LAUSR

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.