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

Abstract

Sepsis is a life-threatening infection that affects over 1.7 million Americans annually. Low-volume rural hospitals have worse sepsis outcomes, and emergency department (ED)-based telemedicine (tele-ED) has been one promising strategy for improving rural sepsis care. The objective of this study is to evaluate the impact of tele-ED consultation on sepsis care and outcomes in rural ED patients. The TELEvISED study is a multicenter (n = 25) retrospective propensity-matched comparative effectiveness study of tele-ED care for rural sepsis patients in a mature tele-ED network. Telemedicine-exposed patients will be matched with non telemedicine patients using a propensity score to predict tele-ED use. The primary outcome is 28-day hospital free days, and secondary outcomes include adherence with guidelines, mortality and organ failure. ClinicalTrials.gov: NCT04441944.

Keywords: emergency service; hospital; hospitals; rural; sepsis; telemedicine.

Conflict of interest statement

Financial & competing interests disclosure

This study is supported by the Agency for Healthcare Research and Quality (K08HS025753), 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 NIH (UL1TR002537), and the Rural Telehealth Research Center through a grant from the Federal Office of Rural Health Policy, Health Resources and Services Administration (U1CRH29074). These contents are solely the responsibility of the authors and do not necessarily reflect the views of the Agency for Healthcare Research and Quality, and National Institutes of Health, or the Federal Office of Rural Health Policy. LJM, AB, and KD declare that they are employed by Avera eCARE, an organization that provides tele-ED services to rural hospitals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1.. Case selection definition.

(A) First, discharge diagnosis will be screened for sepsis discharge codes. (B) Then the ED electronic medical record will be examined for appropriate clinical criteria to determine the analytic dataset. ED: Emergency department.

Figure 2.. Standardized nurse screening for sepsis for all patients during emergency department triage (prior to telemedicine activation).

ED: Emergency department.

Figure 3.. Causal model.

The relationship between telemedicine use and clinical outcomes in rural sepsis patients is complicated and acts through multiple pathways. In addition, patient factors, provider factors and hospital factors confound the causal model.

Figure 4.. Sample size estimate.

An estimated 234 pairs of propensity-matched cases are required to detect a 10% difference in 28-day hospital-free days with 80% power.