TELEmedicine as an intervention for sepsis in emergency departments: a multicenter, comparative effectiveness study (TELEvISED Study)

Mohr, Nicholas M.; Harland, Karisa; Okoro, Uche; Fuller, Brian M.; Campbell, Kalyn; Simpson, Stephen; Parker, Edith A.; Mack, Luke; Bell, Amanda; DeJong, Katie; Faine, Brett; Zepeski, Anne; Mueller, Keith J.; Chrischilles, Elizabeth A.; Carpenter, Christopher R.; Jones, Michael P.; Ward, Marcia M.

doi:10.2217/cer-2020-0141

Cited by 7 publications

(3 citation statements)

References 67 publications

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“…The TELEmedicine as a Virtual Intervention for Sepsis in Emergency Departments (TELEVISED) study was developed to understand how real-time video consultation is associated with improved guideline adherence and clinical outcomes in rural patients with sepsis. 20,21 An early study showed that telehealth in rural EDs was associated with higher sepsis bundle adherence (adjusted odds ratio [aOR] 17.3, 95% confidence interval [CI] 6.6 to 44.9) 22 , but we subsequently found that one significant barrier to telehealth use was sepsis diagnosis and recognition. 23 In another multicenter study in telehealth-capable hospitals with contemporary controls (n=1,191), we found telehealth consultation was not associated with improved outcomes, but the subgroup of patients treated in the most remote hospitals by advanced practice providers may have had reduced mortality (aOR 0.11, 95% CI 0.02 to 0.73).…”

Section: Importancementioning

confidence: 76%

The Role of Sepsis Care in Rural Emergency Departments: A Qualitative Study of Emergency Department User Perspectives

Mohr,

Merchant,

Fuller

et al. 2024

Preprint

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Objective: Sepsis is a leading cause of hospitalization and death in the United States, and rural patients are at particularly high risk. Telehealth has been proposed as one strategy to narrow rural-urban disparities. The objective of this study was to understand why staff use provider-to-provider telehealth in rural emergency departments (tele-ED) and how tele-ED care changes the care for rural patients with sepsis. Methods: We conducted a qualitative interview study between March 1, 2022 and May 22, 2023 with participants from upper Midwest rural EDs the tele-ED hub physicians in a single tele-ED network that delivers provider-to-provider consultation for sepsis patients. One interviewer conducted individual telephone interviews, then we used standard qualitative methods based on modified grounded theory to identify themes and domains. Results: We interviewed 27 participants, and from the interviews we identified nine themes within three domains. Participants largely felt tele-ED for sepsis was valuable in their practice. We identified that telehealth was consulted to facilitate interhospital transfer, provide surge capacity for small teams, to adhere with policy around provider scope of practice, for inexperienced providers, and for patients with increased severity of illness or complex comorbidities. Barriers to tele-ED use and impact of tele-ED included increased sepsis care standardization, provider reluctance, and sepsis diagnostic uncertainty. Additionally, we identified that real-time education and training were important secondary benefits identified from tele-ED use. Conclusions: Tele-ED care was used by rural providers for sepsis treatment, but many barriers existed that may have limited potential benefits to its use.

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Section: Importancementioning

confidence: 76%

The Role of Sepsis Care in Rural Emergency Departments: A Qualitative Study of Emergency Department User Perspectives

Mohr,

Merchant,

Fuller

et al. 2024

Preprint

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“…The methods of the study have been reported previously (ClinicalTrials.gov NCT04441944), including a detailed description of participating sites. 35 Initially we planned to include 25 hospitals, but two hospitals were excluded because of a lack of data availability ( Supplemental Figure S1 ). This article is reported consistent with the Template for Intervention Description and Replication checklist for Population Health and Policy (TIDieR-PHP), and the study was designed using the Strengthening the Reporting of Observational Studies in the Epidemiology (STROBE) statement.…”

Section: Methodsmentioning

confidence: 99%

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

Mohr

Okoro

Harland

et al. 2022

Preprint

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Objective: To test the hypothesis that provider-to-provider tele-emergency department (tele-ED) care is associated with more 28-day hospital-free days and improved Surviving Sepsis Campaign (SSC) guideline adherence in rural emergency departments (EDs). Methods: Multicenter (n=23), propensity-matched, cohort study using medical records of sepsis patients from rural hospitals in a well-established, on-demand, rural video tele-ED network in the upper Midwest between August 2016 and June 2019. The primary outcome was 28-day hospital-free days, with secondary outcomes of 28-day in-hospital mortality and SSC guideline adherence. Results: A total of 1,191 patients were included in the analysis, with tele-ED used for 326 (27%). Tele-ED cases were more likely to be transferred to another hospital (88% vs. 8%, difference 79%, 95% CI 75-83%). After matching and regression adjustment, tele-ED cases did not have more 28-day hospital-free days (difference 0.80 days longer for non-tele-ED, 95% confidence interval [CI] [-0.87]-2.47) or 28-day in-hospital mortality (adjusted odds ratio [aOR] 1.61, 95% CI 0.74-3.57). Adherence with both the SSC 3-hour bundle (aOR 0.80, 95% CI 0.24-2.70) and complete bundle (aOR 0.81, 95% CI 0.15-4.41) were similar. An a priori-defined subgroup analysis of patients treated by advanced practice providers suggested that the mortality was lower in the cohort with tele-ED use (aOR 0.19, 95% CI 0.04-0.90) despite no significant difference in complete SSC bundle adherence (aOR 2.48, 95% CI 0.45-13.76). Conclusions: Rural ED patients treated with provider-to-provider tele-ED care in a mature network appear to have similar clinical outcomes to those treated without.

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“…In addition to avoiding the need for emergency care, as in cases where driving must be outpatient, remote care is helpful to reinforce the need for face-to-face assessment for those who have diseases for which rapid intervention is essential. Finally, for populations that live or work in places far from large centers, for which access to the emergency requires long and/or complex commuting, the initial stages of care can be directed by Telemedicine directly to the patient or between health professionals 19,23,26 .…”

Section: Editorialmentioning

confidence: 99%

Novas tecnologias e excelência na unidade de emergência

Accorsi

Cardoso

Paixão

et al. 2021

Rev. Med. (São Paulo)

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TELEmedicine as an intervention for sepsis in emergency departments: a multicenter, comparative effectiveness study (TELEvISED Study)

Cited by 7 publications

References 67 publications

The Role of Sepsis Care in Rural Emergency Departments: A Qualitative Study of Emergency Department User Perspectives

The Role of Sepsis Care in Rural Emergency Departments: A Qualitative Study of Emergency Department User Perspectives

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

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