DAR File No. 30489

Health, Health Systems Improvement, Emergency Medical Services

R426-5-8

Data Requirements for an Inclusive Trauma System

NOTICE OF PROPOSED RULE

DAR File No.: 30489
Filed: 09/25/2007, 03:54
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The amendment brings Utah's Statewide Trauma Registry into compliance with the newly formulated National Trauma Data Standards (NTDS) and brings the reporting standards into closer alignment with American College of Surgeons (ACS) reporting requirements for trauma centers.

Summary of the rule or change:

This rule change modifies the inclusion and exclusion criteria and some of the data elements hospitals are required to submit to Utah's Statewide Trauma Registry. The proposed rule change will bring Utah's Statewide Trauma Registry into compliance with the newly formulated NTDS and brings the reporting standards into closer alignment with ACS reporting requirements. In addition to revising the data elements collected in the Trauma Registry to align with the NTDS, the inclusion criterion for the Trauma Registry on the length of stay in a hospital admission has been changed from 48 hours to 24 hours. The change will increase the number of patients who are entered in the Trauma Registry annually.

State statutory or constitutional authorization for this rule:

Title 26, Chapter 8a

Anticipated cost or savings to:

the state budget:

Anticipated costs are $35,000 for data entry and $5,000 for copying expenses for a total of $40,000 which are covered by dedicated credits under the Emergency Medical Services Grants Program under Section 26-8a-207.

local governments:

Local governments that own hospitals will not accrue any additional costs. The State Trauma System funding, through the Bureau of Emergency Medical Services, will reimburse all costs to local governments.

small businesses and persons other than businesses:

Small businesses that own hospitals will not accrue any additional costs. The State Trauma System funding, through the Bureau of EMS, will reimburse all costs to hospitals.

Compliance costs for affected persons:

There will be an increase in the number of patient records to be entered into the trauma registry. The state will continue to cover the costs of the trauma registry data collection process for personnel and copying expenses for hospitals not designated as trauma centers.

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

No fiscal impact on regulated business is anticipated as the Utah Department of Health has funding to reimburse expenses related to the Statewide Trauma System. Standardization of data is important to maximize the usefulness of this data. David N. Sundwall, MD, 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
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

Direct questions regarding this rule to:

Jolene Whitney at the above address, by phone at 801-538-6290, by FAX at 801-538-6808, or by Internet E-mail at jrwhitney@utah.gov

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:

11/14/2007

This rule may become effective on:

11/21/2007

Authorized by:

David N. Sundwall, Executive Director

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

R426-5. Statewide Trauma System Standards.

R426-5-8. 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 [is]are as follows:

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

760.5 (fetus or newborn affected by trauma); or

641.8 (antepartum history due to trauma); or

518.5 (pulmonary embolism due to trauma);]and

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

admitted to the hospital for [48]24 hours or longer; transferred in or out of your hospital via EMS transport (including air ambulance); [died]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

[ City of Injury

State of Injury

Zip Code of Injury

] Blunt, Penetrating, or Burn Injury

Cause of Injury Description

Cause of Injury Code

[ Cause of Injury E-code

Site/Location of Injury

] 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)

[ Arrival Time at (First) Hospital

Arrival Date at Hospital

] 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

[ Pulse

] Initial ED/Hospital Pulse Rate

Initial ED/Hospital Temperature

[ Capillary Refill

Respiratory Rate

] Initial ED/Hospital Respiratory Rate

Initial ED/Hospital Respiratory Assistance

Initial ED/Hospital Oxygen Saturation

[ Respiratory Effort

Blood Pressure

] Initial ED/Hospital Systolic Blood Pressure

[ Eye Movement

] 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

[ Verbal Response

Motor Response

Arrival Glascow Coma Score Total

] 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)

[ Disposition

] (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 90 or 95 Used?

] AIS Score for Diagnosis (calculated)

Injury Severity Score

(ix) [Operations/Procedures:

ICD9 Codes

(x) ]Quality Assurance Indicators:

[None]Hospital Complications

(x[i]) [Complications]Outcome:

[ None

(xii) Outcome:]

Discharge Time

Discharge Date

Total Days Length of Stay

Total ICU Length of Stay

Total Ventilator Days

Disposition from Hospital

Destination Facility

[GCS Outcome Score

](xi[ii])Charges:

Payment Sources

 

KEY: emergency medical services, trauma, reporting

Date of Enactment or Last Substantive Amendment: [August 30, 2006]2007

Notice of Continuation: July 18, 2007

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