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Health Services Research & Development

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HSR&D In Progress

In this issue: Advancing VA Telehealth and Virtual Care
>> Table of Contents

June 2021

Improving Sepsis Outcomes in the VA TeleICU Network

Takeaway: This study will use a novel data source (TeleICU) to identify patient-level factors associated with negative outcomes among Veterans with sepsis, quantify the practices of high- and low-performing VA units, and, subsequently, improve the care provided to septic patients in VA intensive care units.

– the body's overwhelming systemic response to infection – strikes more than one million patients annually in the United States and is known to impact more than 48,000 Veterans every year. Over the past decade, sepsis survival has continued to improve through a better understanding of effective therapies, early intervention, and prophylaxis. This has been seen in the private sector and VA with inpatient mortality dropping from 15% in 2008 to 10% in 2012. Despite this improvement, a patient with sepsis may have up to a 50% increased risk of death at 30 days depending on the hospital to which he/she is admitted within the VA healthcare system.

This ongoing study (July 2020 – June 2024) seeks to characterize and identify patient- and ICU-level factors associated with negative sepsis outcomes. Investigators also will examine sepsis practices at high- and low-performing sites, including documented protocols, clinical workflows, and TeleICU support and consultation, with the goal of identifying future targets for improvement. In addition, study investigators will evaluate the incidence of previously unmonitored management strategies and their impact on outcomes (ICU mortality as primary outcome) in VA patients with sepsis.

Tele-ICU enables off-site clinicians to interact with bedside staff to consult on patient care.

Methodology

As part of this study, investigators will conduct a mixed-methods investigation by merging data from the TeleICU and VA’s Corporate Data Warehouse (CDW) to identify high- and low-performing ICUs in the treatment of sepsis. They will then perform an ethnographic investigation of three high- and three low-performing ICUs. Simultaneously, researchers will use quantitative methods to examine the management of hypotension, the use of lung protective ventilation, and the use and efficacy of antibiotics in septic patients in the ICU.

Findings

No findings to report thus far.

Anticipated Impact

It is expected that dashboards will be developed to provide local clinicians with real-time updates on patients with sepsis in VA intensive care units that provide information regarding the state of septic patients, as well as their compliance with metrics that are associated with improved outcomes. It is anticipated this will improve the overall survival of sepsis patients and potentially reduce cost of care.

Principal Investigators

James Blum, MD, was the Chief of Anesthesiology at the Atlanta VAMC and Director of Analytics for the VA TeleICU program before being named the Chief Medical Information Officer for the University of Iowa in Iowa City, IA. Heather Reisinger, PhD, is a core investigator at HSR&D’s Center for Access & Delivery Research and Evaluation (CADRE), also in Iowa City.

Publications

No publications to report thus far.

View study abstract

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