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Critical Care Excellence in Sepsis and Trauma - CREST

C R E S T. Critical Care Excellence in Sepsis and Trauma - CREST. NIH Challenge Grant from the National Institute of Health’s Center for Minority Health and Disparities. C R E S T. CREST Personnel. Principal Investigators: Dee W. Ford, MD, MSCR Samir M. Fakhry, MD Co-investigators:

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Critical Care Excellence in Sepsis and Trauma - CREST

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  1. C R E S T Critical Care Excellence in Sepsis and Trauma - CREST NIH Challenge Grant from the National Institute of Health’s Center for Minority Health and Disparities

  2. C R E S T CREST Personnel Principal Investigators: • Dee W. Ford, MD, MSCR • Samir M. Fakhry, MD Co-investigators: • Jane Zapka, ScD • Kit Simpson, PhD • Anbesaw Selassie, DrPh Program Coordinator • Laura Langston

  3. CREST Rationale • Intensivists improve outcomes • There is a national shortage of intensivists • Small, rural communities lack resources and economies of scale • Proprietary, full-service tele-ICU’s are costly

  4. CREST Rationale • Is there a technologic middle-ground to selectively leverage MUSC’s critical care expertise into rural, local hospitals when it is clinically most imperative? • The “golden hours”…

  5. CREST Hypothesis 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.

  6. C R E S T CREST Research Design • Quasi-experimental pre/post intervention • Propensity score matched controls • Multivariable regression modeling accounting for clustering

  7. Patient in Spoke ED MUSC=hub Hub MD + laptop Hub-and-Spoke Model

  8. CREST Telemedicine Platform

  9. C R E S T Hospital Selection • Four sites enrolled • Medically underserved counties • USDA designated rural counties • First site: Orangeburg Regional Medical Center • Education roll out complete • Consults beginning soon

  10. Lessons Learned (so far) • Institutional • Technological • Research

  11. Lessons Learned • Institutional • Low resource hospitals have few resources • Everything takes more time than anticipated • Arrange 1st visit, MOA, credentialing, etc. • Internal procedures • Patients are hospitals’ economic basis • Concern over loosing patients to larger center • Communication is essential • Local champion is invaluable

  12. Lessons Learned • Technological • There is always something with IT • Stipulate in the contract key details • Timelines • Deliverables • Contingency plans • Technical dry runs and more dry runs

  13. Lessons Learned • Research • Different perspectives – research project versus educational and clinical program • Federal Wide Assurance (FWA) – you gotta’ have one • Training onsite staff is challenging

  14. CREST Pre-implementation Research Products • Organizational assessment tools • Domains • evidence assessment • clinical experience • hospital characteristics • program champion • culture/climate • perceived ease of use • usefulness • change readiness • change efficacy • style • leadership

  15. CREST Pre-implementation Research Products • Key informant interviews • Orangeburg: n=8 • Bamberg: n=4 • Barnwell: n=6 • Williamsburg: n=5 • CME/CE (thus far only at Orangeburg) • Sepsis CE credit given to: 21 • Sepsis CME credit given to: 14 • Trauma CE credit given to: 23 • Trauma CME credit given to: 11

  16. Summary • Substantial pre-research effort is necessary • Distinct from conventional clinical trials • Unique scientific skills required • Effectiveness versus efficacy

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