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. 2025 Apr 23;20(4):e0321299.
doi: 10.1371/journal.pone.0321299. eCollection 2025.

The role of telehealth in sepsis care in rural emergency departments: A qualitative study of emergency department sepsis telehealth user perspectives

Nicholas M Mohr  1   2   3 , Kimberly A S Merchant  4 , Brian M Fuller  5 , Brett Faine  1   6 , Luke Mack  7 , Amanda Bell  8 , Katie DeJong  8 , Edith A Parker  9 , Keith Mueller  4 , Elizabeth Chrischilles  3 , Christopher R Carpenter  10 , Michael P Jones  11 , Steven Q Simpson  12 , Marcia M Ward  4
Affiliations

The role of telehealth in sepsis care in rural emergency departments: A qualitative study of emergency department sepsis telehealth user perspectives

Nicholas M Mohr et al. PLoS One. .

Abstract

Purpose: Sepsis is a leading cause of hospitalization and death in the United States, and rural patients are at particularly high risk. Telehealth has been proposed as one strategy to narrow rural-urban disparities. The objective of this study was to understand why rural emergency department (ED) staff use provider-to-provider telehealth (tele-ED) and how tele-ED care changes the care for rural patients with sepsis.

Methods: We conducted a qualitative interview study between February 15, 2022, and May 22, 2023, with participants from upper Midwest rural EDs and tele-ED hub physicians in a single tele-ED network that delivers provider-to-provider consultation for sepsis patients. One interviewer conducted individual telephone interviews, then we used standard qualitative methods based on modified grounded theory to identify themes and domains.

Findings: We interviewed 27 participants, and from the interviews we identified nine themes within three domains. Participants largely felt tele-ED for sepsis was valuable in their practice. We identified that telehealth was consulted to facilitate interhospital transfer, provide surge capacity for small teams, to adhere with provider scope-of-practice policies, for inexperienced providers, and for patients with increased severity of illness or complex comorbidities. Barriers to tele-ED use and impact included increased sepsis care standardization, provider reluctance, and sepsis diagnostic uncertainty. Additionally, we identified that real-time education and training were important secondary benefits identified from tele-ED use.

Conclusions: Tele-ED care was used by rural providers for sepsis treatment, but many barriers existed that may have limited potential benefits to its use.

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Conflict of interest statement

I have read the journal's policy, and the authors of this manuscript have the following competing interests: AB and KD are both employed by an organization that provides rural emergency care services. All other authors declare no conflicts of interest.

Figures

Fig 1
Fig 1. Themes and domains of qualitative findings.
We identified 9 themes from our qualitative data that grouped into 3 main domains: facilitators and benefits of tele-emergency (tele-ED) use, barriers and factors mitigating clinical benefits of tele-ED use, and other considerations. Within the first 2 categories, we considered themes according to three categories: facility-based, staff-based, and patient-based themes.
See this image and copyright information in PMC

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