Abstract
BACKGROUND: Protocol-based resuscitation strategies in the Emergency Department (ED) improve survival for out-of-hospital cardiac arrest (OHCA) and severe sepsis but implementation has been inconsistent. OBJECTIVE: To determine the feasibility of a real-time provider-to-provider telemedical intervention for the treatment of OHCA and severe sepsis. MATERIALS AND METHODS: A three-center pilot study utilizing a "hub-spoke model" with an academic medical center acting both as the hub for teleconsultation as well as a spoke hospital enrolling patients. Eligible patients were adults presenting with either return of spontaneous circulation (ROSC) following OHCA or with severe sepsis. Telemedical encounters were monitored for quality of interface and patient level data (demographics, physiologic, laboratory, treatment) were abstracted. RESULTS: Over a 12-week period, there were 80 text alerts. Of 38 OHCA alerts, 13 achieved ROSC (34.2%), 85% underwent teleconsultation (11/13). Of 42 "lactate ≥4 mmol/L" alerts, 33.3% (14/42) were determined to have severe sepsis and underwent teleconsultation. Mean time from OHCA teleconsultation request to live connection: 3.7 min (95% CI 1.6-5.8); mean call duration: 71.7 min (95% CI 34.6-108.8). Mean time from sepsis teleconsultation request to connection: 8.4 min (95% CI 4.5-12.3); mean call duration: 61.5 min (95% CI 37.2-85.8). DISCUSSION: Telemedicine provides a robust and reliable means of quickly bringing expertise virtually to the bedside at the most proximal point in a patient's hospital care. CONCLUSIONS: Real time ED-based telemedical consultation for patients with ROSC after OHCA or severe sepsis has the potential to improve the dissemination and implementation of evidence-based care.