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.

AB and KD are both employed by an organization that provides rural emergency care services. All other authors declare no conflicts of interest.

This work was supported by a grant from the Agency for Healthcare Research and Quality (AHRQ, K08 HS025753). Dr. Mohr is additionally supported by funding from the Rural Telehealth Research Center, which is supported by the Office for the Advancement of Telehealth, Health Resources and Services Administration (HRSA, U3GRH40003). The views expressed in this publication are solely those of the authors and do not reflect the official views of AHRQ, HRSA, or the U.S. Government.

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The University of Iowa Institutional Review Board IRB-001 gave ethical approval for this work.

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