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EMS/Trauma Performance

EMS/Trauma Performance. Healthcare Safety Net Initiatives Conference February 9, 2007 Charles Begley and Munseok Seo for the H-GAC Emergency/Trauma Care Data Committee. Project Background. The H-GAC Emergency/Trauma Care Policy Council created 2003

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EMS/Trauma Performance

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  1. EMS/Trauma Performance • Healthcare Safety Net Initiatives Conference • February 9, 2007 • Charles Begley and Munseok Seo for the H-GAC Emergency/Trauma Care Data Committee

  2. Project Background • The H-GAC Emergency/Trauma Care Policy Council created 2003 • Members from 13 H/GAC counties in southeast Texas • Emergency physicians, trauma surgeons, hospital administrators, EMS providers and representatives from the two local trauma regional advisory councils • Mission • Develop plans and policies for improving regional emergency/trauma care • Create system for monitoring regional performance • A data committee was charged to develop monitoring system • HHSRC is supporting this effort

  3. Data Committee Activities • Developing integrated database • Hospital ER Visit data • Texas Trauma Registry • Texas Health Care Information Collection hospital discharge database • EMSystem hospital diversion database.  • Monitoring performance indicators • Number and type of ER visits • Hospital hours on diversion • EMS response times and triage • Trauma morbidity and mortality • Changes in trauma system capacity • Changes in the level of uncompensated care • Conducting special studies • ED algorithm study • Impact of hospital diversion • Relationship between trauma care capacity and outcomes

  4. Today’s Presentation • Monitoring data on: • Regional hospital diversion • EMSystem data on the latest trends in hospital diversion • Morbidity and mortality in Houston hospitals • THCIC data on latest trends in trauma cases, morbidity, and mortality • Patient triage in Houston hospitals • THCIC data on latest trends in trauma patients being triaged to appropriate hospitals

  5. Hospital Diversion • EMSystems data on hours that hospitals are on: • Divert: unable to provide level of care demanded by trauma patients. • Caution: a shortage situation that should be noted but does not warrant Divert. • ER Saturation: ER heavily saturated and non-critical patients will have to wait an excessively long period of time. • Examining these data for 2003-06, it is apparent that: • The overall amount of hospital diversion has stayed the same • Diversion has gotten worse among Level I hospitals • ER saturation diversion is rising less rapidly than total diversion

  6. Mortality and Morbidity • THCIC hospital discharge data from 1999-2003 • Trauma cases are defined by ICD-9 Code • Injury severity is measured by ISS score which is derived using the ICDMAP-90 software developed by MacKenzie • Mortality is defined at discharge • Examination of 99-03 trends indicate: • The number of Houston trauma cases declined • The severity of cases is stable • The mortality rate is rising, particularly for the most severe cases

  7. Triage • THCIC hospital discharge data from 1999-2003 • Trauma cases are defined by ICD-9 Code • ISS scores are derived using the ICDMAP-90 software developed by MacKenzie • Undertriage = ISS>=16 treated at non-designated hospital • Overtriage = ISS 1-9 treated at Level I hospital • Examination of the data indicate: • Undertriage is improving and approaching standard • Overtriage is stable but not reaching standard

  8. Conclusion • Hospital diversion continues at a high level • ER saturation-caused diversion may be improving at Level I’s • Mortality is rising for most severe cases • Related to high level of diversion, overtriage, other system and/or other pre-hospital/hospital factors? • Undertriage is fairly good but overtriage may be a problem

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