Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments
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 exam...
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| Veröffentlicht in: | Journal of telemedicine and telecare 2021-09, Vol.27 (8), p.518-526 |
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| creator | Mohr, Nicholas M Campbell, Kalyn D Swanson, Morgan B Ullrich, Fred Merchant, Kimberly A Ward, Marcia M |
| description | 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 |
| doi_str_mv | 10.1177/1357633X19896667 |
| format | Article |
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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.</description><identifier>ISSN: 1357-633X</identifier><identifier>EISSN: 1758-1109</identifier><identifier>DOI: 10.1177/1357633X19896667</identifier><identifier>PMID: 31903840</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adult ; Antibiotics ; Emergency Service, Hospital ; Female ; Guideline Adherence ; Hospital Mortality ; Humans ; Male ; Prospective Studies ; Rural areas ; Sepsis ; Sepsis - therapy ; Telemedicine</subject><ispartof>Journal of telemedicine and telecare, 2021-09, Vol.27 (8), p.518-526</ispartof><rights>The Author(s) 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-a9cddf990c6f1496041b124f4aba82836ebe7053cf196e61ac311025af6cd3063</citedby><cites>FETCH-LOGICAL-c462t-a9cddf990c6f1496041b124f4aba82836ebe7053cf196e61ac311025af6cd3063</cites><orcidid>0000-0003-0558-4191 ; 0000-0003-0497-5828</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1357633X19896667$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1357633X19896667$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>230,314,780,784,885,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31903840$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mohr, Nicholas M</creatorcontrib><creatorcontrib>Campbell, Kalyn D</creatorcontrib><creatorcontrib>Swanson, Morgan B</creatorcontrib><creatorcontrib>Ullrich, Fred</creatorcontrib><creatorcontrib>Merchant, Kimberly A</creatorcontrib><creatorcontrib>Ward, Marcia M</creatorcontrib><title>Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments</title><title>Journal of telemedicine and telecare</title><addtitle>J Telemed Telecare</addtitle><description>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.</description><subject>Adult</subject><subject>Antibiotics</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Guideline Adherence</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Prospective Studies</subject><subject>Rural areas</subject><subject>Sepsis</subject><subject>Sepsis - therapy</subject><subject>Telemedicine</subject><issn>1357-633X</issn><issn>1758-1109</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1r3DAQxUVoadKk95yCoJde3GokW7YugRD6BYHkkEBuQpbHGwVbciQ7sP99tezmo4GcNOj95s08hpBjYN8B6voHiKqWQtyCapSUst4jB1BXTQHA1IdcZ7nY6Pvkc0r3jHEoK_WJ7AtQTDQlOyDjVQyPrsNYzKGYdjWdccARO2edR-rGzT8maro7jOgt0jnQhFNyibaL7wak1sQMemrDOC7ezWua--Mqw2va4WTiPKKf0xH52Jsh4Zfde0hufv28Pv9TXFz-_nt-dlHYUvK5MMp2Xa8Us7KHUklWQgu87EvTmoY3QmKLNauE7UFJlGCsyIl5ZXppO8GkOCSnW99paXMOm2dHM-gputHEtQ7G6f8V7-70KjzqWohKwMbg284ghocF06xHlywOg_EYlqS5EEJxyaXK6Nc36H1Yos_xNK-kyilkCZliW8rGkFLE_nkZYHpzS_32lrnl5HWI54an42Wg2ALJrPBl6ruG_wCoU6na</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Mohr, Nicholas M</creator><creator>Campbell, Kalyn D</creator><creator>Swanson, Morgan B</creator><creator>Ullrich, Fred</creator><creator>Merchant, Kimberly A</creator><creator>Ward, Marcia M</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0558-4191</orcidid><orcidid>https://orcid.org/0000-0003-0497-5828</orcidid></search><sort><creationdate>20210901</creationdate><title>Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments</title><author>Mohr, Nicholas M ; Campbell, Kalyn D ; Swanson, Morgan B ; Ullrich, Fred ; Merchant, Kimberly A ; Ward, Marcia M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-a9cddf990c6f1496041b124f4aba82836ebe7053cf196e61ac311025af6cd3063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Antibiotics</topic><topic>Emergency Service, Hospital</topic><topic>Female</topic><topic>Guideline Adherence</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Prospective Studies</topic><topic>Rural areas</topic><topic>Sepsis</topic><topic>Sepsis - therapy</topic><topic>Telemedicine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mohr, Nicholas M</creatorcontrib><creatorcontrib>Campbell, Kalyn D</creatorcontrib><creatorcontrib>Swanson, Morgan B</creatorcontrib><creatorcontrib>Ullrich, Fred</creatorcontrib><creatorcontrib>Merchant, Kimberly A</creatorcontrib><creatorcontrib>Ward, Marcia M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of telemedicine and telecare</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mohr, Nicholas M</au><au>Campbell, Kalyn D</au><au>Swanson, Morgan B</au><au>Ullrich, Fred</au><au>Merchant, Kimberly A</au><au>Ward, Marcia M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments</atitle><jtitle>Journal of telemedicine and telecare</jtitle><addtitle>J Telemed Telecare</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>27</volume><issue>8</issue><spage>518</spage><epage>526</epage><pages>518-526</pages><issn>1357-633X</issn><eissn>1758-1109</eissn><abstract>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.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>31903840</pmid><doi>10.1177/1357633X19896667</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0558-4191</orcidid><orcidid>https://orcid.org/0000-0003-0497-5828</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Antibiotics Emergency Service, Hospital Female Guideline Adherence Hospital Mortality Humans Male Prospective Studies Rural areas Sepsis Sepsis - therapy Telemedicine |
| title | Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments |
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