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.

This study was funded by the Agency for Healthcare Research and Quality (K08HS025753) and the Institute for Clinical and Translational Science at the University of Iowa through a grant from the National Center for Advancing Translational Sciences at the National Institutes of Health (UL1TR002537). Dr. Mohr is additionally supported by funding from the Rural Telehealth Research Center with funding from the Health Resources and Services Administration (UICRH29074). LM, AB, and KD are employed by an organization that provides commercial telemedicine services. These contents are solely the responsibility of the authors and do not necessarily reflect the views of the Agency for Healthcare Research and Quality.

https://doi.org/10.2217/cer-2020-0141

This study was funded by the Agency for Healthcare Research and Quality (K08HS025753) and the Institute for Clinical and Translational Science at the University of Iowa through a grant from the National Center for Advancing Translational Sciences at the National Institutes of Health (UL1TR002537). Dr. Mohr is additionally supported by funding from the Rural Telehealth Research Center with funding from the Health Resources and Services Administration (UICRH29074). These contents are solely the responsibility of the authors and do not necessarily reflect the views of the Agency for Healthcare Research and Quality.

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