Jump Simulation in partnership with Northwestern University have completed a three-year study on whether in situ simulation can influence the willingness of rural emergency departments to adopt the use of telehealth to improve critical care outcomes.
In this instance, the research staff focused on the treatment of severe sepsis and septic shock, an overwhelming body infection that can quickly become life threatening. The Agency for HealthCare Research and Quality awarded OSF HealthCare and Northwestern $750,000 for this effort.
Sepsis represents a significant health care challenge, affecting 1.7 million Americans each year, and costing the hospital industry upwards of $27 billion to treat.
Rural emergency departments (EDs) in particular face resource constraints, monitoring challenges and transfer decisions unique to their settings. This is where telehealth monitoring can assist in the care of sepsis patients presenting to EDs, regardless of location.
In mid-2012, OSF HealthCare rolled out OSF ConstantCare or the eICU, a telehealth hub that provides an extra set of eyes for physicians and nurses taking care of patients with intensive care needs across the organization.
As part of the study, Jump used in situ or on-site simulation to introduce two rural ED teams to the eICU as a resource for treating patients with severe sepsis and septic shock. The idea was to give clinicians the practice they need with telemedicine in their own environments, and eventually adopt it as a daily practice.
Two rural ED teams (Site A and B) were trained to use the eICU in the treatment of patients with severe sepsis and septic shock through in situ simulation. Jump conducted simulations in a 3-Act-3-Debrief 60-minute format that interspersed training in telehealth use, debrief/discussion of barriers and facilitating factors and review of sepsis care. Site A received an additional refresher simulation.
The sample size goal was 80% nurse participation. Readiness to adopt telehealth technology was evaluated at each time point by six questions around improving quality of care, feasibility, role clarity, ease of use, resources and receptiveness to use.
Enrollment targets were met for participation at both rural sites. Survey results revealed staff "readiness to adopt telehealth" from pre to post simulation. Confidence in managing sepsis and using telehealth also rose.
Qualitative analysis of staff interviews conducted a few months after the in situ simulations are currently being analyzed. A chart review of patients who presented to both EDs with sepsis one year before and one year after the trainings was also conducted to assess if telehealth use impacted sepsis outcomes. Those results will be presented in the future.
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