Longer Total Interhospital Transfer Times for Rural Sepsis Patients Not Associated with Increased Mortality.

Objectives: Sepsis is a time-sensitive condition, and many rural emergency department (ED) sepsis patients are transferred to tertiary hospitals. The objective of this study was to determine whether longer transport times during interhospital transfer are associated with higher sepsis mortality or increased hospital length-of-stay (LOS).

Methods:  A cohort of rural adult (age ≥ 18 y) sepsis patients transferred between hospitals were identified in the TELEmedicine as a Virtual Intervention for Sepsis Care in Emergency Departments (TELEVISED) parent study. We collected data on the time spent between triage and disposition at the rural ED (ED LOS), time from rural ED disposition to arrival at the destination hospital (transport duration), and overall time from rural ED triage to arrival at the destination hospital (total transfer time). We used a zero inflated negative binomial model with log link for the primary outcome (28-day hospital-free days), and a logit model for secondary outcomes of Surviving Sepsis Campaign (SSC) bundle adherence and in-hospital mortality. We included clinical and demographic covariates in model development.

Results:  We included 359 transferred rural sepsis patients. There was no association between ED LOS (aRR: 1.00; 95% CI: 0.98-1.02), transport duration (aRR: 1.03; 95% CI: 0.99-1.07), or total transfer time (aRR: 1.01; 95% CI: 0.99-1.03) and 28-day hospital free days. Similarly, we found no association between ED LOS, transport duration, and total transfer time with secondary outcomes.

Conclusions:  Longer total transfer time showed no association with 28-day hospital free days in rural sepsis patients. Future work will seek to better understand how rural ED sepsis care can be optimized to maximize outcomes in transferred patients.