eICU Sepsis Study

OSF HealthCare and the University of Illinois College of Medicine at Peoria through Jump Simulation are partnering with Northwestern University to evaluate how on-site simulation can be used to integrate telemedicine in rural hospitals to improve critical care outcomes.

In this instance, the team is focusing its efforts on the treatment of severe sepsis and septic shock, an overwhelming infection that can quickly become life threatening. The Agency for HealthCare Research and Quality awarded OSF and Northwestern $750,000 for this effort.

The Background

Sepsis represents a significant health care challenge, affecting more than one-million Americans each year, and costing the hospital industry upwards of $54-billion to treat. Rural emergency departments (EDs) in particular face resource constraints, monitoring challenges and transfer decisions unique to their settings. In response, telemedicine is growing rapidly to help address these challenges, and simulation systems will be called upon to support the adoption of this technology.

Jump Sim initiated a project utilizing on-site simulation to introduce rural emergency department (ED) teams to the OSF electronic intensive care unit (eICU) as a resource for treating patients with severe sepsis and septic shock. The idea is that conducting training through simulation gives clinicians the practice they need with telemedicine technology in their own environments, so they can easily integrate it into their daily practice.

Jump Sim used simulation debriefing to explore the barriers and facilitating factors for the adoption of video telemedicine. 

Methodology

In spring of 2016, Jump Sim staff conducted three days of simulation with 10 ED teams made up of physicians, nurses and other staff at one rural hospital. Learners were first offered pre-training education on sepsis and telemedicine communication.  The participants went through one simulation broken into three acts using a standardized participant and a vital signs generator with debriefs in between.

Act 1 was the assessment of a stable sepsis patient.  Act 2 presented a deteriorating patient and the chance to initiate a telemedicine interaction and establish a video cart connection to the eICU.

Act 3 opened with the eICU alerting the ED team to patient deterioration to septic shock to highlight the added vigilance benefits of the eICU.  Debriefings were recorded without video using a smartphone, de-identified and transcribed.

Jump Sim used a consensus process among the three lead authors to develop a thematic framework for qualitative analysis.

Results

The on-site simulation method of using interrupted “acts” with staged debriefings served as a trigger to bring out discussion of past telemedicine experiences, and reasons for success or failure of those efforts.

Simulation was an excellent catalyst for interprofessional discussion of the adoption of telemedicine into their sepsis treatment process. This includes valuable dialogue on how workflow and communication should proceed.

Themes emerged that can help guide those hoping to introduce telemedicine in the care of septic patients in rural EDs, and may be applicable to other areas of telemedicine introduction.

Jump Sim staff has since provided refresher courses on use of the eICU for sepsis treatment and has also offered these on-site simulations to another rural hospital facility.

Research Stage 3

Phase III Project

More information about the different phases used by Jump Simulation for research projects can be found here.