Steven A Ilko1, J Priyanka Vakkalanka1,2, Azeemuddin Ahmed1,3, Karisa K Harland1,2, Nicholas M Mohr1,2,4. 1. Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. 2. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA. 3. Department of Management and Organizations, University of Iowa Tippie College of Business, Iowa City, IA. 4. Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA.
Abstract
OBJECTIVES: Severe sepsis is a complex, resource intensive, and potentially lethal condition and rural patients have worse outcomes than urban patients. Early identification and treatment are important to improving outcomes. The objective of this study was to identify hospital-specific factors associated with inter-hospital transfer. DESIGN: Mixed method study integrating data from a telephone survey and retrospective cohort study of state administrative claims. SETTING AND SUBJECTS: Survey of Iowa emergency department administrators between May 2017 and June 2017 and cohort of adults seen in Iowa emergency departments for severe sepsis and septic shock between January 2005 and December 2013. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Multivariable logistic regression was used to identify independent predictors of inter-hospital transfer. We included 114 institutions that provided data (response rate = 99%), and responses were linked to a total of 150,845 visits for severe sepsis/septic shock. In our adjusted model, having the capability to place central venous catheters or having a subscription to a tele-ICU service was independently associated with lower odds of inter-hospital transfer (adjusted odds ratio, 0.69; 95% CI, 0.54-0.86 and adjusted odds ratio, 0.69; 95% CI, 0.54-0.88, respectively). A facility's participation in a sepsis-specific quality improvement initiative was associated with 62% higher odds of transfer (adjusted odds ratio, 1.62; 95% CI, 1.10-2.39). CONCLUSIONS: The insertion of central venous catheters and access to a critical care physician during sepsis treatment are important capabilities in hospitals that transfer fewer sepsis patients. In the future, hospital-specific capabilities may be used to identify institutions as regional sepsis centers.
OBJECTIVES: Severe sepsis is a complex, resource intensive, and potentially lethal condition and rural patients have worse outcomes than urban patients. Early identification and treatment are important to improving outcomes. The objective of this study was to identify hospital-specific factors associated with inter-hospital transfer. DESIGN: Mixed method study integrating data from a telephone survey and retrospective cohort study of state administrative claims. SETTING AND SUBJECTS: Survey of Iowa emergency department administrators between May 2017 and June 2017 and cohort of adults seen in Iowa emergency departments for severe sepsis and septic shock between January 2005 and December 2013. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Multivariable logistic regression was used to identify independent predictors of inter-hospital transfer. We included 114 institutions that provided data (response rate = 99%), and responses were linked to a total of 150,845 visits for severe sepsis/septic shock. In our adjusted model, having the capability to place central venous catheters or having a subscription to a tele-ICU service was independently associated with lower odds of inter-hospital transfer (adjusted odds ratio, 0.69; 95% CI, 0.54-0.86 and adjusted odds ratio, 0.69; 95% CI, 0.54-0.88, respectively). A facility's participation in a sepsis-specific quality improvement initiative was associated with 62% higher odds of transfer (adjusted odds ratio, 1.62; 95% CI, 1.10-2.39). CONCLUSIONS: The insertion of central venous catheters and access to a critical care physician during sepsis treatment are important capabilities in hospitals that transfer fewer sepsispatients. In the future, hospital-specific capabilities may be used to identify institutions as regional sepsis centers.
Authors: Nicholas M Mohr; Karisa K Harland; Dan M Shane; Azeemuddin Ahmed; Brian M Fuller; James C Torner Journal: J Crit Care Date: 2016-07-26 Impact factor: 3.425
Authors: H Bryant Nguyen; Anja Kathrin Jaehne; Namita Jayaprakash; Matthew W Semler; Sara Hegab; Angel Coz Yataco; Geneva Tatem; Dhafer Salem; Steven Moore; Kamran Boka; Jasreen Kaur Gill; Jayna Gardner-Gray; Jacqueline Pflaum; Juan Pablo Domecq; Gina Hurst; Justin B Belsky; Raymond Fowkes; Ronald B Elkin; Steven Q Simpson; Jay L Falk; Daniel J Singer; Emanuel P Rivers Journal: Crit Care Date: 2016-07-01 Impact factor: 9.097
Authors: Nicholas M Mohr; Karisa K Harland; Uche E Okoro; Brian M Fuller; Kalyn Campbell; Morgan B Swanson; Stephen Q Simpson; Edith A Parker; Luke J Mack; Amanda Bell; Katie DeJong; Brett Faine; Anne Zepeski; Keith Mueller; Elizabeth Chrischilles; Christopher R Carpenter; Michael P Jones; Marcia M Ward Journal: J Comp Eff Res Date: 2021-01-20 Impact factor: 1.744
Authors: Nicholas M Mohr; Kalyn D Campbell; Morgan B Swanson; Fred Ullrich; Kimberly A Merchant; Marcia M Ward Journal: J Telemed Telecare Date: 2020-01-05 Impact factor: 6.344