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.

中文翻译：

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与农村急诊科提供者对提供者的脓毒症护理远程医疗相关的结果：一项多中心队列研究

目的：检验提供者间远程急诊科 (tele-ED) 护理与更多 28 天无住院天数和改善农村急诊科 (EDs) 的脓毒症幸存运动 (SSC) 指南依从性相关的假设. 方法：多中心 (n=23)、倾向匹配、队列研究，使用 2016 年 8 月至 2019 年 6 月期间在中西部上游一个完善的、按需的农村视频远程 ED 网络中来自农村医院的脓毒症患者的医疗记录. 主要结果是 28 天住院天数，次要结果是 28 天住院死亡率和 SSC 指南依从性。结果：共有 1,191 名患者被纳入分析，其中 326 名（27%）使用了远程 ED。Tele-ED 病例更有可能被转移到另一家医院（88% 对 8%，差异 79%，95% CI 75-83%）。在匹配和回归调整后，远程 ED 病例没有更多的 28 天住院天数（非远程 ED 的差异延长 0.80 天，95% 置信区间 [CI] [-0.87]-2.47）或 28-住院日死亡率（调整优势比 [aOR] 1.61, 95% CI 0.74-3.57）。SSC 3 小时捆绑（aOR 0.80, 95% CI 0.24-2.70）和完整捆绑（aOR 0.81, 95% CI 0.15-4.41）的依从性相似。对由高级实践提供者治疗的患者进行的先验定义的亚组分析表明，尽管在完全 SSC 束依从性方面没有显着差异（aOR 2.48, 95% CI 0.45-13.76)。结论：在成熟网络中接受提供者对提供者远程 ED 护理治疗的农村 ED 患者似乎与未接受治疗的患者具有相似的临床结果。