No. 34680 (Amendment): Rule R426-5. Statewide Trauma System Standards

(Amendment)

DAR File No.: 34680
Filed: 04/12/2011 01:27:32 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to simplify and reduce the duplication of resources required of hospitals seeking designation as a trauma center.

Summary of the rule or change:

The rule change eliminates duplication in the present rule which requires a state site designation team for American College of Surgeons (ACS) Verified Trauma Centers and reduces the burden of reporting required for trauma centers already verified by the ACS.

State statutory or constitutional authorization for this rule:

• Section 26-8a-252

Anticipated cost or savings to:

the state budget:

There will be $6,000 savings per year by eliminating the expense of two surveyors for ACS-verified trauma centers.

local governments:

No hospitals currently designated at Trauma Centers by the Department are owned by local government entities.

small businesses:

There are no acute care hospitals in Utah employing fewer than 30 employees.

persons other than small businesses, businesses, or local governmental entities:

There will be $1,000 savings per year by eliminating the need to file duplicate/separate applications for trauma center designation in Level I and Level II trauma centers.

Compliance costs for affected persons:

Cost savings of up to $1,000 per year are expected for any person affected by this rule change. No compliance burden is expected.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule change will reduce the fees paid by hospitals voluntarily seeking a trauma center designation as well as the reporting requirement, while still protecting the public

W. David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Systems Improvement, Emergency Medical Services
3760 S HIGHLAND DR
SALT LAKE CITY, UT 84106

Direct questions regarding this rule to:

• Guy Dansie at the above address, by phone at 801-273-6671, by FAX at 801-273-4165, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

05/31/2011

This rule may become effective on:

06/07/2011

Authorized by:

W. David Patton, Executive Director

RULE TEXT

R426. Health, Health Systems Improvement, Emergency Medical Services.

R426-5. Statewide Trauma System Standards.

R426-5-6. Trauma Center Designation Process.

(1) [Hospitals wishing designation recognition shall complete a Department application as outlined in R426-5-7.

(2) The Department shall, upon receipt of the completed application and appropriate fees, verify compliance to the designation level sought in accordance with protocols established by the department.

(3) Trauma centers shall be designated for a period of three years unless the designation is rescinded by the Department for non-compliance to standards set forth in R426-5-7.

(4) The Department shall disseminate a list of designated trauma centers to all Utah hospitals, and state EMS agencies, and as appropriate, to hospitals in nearby states which refer patients to Utah hospitals.

 

R426-5-7. Trauma Center Verification Process.

(1)] Hospitals seeking voluntary designation and [All]all designated Trauma Centers desiring to remain designated, shall apply for [verification]designation by submitting the following information to the Department at least [six months]30 days prior to the [anniversary date of initial designation]date of the scheduled site visit:

(a) A completed and signed application and appropriate fees for trauma center verification;

(b) A letter from the hospital administrator of continued commitment to comply with current trauma center designation standards as applicable to the applicant's designation level;

(c) The data specified under R426-5-8 are current;

(d) [The minutes of pertinent hospital committee meetings for the previous year as specified by the Trauma Review Subcommittee, for example, trauma conferences, surgical morbidity and mortality meetings, emergency department or trauma death audits]Level I and Level II Trauma Centers must submit a copy of the Pre-review Questionnaire (PRQ) from the American College of Surgeons in lieu of the application in 1a above.

(e) [A brief narrative report of trauma outreach education activities for the previous year]Level III Level IV and Level V trauma centers must submit a complete Department approved application[;].

[ (f) A brief narrative report of trauma research activities for the previous year including protocols and publications.

] (2) [All trauma centers desiring to apply for verification shall submit the required application and appropriate fees to the Department no later than January 1]Hospitals desiring to be designated as Level I and Level II Trauma Centers must be verified by the American College of Surgeons (ACS) within three (3) months of the expiration date of previous designation and must submit a copy of the full ACS report detailing the results of he ACS site visit. A Department representative must be present during the entire ACS verification visit.[

(3) Upon receipt of a verification application from the Department, accompanied by the information specified under R426-5-7(1)(a) through (f), the Trauma Review Committee shall conduct a review and report the results to the Department.] Hospitals desiring to be Level III, Level IV or Level v Trauma Centers must be designated by hosting a formal site visit by the Department.

[ (4) Every three years, the Level I and II Trauma Centers must submit written documentation detailing the results of an American College of Surgeons site visit.

(5) Every three years from the date of initial designation or from a date specified by the Department, the Trauma Review Subcommittee shall conduct a formal site visit for each designated Level III, IV, or V trauma center and report the results to the Department.

] ([6]3) The Department and [the Trauma Review Committee]its consultants may conduct observation, review and monitoring activities with any designated trauma center to verify compliance with designation requirements[ which may include:].

[ (a) Site visits to observe, unannounced, an actual trauma resuscitation, including the care and treatment of a trauma patient.

(b) Interview or survey prehospital care providers who frequent the trauma center, to ascertain that the pledged level of trauma care commitment is being maintained by the trauma center.

] (4) Trauma centers shall be designated for a period of three years unless he designation is rescinded by the Department for non-compliance to standards set forth in R426-5-6 or adjusted to coincide with the American College of Surgeons verification timetable.

(5)The Department shall disseminate a list of designated trauma centers to all Utah hospitals, and state EMS agencies, and as appropriate, to hospitals in nearby states which refer patients to Utah hospitals.

 

R426-5-[8]7. Data Requirements for an Inclusive Trauma System.

(1) All hospitals shall collect, and quarterly submit to the Department, Trauma Registry information necessary to maintain an inclusive trauma system. The Department shall provide funds to hospitals, excluding designated trauma centers, for the data collection process. The inclusion criteria for a trauma patient are as follows:

(a) ICD9 Diagnostic Codes between 800 and 959.9 (trauma); and

(b) At least one of the following patient conditions:

admitted to the hospital for 24 hours or longer; transferred in or out of your hospital via EMS transport (including air ambulance); death resulting from the traumatic injury (independent of hospital admission or hospital transfer status; all air ambulance transports (including death in transport and patients flown in but not admitted to the hospital).

(c) Exclusion criteria are ICD9 Diagnostic Codes:

930-939.9 (foreign bodies)

905-909.9 (late effects of injury)

910-924.9 (superficial injuries, including blisters, contusions, abrasions, and insect bites)

The information shall be in a standardized electronic format specified by the Department which includes:

(i) Demographics:

Database Record Number

Institution ID number

Medical Record Number

Social Security Number

Patient Home Zip Code

Sex

Date of Birth

Age Number and Units

Patient's Home Country

Patient's Home State

Patient's Home County

Patient's Home City

Alternate Home Residence

Race

Ethnicity

(ii) Injury:

Date of Injury

Time of Injury

Blunt, Penetrating, or Burn Injury

Cause of Injury Description

Cause of Injury Code

Work Related Injury (y/n)

Patient's Occupational Industry

Patient's Occupation

Primary E-Code

Location E-Code

Additional E-Code

Incident Location Zip Code

Incident State

Incident County

Incident City

Protective Devices

Child Specific Restraint

Airbag Deployment

(iii) Prehospital:

Name of EMS Service

Transport Origin Scene or Referring Facility

Trip Form Obtained (y/n)

EMS Dispatch Date

EMS Dispatch Time

EMS Unit Arrival on Scene Date

EMS Unit Arrival on Scene Time

EMS Unit Scene Departure Date

EMS Unit Scene Departure Time

Transport Mode

Other Transport Mode

Initial Field Systolic Blood Pressure

Initial Field Pulse Rate

Initial Field Respiratory Rate

Initial Field Oxygen Saturation

Initial Field GCS-Eye

Initial Field GCS-Verbal

Initial Field GCS-Motor

Initial Field GCS-Total

Inter-Facility Transfer

(iv) Referring Hospital:

Transfer from Another Hospital (y/n)

Name or Code

Arrival Date

Arrival Time

Discharge Date

Discharge time

Transfer Mode

Admitted or ER

Procedures

Pulse

Capillary Refill

Respiratory Rate

Respiratory Effort

Blood Pressure

Eye Movement

Verbal Response

Motor Response

Glascow Coma Score Total

Revised Trauma Score Total

(v) Emergency Department Information:

Mode of Transport

Arrival Date

Arrival Time

Discharge Time

Discharge Date

Initial ED/Hospital Pulse Rate

Initial ED/Hospital Temperature

Initial ED/Hospital Respiratory Rate

Initial ED/Hospital Respiratory Assistance

Initial ED/Hospital Oxygen Saturation

Initial ED/Hospital Systolic Blood Pressure

Initial ED/Hospital GCS-Eye

Initial ED/Hospital GCS-Verbal

Initial ED/Hospital GCS-Motor

Initial ED/Hospital GCS-Total

Initial ED/Hospital GCS Assessment Qualifiers

Revised Trauma Score Total

Alcohol Use Indicator

Drug Use Indicator

ED Discharge Disposition

ED Death

ED Discharge Date

ED Discharge Time

(vi) Emergency Department Treatment:

Procedures Done (pick list)

Paralytics used prior to GCS (y/n)

(vii) Admission Information:

Admit from ER or Direct Admit

Admitted from what Source

Time of Hospital Admission

Date of Hospital Admission

Hospital Procedures

Hospital Procedure Start Date

Hospital Procedure Start Time

(viii) Hospital Diagnosis:

ICD9 Diagnosis Codes

Injury Diagnoses

Co-Morbid Conditions

AIS Score for Diagnosis (calculated)

Injury Severity Score

(ix) Quality Assurance Indicators:

Hospital Complications

(x) Outcome:

Discharge Time

Discharge Date

Total Days Length of Stay

Total ICU Length of Stay

Total Ventilator Days

Disposition from Hospital

Destination Facility

(xi)Charges:

Payment Sources

 

R426-5-[9]8. Trauma Triage and Transfer Guidelines.

The Department adopts by reference the 2009 Resources and Guidelines for the Triage and Transfer of Trauma Patients published by the Utah Department of Health as model guidelines for triage, transfer, and transport of trauma patients. The guidelines do not mandate the transfer of any patient contrary to the judgment of the attending physician. They are a resource for pre-hospital and hospital providers to assist in the triage, transfer and transport of trauma patients to designated trauma centers or acute care hospitals which are appropriate to adequately receive trauma patients.

 

R426-5-[10]9. Noncompliance to Standards.

(1) The Department may warn, reduce, deny, suspend, revoke, or place on probation a facility designation, if the Department finds evidence that the facility has not been or will not be operated in compliance to standards adopted under R426-5.

(2) A hospital, clinic, health care provider, or health care delivery system may not profess or advertise to be designated as a trauma center if the Department has not designated it as such pursuant to this rule.

 

R426-5-[11]10. Statutory Penalties.

A person who violates this rule is subject to the provisions of Title 26, Chapter 23.

 

KEY: emergency medical services, trauma, reporting, trauma center designation

Date of Enactment or Last Substantive Amendment: [March 15, 2010]2011

Notice of Continuation: July 18, 2007

Authorizing, and Implemented or Interpreted Law: 26-8a-252

 

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