, MD, MS, FCCM
Professor
University of Iowa Hospital and Clinics
Iowa City, IA
Disclosure information not submitted.
Uche Okoro, MBBS, DrPH
Biostatistician
University of Iowa, United States
Disclosure information not submitted.
Kalyn Campbell, MD
Resident Physician
University of Minnesota, United States
Disclosure information not submitted.
Steven Simpson, MD
Professor
University of Kansas, Kansas, United States
Disclosure information not submitted.
Brian Fuller, MD, MSCI,FCCM
Associate Professor of Anesthesiology and Emergency Medicine
Washington University/Barnes-Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Title: Emergency Department Telemedicine is Used for Patients with More Severe Sepsis in Rural Hospitals
Introduction: Sepsis treatment in rural emergency departments (EDs) is common, but guideline adherence is low and outcomes among transferred patients are poor. Provider-to-provider telemedicine has been proposed to improve rural sepsis care. The objective of this study was to describe the use of rural ED telemedicine for sepsis care in a cohort of rural hospitals.
Methods: The TELEmedicine as a Virtual Intervention for Sepsis in Emergency Departments (TELEVISED) study was a multicenter cohort study in 25 rural Midwestern EDs participating in an ED-based telemedicine network. We identified sepsis patients treated between January 2014 and July 2019 by medical records and stratified them on whether telemedicine was used. Our primary outcome for this analysis was whether provider-to-provider telemedicine was used as an adjunct for rural sepsis care.
Results: A total of 1,278 sepsis patients were identified, of which 390 (30.5%) had telemedicine used for their care. Telemedicine cases were younger (p< 0.001) and had greater illness severity than non-telemedicine cases (SOFA ≥ 4: 65% vs. 45%, p< 0.001). Seventy-four percent (n=269) had telemedicine consulted more than 60 minutes into the ED visit, and telemedicine patients were much more likely to be transferred to another hospital (86% vs. 9%, p< 0.001). Physician involvement was requested in 89% of telemedicine cases, and telemedicine cases were less likely (72% vs. 91%, p< 0.001) to have a physician provider in the rural ED. Hospital-specific telemedicine use was strongly associated with hospital-specific transfer proportion (p< 0.001).
Conclusions: ED telemedicine was used for sicker patients in more rural hospitals with less physician coverage. Future work should identify barriers and facilitators to telemedicine use and heterogeneity of treatment affects between hospitals.