Critical Care Excellence in Sepsis and Trauma (CREST)
The care of patients with sepsis and trauma requires the delivery of appropriate definitive care in the early stages of the illness. Hospitals with limited resources, those in rural and underserved areas of South Carolina, may be unable to consistently provide optimal care to these patients. In addition, the shortage of specialists nationally makes it more difficult for these hospitals to recruit and retain the specialists needed. Patients in these areas continue to pay the rural penalty of poorer outcomes. This study provides specialists' level care through telemedicine consults to rural emergency departments in rural areas of SC to improve outcomes for these patients.
The CREST study is a project that specifically addresses the need to bring health care to rural communities in SC, as well as evaluates methods and tests technology to implement this care in rural communities. The CREST study uses telemedicine remotely from MUSC to rural community hospitals to provide rural community physicians care from specialists for trauma and sepsis, which are both high acuity, difficult to treat conditions.
CREST is a multi-site trial of telemedicine services to meet rural patients' and providers' need for expert evaluation and management of sepsis and trauma. The specific aims of CREST are:
- To test the hypothesis that a telemedicine program including education and clinical consultation between a tertiary care academic medical center and rural, local hospitals will significantly improve key treatment decisions and outcome measures in sepsis and trauma.
- To test the hypothesis that the differences in ISS and time to antibiotics for trauma and sepsis patients exposed to telemedicine intervention and those without the intervention matched on propensity scores are not due to unmeasured confounders.
CREST seeks new solutions to rural health disparities, to advance technology, create and retain jobs and address important research opportunities by combining implementation of a novel, trans disciplinary clinical program with rigorous, mixed methods scientific evaluation including clinical, process, and economic outcome measures. The impact on both science and quality healthcare outcomes is broad and CREST has far reaching implications for addressing rural health disparities for acute, life-threatening illnesses.
|Official Title:||Critical Care Excellence in Sepsis and Trauma|
- Mortality [ Time Frame: Two Years ] [ Designated as safety issue: No ]
-Data from the medical record
- Cost Elements [ Time Frame: Two Years ] [ Designated as safety issue: No ]
- Patient charges and cost (before and after telemedicine)
- Cost of telemedicine
- Total charges per admission
- Hospital billing records
- Staff and consultant time estimates and invoices
- All-payer hospital discharge data set annual staff salary data
- Provider Acceptance and Satisfaction [ Time Frame: Two Years ] [ Designated as safety issue: No ]
- Provider Experience and Ratings
- Reports of use, frequency, type
- Ratings of reliability, expertise, technology
- Personal efficacy
- Overall satisfaction
- Post-project Survey
- Actual use of the system
|Study Start Date:||September 2009|
|Estimated Study Completion Date:||March 2012|
|Estimated Primary Completion Date:||March 2012 (Final data collection date for primary outcome measure)|
|United States, South Carolina|
|Bamberg County Hospital|
|Bamberg, South Carolina, United States, 29003|
|Barnwell County Hospital|
|Barnwell, South Carolina, United States, 29812|
|Medical University of South Carolina|
|Charleston, South Carolina, United States, 29425|
|Williamsburg Regional Medical Center|
|Kingstree, South Carolina, United States, 29556|
|Regional Medical Center of Orangeburg|
|Orangeburg, South Carolina, United States, 29118|
|Principal Investigator:||Dee W Ford, MD||Medical University of South Carolina|
|Principal Investigator:||Samir M. Fakhry, MD||Medical University of South Carolina|