Mohr Nicholas M, Merchant Kimberly A S, Fuller Brian M, Faine Brett, Mack Luke, Bell Amanda, DeJong Katie, Parker Edith A, Mueller Keith, Chrischilles Elizabeth, Carpenter Christopher R, Jones Michael P, Simpson Steven Q, Ward Marcia M
Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America.
Department of Anesthesia Critical Care, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America.
PLoS One. 2025 Apr 23;20(4):e0321299. doi: 10.1371/journal.pone.0321299. eCollection 2025.
Sepsis is a leading cause of hospitalization and death in the United States, and rural patients are at particularly high risk. Telehealth has been proposed as one strategy to narrow rural-urban disparities. The objective of this study was to understand why rural emergency department (ED) staff use provider-to-provider telehealth (tele-ED) and how tele-ED care changes the care for rural patients with sepsis.
We conducted a qualitative interview study between February 15, 2022, and May 22, 2023, with participants from upper Midwest rural EDs and tele-ED hub physicians in a single tele-ED network that delivers provider-to-provider consultation for sepsis patients. One interviewer conducted individual telephone interviews, then we used standard qualitative methods based on modified grounded theory to identify themes and domains.
We interviewed 27 participants, and from the interviews we identified nine themes within three domains. Participants largely felt tele-ED for sepsis was valuable in their practice. We identified that telehealth was consulted to facilitate interhospital transfer, provide surge capacity for small teams, to adhere with provider scope-of-practice policies, for inexperienced providers, and for patients with increased severity of illness or complex comorbidities. Barriers to tele-ED use and impact included increased sepsis care standardization, provider reluctance, and sepsis diagnostic uncertainty. Additionally, we identified that real-time education and training were important secondary benefits identified from tele-ED use.
Tele-ED care was used by rural providers for sepsis treatment, but many barriers existed that may have limited potential benefits to its use.
脓毒症是美国住院和死亡的主要原因，农村患者面临的风险尤其高。远程医疗已被提议作为缩小城乡差距的一种策略。本研究的目的是了解农村急诊科（ED）工作人员为何使用提供者对提供者的远程医疗（远程急诊）以及远程急诊护理如何改变对农村脓毒症患者的护理。
我们在2022年2月15日至2023年5月22日期间进行了一项定性访谈研究，参与者来自中西部上游农村急诊科以及一个为脓毒症患者提供提供者对提供者咨询的单一远程急诊网络中的远程急诊中心医生。一名访谈员进行了个人电话访谈，然后我们使用基于改良扎根理论的标准定性方法来确定主题和领域。
我们采访了27名参与者，从访谈中我们在三个领域内确定了九个主题。参与者大多认为用于脓毒症的远程急诊在他们的实践中很有价值。我们确定咨询远程医疗是为了促进医院间转运、为小团队提供应急能力、遵守提供者执业范围政策、为经验不足的提供者以及为病情严重程度增加或有复杂合并症的患者提供服务。使用远程急诊的障碍和影响包括脓毒症护理标准化提高、提供者不情愿以及脓毒症诊断不确定性。此外，我们确定实时教育和培训是使用远程急诊所带来的重要次要益处。
农村提供者使用远程急诊护理来治疗脓毒症，但存在许多障碍，这可能限制了其使用的潜在益处。
