{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T18:14:25Z","timestamp":1783707265979,"version":"3.55.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["K08HS025753"],"award-info":[{"award-number":["K08HS025753"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR002537"],"award-info":[{"award-number":["UL1TR002537"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["U3GRH40003"],"award-info":[{"award-number":["U3GRH40003"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The objective of this study was to assess whether interhospital transfer delays completion of the Surviving Sepsis Campaign (SSC) 3-hour bundle among rural sepsis patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter (n\u2009=\u200923) cohort study among adult rural sepsis patients in an ED-based telemedicine network between August 2016 and June 2019. The primary exposure was interhospital transfer and the primary outcome was completion of the SSC 3-hour bundle. Secondary outcomes included SSC component adherence, ED length-of-stay, and in-hospital mortality. We used a Cox proportional hazards model to evaluate time to bundle completion by transfer status, generalized linear models for dichotomous outcomes, and linear and quantile regression for ED length-of-stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1,191 patients were treated in participating hospitals, with 359 (30%) undergoing interhospital transfer. SSC bundle adherence was similar in both groups (difference 2.2%; 95% confidence interval [CI]: \u2013 2.2, 6.5%). Among eligible patients, transfer was associated with a longer ED length-of-stay (3.1 hours vs 2.6 hours; difference 0.6 hours; 95%CI: 0.4, 0.7).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351133","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:26:18Z","timestamp":1783704378000},"page":"e0351133","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The association between interhospital transfer and sepsis guideline adherence among rural emergency department patients"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7340-9421","authenticated-orcid":true,"given":"Cole","family":"Wymore","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliezer","family":"Santos Le\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Vakkalanka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uche","family":"Okoro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9482-8447","authenticated-orcid":true,"given":"Karisa K.","family":"Harland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"Fuller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalyn","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan B.","family":"Swanson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Faine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Zepeski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edith A.","family":"Parker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke J.","family":"Mack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"DeJong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Mueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Chrischilles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher R.","family":"Carpenter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelli","family":"Wallace","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia M.","family":"Ward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas M.","family":"Mohr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"issue":"13","key":"pone.0351133.ref001","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1001\/jama.2017.13836","article-title":"Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014","volume":"318","author":"C Rhee","year":"2017","journal-title":"JAMA"},{"issue":"19","key":"pone.0351133.ref002","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1056\/NEJMoa010307","article-title":"Early goal-directed therapy in the treatment of severe sepsis and septic shock","volume":"345","author":"E Rivers","year":"2001","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0351133.ref003","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1378\/chest.10-1405","article-title":"Point: adherence to early goal-directed therapy: does it really matter? Yes. After a decade, the scientific proof speaks for itself","volume":"138","author":"EP Rivers","year":"2010","journal-title":"Chest"},{"issue":"3","key":"pone.0351133.ref004","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s00134-017-4683-6","article-title":"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016","volume":"43","author":"A Rhodes","year":"2017","journal-title":"Intensive Care Med"},{"issue":"2","key":"pone.0351133.ref005","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.jen.2010.07.022","article-title":"Early recognition of sepsis in the emergency department: an evidence-based project","volume":"38","author":"N Kent","year":"2012","journal-title":"J Emerg Nurs"},{"issue":"4","key":"pone.0351133.ref006","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1097\/CCM.0b013e3181cc4824","article-title":"Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department","volume":"38","author":"DF Gaieski","year":"2010","journal-title":"Crit Care Med"},{"issue":"6","key":"pone.0351133.ref007","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1097\/01.CCM.0000217961.75225.E9","article-title":"Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock","volume":"34","author":"A Kumar","year":"2006","journal-title":"Crit Care Med"},{"issue":"18","key":"pone.0351133.ref008","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1056\/NEJMoa1401602","article-title":"A randomized trial of protocol-based care for early septic shock","volume":"370","author":"ProCESS Investigators","year":"2014","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0351133.ref009","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1097\/CCM.0000000000000026","article-title":"Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*","volume":"42","author":"EK Stevenson","year":"2014","journal-title":"Crit Care Med"},{"key":"pone.0351133.ref010","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.jcrc.2020.07.027","article-title":"Timeline of sepsis bundle component completion and its association with septic shock outcomes","volume":"60","author":"B Hu","year":"2020","journal-title":"J Crit Care"},{"issue":"5","key":"pone.0351133.ref011","doi-asserted-by":"crossref","DOI":"10.1016\/j.annemergmed.2014.06.008","article-title":"Emergency department hospitalization volume and mortality in the United States","volume":"64","author":"KE Kocher","year":"2014","journal-title":"Ann Emerg Med"},{"key":"pone.0351133.ref012","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.jcrc.2016.07.016","article-title":"Inter-hospital transfer is associated with increased mortality and costs in severe sepsis and septic shock: An instrumental variables approach","volume":"36","author":"NM Mohr","year":"2016","journal-title":"J Crit Care"},{"key":"pone.0351133.ref013","unstructured":"Bureau UC. 2010 Census Urban and Rural Classification and Urban Area Criteria. 2010. https:\/\/www.census.gov\/programs-surveys\/geography\/guidance\/geo-areas\/urban-rural\/2010-urban-rural.html"},{"issue":"6","key":"pone.0351133.ref014","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1164\/rccm.201402-0289OC","article-title":"The relationship between hospital volume and mortality in severe sepsis","volume":"190","author":"DF Gaieski","year":"2014","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"pone.0351133.ref015","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1378\/chest.14-2195","article-title":"The Volume-Outcome Relationship in Critical Care: A Systematic Review and Meta-analysis","volume":"148","author":"Y-L Nguyen","year":"2015","journal-title":"Chest"},{"issue":"2","key":"pone.0351133.ref016","doi-asserted-by":"crossref","first-page":"186","DOI":"10.5811\/westjem.2012.8.12783","article-title":"Board-certified emergency physicians comprise a minority of the emergency department workforce in iowa","volume":"14","author":"H Groth","year":"2013","journal-title":"West J Emerg Med"},{"issue":"11","key":"pone.0351133.ref017","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1097\/CCM.0b013e3181f3e09c","article-title":"Volume of emergency department admissions for sepsis is related to inpatient mortality: results of a nationwide cross-sectional analysis","volume":"38","author":"ES Powell","year":"2010","journal-title":"Crit Care Med"},{"issue":"12","key":"pone.0351133.ref018","doi-asserted-by":"crossref","first-page":"2589","DOI":"10.1097\/CCM.0000000000001301","article-title":"Interhospital Transfer Delays Appropriate Treatment for Patients With Severe Sepsis and Septic Shock: A Retrospective Cohort Study","volume":"43","author":"BA Faine","year":"2015","journal-title":"Crit Care Med"},{"issue":"4","key":"pone.0351133.ref019","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1111\/jrh.12339","article-title":"Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States","volume":"35","author":"MB Greenwood-Ericksen","year":"2019","journal-title":"J Rural Health"},{"issue":"2","key":"pone.0351133.ref020","doi-asserted-by":"crossref","first-page":"77","DOI":"10.2217\/cer-2020-0141","article-title":"TELEmedicine as an intervention for sepsis in emergency departments: a multicenter, comparative effectiveness study (TELEvISED Study)","volume":"10","author":"NM Mohr","year":"2021","journal-title":"J Comp Eff Res"},{"issue":"1","key":"pone.0351133.ref021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.annemergmed.2022.07.024","article-title":"Outcomes Associated With Rural Emergency Department Provider-to-Provider Telehealth for Sepsis Care: A Multicenter Cohort Study","volume":"81","author":"NM Mohr","year":"2023","journal-title":"Ann Emerg Med"},{"issue":"3","key":"pone.0351133.ref022","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.annemergmed.2014.03.025","article-title":"Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies","volume":"64","author":"AH Kaji","year":"2014","journal-title":"Ann Emerg Med"},{"key":"pone.0351133.ref023","unstructured":"Defining Rural Population. HRSA. https:\/\/www.hrsa.gov\/rural-health\/about-us\/what-is-rural"},{"key":"pone.0351133.ref024","article-title":"TIDieR-PHP: a reporting guideline for population health and policy interventions","volume":"361","author":"M Campbell","year":"2018","journal-title":"BMJ"},{"issue":"9596","key":"pone.0351133.ref025","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"E von Elm","year":"2007","journal-title":"Lancet"},{"issue":"6","key":"pone.0351133.ref026","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1378\/chest.101.6.1644","article-title":"Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis","volume":"101","author":"RC Bone","year":"1992","journal-title":"Chest"},{"issue":"339","key":"pone.0351133.ref027","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1080\/01621459.1972.10481279","article-title":"Constructing Confidence Sets Using Rank Statistics","volume":"67","author":"DF Bauer","year":"1972","journal-title":"Journal of the American Statistical Association"},{"issue":"4","key":"pone.0351133.ref028","doi-asserted-by":"crossref","DOI":"10.1214\/aos\/1176345976","article-title":"Cox\u2019s Regression Model for Counting Processes: A Large Sample Study","volume":"10","author":"PK Andersen","year":"1982","journal-title":"Ann Statist"},{"key":"pone.0351133.ref029","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4757-3294-8","volume-title":"Modeling survival data: extending the cox model","author":"TM Therneau","year":"2000"},{"key":"pone.0351133.ref030","volume-title":"An Introduction to Generalized Linear Models","author":"AJ Dobson","year":"2002","edition":"2"},{"key":"pone.0351133.ref031","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4899-3242-6","volume-title":"Generalized Linear Models","author":"P McCullagh","year":"1989"},{"key":"pone.0351133.ref032","unstructured":"Heinze G, Ploner M, Dunkler D, Southworth H, Jiricka L, Steiner G. logistf: Firth\u2019s Bias-Reduced Logistic Regression. 2023. https:\/\/cran.r-project.org\/web\/packages\/logistf\/index.html"},{"issue":"1","key":"pone.0351133.ref033","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1093\/biomet\/80.1.27","article-title":"Bias reduction of maximum likelihood estimates","volume":"80","author":"D Firth","year":"1993","journal-title":"Biometrika"},{"issue":"16","key":"pone.0351133.ref034","doi-asserted-by":"crossref","first-page":"2409","DOI":"10.1002\/sim.1047","article-title":"A solution to the problem of separation in logistic regression","volume":"21","author":"G Heinze","year":"2002","journal-title":"Stat Med"},{"issue":"1","key":"pone.0351133.ref035","doi-asserted-by":"crossref","first-page":"33","DOI":"10.2307\/1913643","article-title":"Regression quantiles","volume":"46","author":"R Koenker","year":"1978","journal-title":"Econometrica"},{"issue":"2","key":"pone.0351133.ref036","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00134-012-2769-8","article-title":"Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012","volume":"39","author":"RP Dellinger","year":"2013","journal-title":"Intensive Care Med"},{"issue":"4","key":"pone.0351133.ref037","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1097\/CCM.0000000000002254","article-title":"Case Volume-Outcomes Associations Among Patients With Severe Sepsis Who Underwent Interhospital Transfer","volume":"45","author":"UR Ofoma","year":"2017","journal-title":"Crit Care Med"},{"issue":"1","key":"pone.0351133.ref038","doi-asserted-by":"crossref","first-page":"36","DOI":"10.2310\/8000.2011.110610","article-title":"Canadian Association of Emergency Physicians sepsis treatment checklist: optimizing sepsis care in Canadian emergency departments","volume":"14","author":"D Djogovic","year":"2012","journal-title":"CJEM"},{"issue":"11","key":"pone.0351133.ref039","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"L Evans","year":"2021","journal-title":"Intensive Care Med"},{"issue":"1","key":"pone.0351133.ref040","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1378\/chest.08-2706","article-title":"The importance of fluid management in acute lung injury secondary to septic shock","volume":"136","author":"CV Murphy","year":"2009","journal-title":"Chest"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351133","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:26:25Z","timestamp":1783704385000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351133"}},"subtitle":[],"editor":[{"given":"Ramya","family":"Iyadurai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":40,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0351133","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]}}}