The association between interhospital transfer and sepsis guideline adherence among rural emergency department patients

Abstract

Introduction The objective of this study was to assess whether interhospital transfer delays completion of the Surviving Sepsis Campaign (SSC) 3-hour bundle among rural sepsis patients. Methods We conducted a multicenter (n = 23) cohort study among adult rural sepsis patients in an ED-based telemedicine network between August 2016 and June 2019. The primary exposure was interhospital transfer and the primary outcome was completion of the SSC 3-hour bundle. Secondary outcomes included SSC component adherence, ED length-of-stay, and in-hospital mortality. We used a Cox proportional hazards model to evaluate time to bundle completion by transfer status, generalized linear models for dichotomous outcomes, and linear and quantile regression for ED length-of-stay. Results A total of 1,191 patients were treated in participating hospitals, with 359 (30%) undergoing interhospital transfer. SSC bundle adherence was similar in both groups (difference 2.2%; 95% confidence interval [CI]: – 2.2, 6.5%). Among eligible patients, transfer was associated with a longer ED length-of-stay (3.1 hours vs 2.6 hours; difference 0.6 hours; 95%CI: 0.4, 0.7).