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 Telemedicine Reduces Mortality in Rural Sepsis Cases Treated by Non-Physician Providers
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 association between ED telemedicine use and survival in rural sepsis care.
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 was mortality and Surviving Sepsis Campaign (SSC) bundle adherence. We used logistic regression to adjust for triage pulse, blood pressure, ED SOFA score, and lactate to measure the association between telemedicine use and our outcomes.
Results: Provider-to-provider physician-provided telemedicine was used in 347 of 1,278 (27%) total ED sepsis cases and 95 of 179 (53%) cases treated by a non-physician provider. Adjusting for potentially confounding covariates, telemedicine use was associated with lower mortality (aOR 0.11, 95% CI 0.02-0.71), but no difference in SSC guideline adherence (aOR 3.09, 95% CI 0.57-16.84) or antibiotic appropriateness (aOR 1.18, 95% CI 0.42-3.29).
Conclusions: ED telemedicine was used more frequently when rural emergency care was delivered by a non-physician provider, and telemedicine cases had lower adjusted mortality. Future work should better evaluate the pathways by which telemedicine impacts rural sepsis care.