Central Venous Access Capability and Critical Care Telemedicine Decreases Inter-Hospital Transfer Among Severe Sepsis Patients: A Mixed Methods Design

Ilko, Steven A.; Vakkalanka, J. Priyanka; Ahmed, Azeemuddin; Harland, Karisa; Mohr, Nicholas M.

doi:10.1097/ccm.0000000000003686

Cited by 12 publications

(8 citation statements)

References 33 publications

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“…In small hospitals, teleED may improve sepsis care and prevent costly and potentially avoidable transfer. 10,11 Previous reports of teleED for sepsis have been limited to a small pilot study and single-centre before-after study. 12,13 While the vague and nonspecific symptoms that may indicate sepsis represent a diagnostic challenge for teleED sepsis programmes, 14 the time-sensitive nature of early sepsis treatment, the ability to provide care in any ED even without advanced procedural capability, and the clear benefit of expert consultation on sepsis outcomes suggest that sepsis could be the perfect application for teleED care.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Although sepsis care does not require advanced technology, it does require staffing and procedural resources–notably critical care and in some cases interventional radiology or surgery for source control–that are not routinely available in all hospitals. 134 Critical care services for advanced organ failure support for sepsis, however, often exist within other regionalized networks, such as trauma and stroke systems.…”

Section: The Case For Regionalizing Sepsis Carementioning

confidence: 99%

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

Walton

Mohr

2022

JACEP Open

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Regionalization has become a buzzword in US health care policy. Regionalization, however, has varied meanings, and definitions have lacked contextual information important to understanding its role in improving care. This concept review is a comprehensive primer and summation of 8 common core components of the national models of regionalization informed by text‐based analysis of the writing of involved organizations (professional, regulatory, and research) guided by semistructured interviews with organizational leaders. Further, this generalized model of regionalized care is applied to sepsis care, a novel discussion, drawing on existing small‐scale applications. This discussion highlights the fit of regionalization principles to the sepsis care model and the actualized and perceived potential benefits. The principal aim of this concept review is to outline regionalization in the United States and provide a roadmap and novel discussion of regionalized care integration for sepsis care.

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“…[49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] In trauma and critical illness, evidence suggests that telehealth can optimize triage, reduce transfers, and better stabilize transferred patients, with decreased mortality and ICU admission rates. [68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84] Among pediatric critical care patients, telehealth has been shown to decrease ICU admissions, transfers, medication errors, and improve provider satisfaction. 29,85-10 0 In behavioral health, telehealth has reduced length of stay, improved transfer processes, and enabled "psychiatry clearance" and discharge planning.…”

Section: Access To Specialistsmentioning

confidence: 99%

Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine

Hayden

Davis

Clark

et al. 2021

Academic Emergency Medicine

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Introduction: Telehealth has the potential to significantly change the specialty of emergency medicine (EM) and has rapidly expanded in EM during the COVID pandemic; however, it is unclear how EM should intersect with telehealth. The field lacks a unified research agenda with priorities for scientific questions on telehealth in EM. Methods: Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in EM and telehealth created a research agenda for the topic. The multiyear process used a modified Delphi technique to develop research questions related to telehealth in EM. Research questions were excluded from the final research agenda if they did not meet a threshold of at least 80% of votes indicating "important" or "very important." Results: Round 1 of voting included 94 research questions, expanded to 103 questions in round 2 and refined to 36 questions for the final vote. Consensus occurred with a final set of 24 important research questions spanning five breakout group topics. Each breakout group domain was represented in the final set of questions. Examples of the questions include: "Among underserved populations, what are mechanisms by | 1453 HAYDEN Et Al.

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Central Venous Access Capability and Critical Care Telemedicine Decreases Inter-Hospital Transfer Among Severe Sepsis Patients: A Mixed Methods Design

Cited by 12 publications

References 33 publications

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

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

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

Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine

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