Closing Gaps in Rural Care

December 3, 2015

Patients should be able to receive the same level of care, no matter where they live. Implementing new ways for clinicians to respond to time-sensitive critical care conditions, such as sepsis, across a hospital system can be tough-especially in rural hospitals.

They have varying levels of resources and in some areas fewer physicians, nurses, and staff with emergency medicine specialty training. This creates variability in care throughout many hospital systems. It's something OSF HealthCare wants to eliminate.

We are excited to be part of a dedicated team (Drs. John Vozenilek, William Tillis, Lisa Barker, and Andrew Vincent) working on a research project with local OSF emergency department leaders that could improve care at their sites, and help us close inconsistencies across all hospital settings. The Agency for Healthcare Research and Quality has awarded Northwestern University and Jump/OSF HealthCare a three-year, $750,000 grant.

The funding will help us evaluate whether in situ simulation can be used to integrate telehealth in rural hospitals to improve critical care outcomes. In this instance, we'll be focusing on the treatment of severe sepsis and septic shock, an overwhelming body infection that can quickly become life threatening.

Sepsis affects more than one-million Americans each year, and costs the hospital industry upwards of $54-billion to treat. Septic Shock has a fatality rate of up to 30%, but early recognition and treatment can reduce mortality and morbidity greatly.

Bundles of Care

OSF HealthCare has implemented the use of early warning systems and evidence-based care processes to identify and treat patients with sepsis. These processes, or "bundles of care," are prescribed steps for how emergency departments should treat the malady in the first three to six hours of diagnosis. The Institute for Healthcare Improvement and Surviving Sepsis Campaign have endorsed these bundles of care.

OSF wants to ensure accurate application of these bundles in rural emergency departments by using telemedicine. The idea is for rural clinicians to consult with specially trained critical care medical staff over videoconferencing as they treat patients presenting with sepsis. Transitions of care to the ICU may also be improved.

It sounds easy in theory, but in reality it's difficult to execute new technology like telehealth in rural EDs. This can be due to constant changes in patient volume, types of conditions, and the variability in clinician expertise with the new technology and staffing. We're asking medical personnel to change their workflow for the benefit of patients. This is where we hope simulation will be valuable.

Utilizing In Situ Simulation in Rural Hospitals

Jump, University of Illinois College of Medicine at Peoria, and Northwestern University faculty and simulation specialists will use in situ simulation to train doctors and nurses in rural EDs to use telehealth to support the implementation of these sepsis bundles. This way, clinicians get the practice they need using this technology in their own environments before using it in real practice.

This research will evaluate the impact of in situ simulation on telehealth and acute sepsis bundle implementation. It will also measure how many lives are saved after using simulation to integrate telehealth technology into the practice of ED sepsis care.

If we can validate the use of simulation to incorporate new technologies to improve care, we can use this idea to target other time-sensitive critical conditions like stroke, acute heart conditions, pediatric critical care, and trauma.

These findings could improve patient safety in the country's many rural emergency departments.

Featured Author

Emilie_Powell.jpgEmilie Powell, MD MS MBA is an Emergency Physician and Health Services Researcher in the Department of Emergency Medicine and Center for Healthcare Studies at Northwestern University. She has collaborated with faculty members within OSF Healthcare and Jump for over five years with a focus on improving the efficiency of sepsis care delivery.


Bond_William.jpgWilliam Bond, MD is the Director of Simulation Research at Jump and is instrumental in shaping the research agenda. Dr. Bond is committed to many areas of patient safety, improving health care for professionals and supporting the structure of the work surrounding simulation at Jump.
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