No. 35196 (Amendment): Rule R426-5. Statewide Trauma System Standards  

  • (Amendment)

    DAR File No.: 35196
    Filed: 08/30/2011 01:38:43 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 survey personnel participating in hospital on-site trauma center designation surveys. In addition, reporting requirements for trauma center is reduced, while still protecting the public.

    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:

    Anticipated cost or savings to:

    the state budget:

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

    local governments:

    Local governments do not operate hospitals affected by this rule and no cost is expected.

    small businesses:

    Small businesses do not operate hospitals affected by this rule and no cost is expected.

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

    $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:

    $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.

    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.

    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
    Family Health and Preparedness, Emergency Medical Services
    3760 S HIGHLAND DR
    SALT LAKE CITY, UT 84106

    Direct questions regarding this rule to:

    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:

    10/17/2011

    This rule may become effective on:

    10/24/2011

    Authorized by:

    David Patton, Executive Director

    RULE TEXT

    R426. Health, Family Health and Preparedness, 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 the 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

     


Document Information

Effective Date:
10/24/2011
Publication Date:
09/15/2011
Filed Date:
08/30/2011
Agencies:
Health,Family Health and Preparedness, Emergency Medical Services
Rulemaking Authority:

Section 26-8a-252

Authorized By:
David Patton, Executive Director
DAR File No.:
35196
Related Chapter/Rule NO.: (1)
R426-5. Hospital Trauma Categorization Standards.