Telemedicine Helps Sepsis Care

It has been shown that sepsis patients in rural low-volume hospitals have worse outcomes than patients treated at high volume hospitals and inter-hospital transfers to high volume centers does not change this disparity.

Much of this mortality gap treating sepsis has been associated with low ED volume, poor adherence with sepsis care guidelines in low volume hospitals, rural staff does not always have the training and experience to recognize a challenging diagnosis, and there can be frequent staff turnover.

Rural Telehealth Research Center’s Research and Policy brief titled “Improving Access to High Quality Sepsis Care in a South Dakota Emergency Network” published August 2017 was supported by grant funding by the Federal Office of Rural Health Policy within HRSA.

The lead researchers Nicholas Mohr MD and Marcia M. Ward PhD, set out to explore whether the use of real time access to sepsis experts as part of an ED-based telemedicine network can decrease the overall variation in care and improve clinical outcomes.

The study set out to examine if telemedicine could be used to promote adherence by monitoring guideline adherence and providing real-time prompts to bedside clinicians who might otherwise be occupied with competing demands.

To provide critical data, Avera Health www.avera.org, a regional health system based in Sioux Falls, South Dakota, implemented a pilot program to study the use of telemedicine for ED patients with sepsis in critical access hospitals that participate in Avera’s eCARE telemedicine network. Avera Health, serves as the hub for 140 hospital ED-based network spanning 12 states.

Avera Health’s first goal was to increase telemedicine use to improve sepsis care, but the secondary objective was to measure the effect of telemedicine consultation on sepsis care quality and clinical outcomes. The pilot study showed that the use of a multi-pronged approach of nurse-directed screening, consultations and real time decision support did show improvement in screening for sepsis.

The pilot study also showed that despite aggressive marketing and education, follow-up consultations on suspected sepsis cases are still on the relatively low side. This could be related to the fact that many clinicians feel very comfortable managing patients with severe infections, and felt that telemedicine consultations would add little value.

Another relevant finding concerns the low availability of sepsis screening laboratory tests in rural hospitals. Serum lactate measurement was available in only 72 percent of rural critical access hospitals in Avera’s primary service area.

In addition, the study showed that sepsis treatment via telemedicine continues to suffer from alarm fatigue and it was found that clinicians see little value in telemedicine involvement for patients at low risk of sepsis, and therefore, these clinicians can miss qualifying patients.

In conclusion, increasing telemedicine utilization for sepsis requires a multi-pronged approach to successfully increase telemedicine utilization. Future research will focus on the impact of telemedicine utilization on clinical outcomes of sepsis treatment and on barriers to more widespread telemedicine adoption to treat sepsis.

Go to www.ruraltelehealth.org/publications.php or email Nicholas Mohr MD at the rural Telehealth Research Center at nicholas-mohr@uiowa.edu.

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