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There is substantial variability in incidence and mortality of severe sepsis depending on the method of database abstraction used. A uniform, consistent method is needed for use in national registries to facilitate accurate assessment of clinical interventions and outcome comparisons between hospitals and regions.

Use of telehealth, 1 or technologies to support and promote long-distance clinical care, education, and health administration, has increased dramatically in the past decade. Common modalities include live video teleconferencing, store-and-forward technology (eg, radiograph readings), remote patient monitoring (eg, telehealth coverage of intensive care units), mobile health applications, text, and email. The frequency and severity of disasters-or events that cause damage, ecological disruption, loss of human life, or deterioration of health and health services that warrant a response from outside the affected community-have also increased over the same period.The confluence of these unrelated phenomena present an opportunity for creative thinking about how telehealth can strengthen the medical response to disasters. Hurricane Maria, the storm that devastated Puerto Rico in 2017, highlights some of the challenges and opportunities for telehealth when critical infrastructure is compromised, including electricity, internet connectivity, hospitals, clinics, and access to clinicians.Although interest in telemedicine has historically focused on rural settings, and the Centers for Medicare & Medicaid Services primarily limit reimbursement to care provided in rural areas, telehealth is more focused on delivery of care than on geography. Military health systems have broadened the use of telemedicine, including in forward-deployed and difficult-to-reach settings. Congress has directed the Department of Defense to expand telehealth services throughout the military health care system by 2018. 2 The Department of Veterans Affairs has announced plans to deploy telehealth nationwide, allowing for "anywhere to anywhere" health care. 3 Emergency department-based consultations about stroke and telehealth coverage of intensive care units may be the best known examples. Tele-behavioral health care, for the remote delivery of mental health care, is also widely used. A comprehensive market analysis has estimated that the global telemedicine market, valued at $18.2 billion in 2016, would be double that by 2022. 4

Objective The incidence and incidence over time of cardiac arrest in hospitalized patients (IHCA) is unknown. We sought to estimate the event rate and temporal trends of adult inhospital cardiac arrest (IHCA) treated with a resuscitation response. Design Three approaches were used to estimate the IHCA event rate. First approach: Calculate the IHCA event rate at hospitals (n=433) in the Get With The Guidelines-Resuscitation (GWTG-R) registry, years 2003–2007 and multiply this by US annual bed-days. Second approach: Use the GWTG-R, IHCA event rate to develop a regression model (including hospital demographic, geographic, organizational factors) and use the model coefficients to calculate predicted event rates for acute care hospitals (n=5,445) responding to the American Hospital Association survey. Third approach: Classify acute care hospitals into groups based on academic, urban, bed size-and determine the average event rate for GWTG-R hospitals in each group and then use weighted averages to calculate the national IHCA rate. Annual event rates were calculated to estimate temporal trends. Setting GWTG-R registry Patients Adult IHCA with a resuscitation response Measurements and main results The mean adult treated IHCA event rate at GWTG-R hospitals was 0.92/1000 bed-days (IQR 0.58 to 1.2/1000). In hospitals (n=150) contributing data for all years of the study period, the event rate increased from 2003–2007. With 2.09 million annual US bed-days, we estimated 192,000 IHCA throughout the US annually. Based on the regression model, extrapolating GWTG-R hospitals to hospitals participating in the American Hospital Association survey projected 211,000 annual IHCA. Using weighted averages projected 209,000 annual US IHCA. Conclusions There are approximately 200,000 treated cardiac arrests among US hospitalized patients annually and this rate may be increasing. This is important for understanding the burden of IHCA and developing strategies to improve care for hospitalized patients.