DAR File No. 40426

Health, Family Health and Preparedness, Emergency Medical Services

Rule R426-9

Trauma and EMS System Facility Designations

Notice of Proposed Rule

(Amendment)

DAR File No.: 40426
Filed: 05/13/2016 08:49:14 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The amendments align trauma data rules with national level updates and provide clarity on data element requirements.

Summary of the rule or change:

The changes: 1) replace references from ICD-9 to ICD-10; 2) update inclusion criteria to include a hospital stay of longer than 12 hours (as measured from the time of Emergency Department arrival to patient discharge); 3) remove the list of required data elements which is replaced by Subsection R426-9-7(1)(c); 4) no longer require referring hospital information except hospital transfer and hospital name; and 5) replace full Utah Trauma Data Dictionary with addendum that includes only additional elements not included in the National Traffic Data Standard.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 8a

Anticipated cost or savings to:

the state budget:

There is no anticipated fiscal impact to the state budget because amendments update and clarify standards.

local governments:

There is no anticipated fiscal impact to local government budgets because amendments update and clarify standards.

small businesses:

There is no impact on small businesses. Reporting is currently required, and amendments update and clarify reportable data elements.

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

There are no anticipated fiscal impacts. Reporting is currently required, and amendments update and clarify reportable data elements.

Compliance costs for affected persons:

Affected persons will not have any additional compliance costs. The amendments update and clarify existing requirements.

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

There is no fiscal impact upon business because the proposed changes clarify but do not change any currently required reporting requirements.

Joseph Miner, 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
Family Health and Preparedness, 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 gdansie@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:

07/01/2016

This rule may become effective on:

07/08/2016

Authorized by:

Joseph Miner, Executive Director

R426. Health, Family Health and Preparedness, Emergency Medical Services.

R426-9. Trauma and EMS System Facility Designations.

R426-9-100. Authority and Purpose for Trauma System Standards.

(1) Authority - This rule is established under Title 26, Chapter 8a, 252, Statewide Trauma System, which authorizes the Department to:

(a) establish and actively supervise a statewide trauma system;

(b) establish, by rule, trauma center designation requirements and model state guidelines for triage, treatment, transport, and transfer of trauma patients to the most appropriate health care facility; and

(c) designate trauma care facilities consistent with the trauma center designation requirements and verification process established by the Department and applicable statutes.

(2) This rule provides standards for the categorization of all hospitals and the voluntary designation of Trauma Centers to assist physicians in selecting the most appropriate physician and facility based upon the nature of the patient's critical care problem and the capabilities of the facility.

(3) It is intended that the categorization process be dynamic and updated periodically to reflect changes in national standards, medical facility capabilities, and treatment processes. Also, as suggested by the Utah Medical Association, the standards are in no way to be construed as mandating the transfer of any patient contrary to the wishes of his attending physician, rather the standards serve as an expression of the type of facilities and care available in the respective hospitals for the use of physicians requesting transfer of patients requiring skills and facilities not available in their own hospitals.

 

R426-9-700. Data Requirements for an Inclusive Trauma System.

(1) All hospitals shall collect, and monthly submit to the Department, Trauma Registry information necessary to maintain an inclusive trauma system. Designated trauma centers shall provide such data in a[n] standardized electronic format approved by the Department. The Department shall provide funds to hospitals, excluding designated trauma centers, for the data collection process. In order to ensure consistent patient data collection, a trauma patient is defined as a patient sustaining a traumatic injury and meeting the following criteria:[The inclusion criteria for a trauma patient are as follows:]

(a) At least one of the following injury diagnostic codes: [ICD9 Diagnostic Codes between 800 and 959.9 (trauma); and]ICD10 Diagnostic Codes: S00-S00 with 7th character modifiers of A, B, or C only, T07, T14, T20-T28 with 7th character modifier of A, T30-T32, T79.A1-T79.A9 with 7th character modifier of A excluding the following isolated injuries: S00, S10, S20, S30, S40, S50, S60, S70, S80, S90. Late effect codes, which are represented using the same range of injury diagnosis codes but with the 7th digit modifier code of D through S are also exluded; and

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

[(i) Injury resulted in death;

(ii) Admitted to the ]Stay at a hospital greater than 12 hours (as measured from the Emergency Department arrival to patient discharge); [for 24 hours or longer;

(iii) Patient] transferred in or out of reporting hospital via EMS transport (including air ambulance); death resulting from the traumatic injury (independent of hospital admission or hospital transfer status.[and

(iv) Patient transported via air ambulance, independent of hospital admission or hospital transfer status.

(c) Exclusion criteria are ICD9 Diagnostic Codes:

(i) 930-939.9 (foreign bodies)

(ii) 905-909.9 (late effects of injury)

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

(2) The information shall be in a National Trauma Data Standard standardized electronic format and include the following NTDS data elements:

(a) Demographic Data:

D_01 Patient's Home Zip Code

D_02 Patient's Home Country

D_03 Patient's Home State

D_04 Patient's Home County

D_05 Patient's Home City

D_06 Alternate Home Residence

D_07 Date of Birth

D_08 Age

D_09 Age Unit

D_10 Race

D_11 Ethnicity

D_12 Sex

(b) Injury Information:

I_01 Injury Incident Date

I_02 Injury Incident Time

I_03 Work-Related

I_04 Patient's Occupational Industry

I_05 Patient's Occupation

I_06 ICD-9 Primary External Cause Code

I_07 ICD-10 Primary External Cause Code

I_08 ICD-9 Place Of Occurrence External Cause Code

I_09 ICD-10 Place Of Occurrence External Cause Code

I_10 ICD-9 Additional External Cause Code

I_11 ICD-10 Additional External Cause Code

I_12 Incident Location Zip Code

I_13 Incident Country

I_14 Incident State

I_15 Incident County

I_16 Incident City

I_17 Protective Devices

I_18 Child Specific Restraint

I_19 Airbag Deployment

I_20 Report Of Physical Abuse

I_21 Investigation Of Physical Abuse

I_22 Caregiver At Discharge

(c) Pre-Hospital Information

P_01 EMS Dispatch Date

P_02 EMS Dispatch Time

P_03 EMS Unit Arrival Date At Scene Or Transferring Facility

P_04 EMS Unit Arrival Time At Scene Or Transferring Facility

P_05 EMS Unit Departure Date From Scene Or Transferring Facility

P_06 EMS Unit Departure Time From Scene Or Transferring Facility

P_07 Transport Mode

P_08 Other Transport Mode

P_09 Initial Field Systolic Blood Pressure

P_10 Initial Field Pulse Rate

P_11 Initial Field Respiratory Rate

P_12 Initial Field Oxygen Saturation

P_13 Initial Field GCS -Eye

P_14 Initial Field GCS -Verbal

P_15 Initial Field GCS -Motor

P_16 Initial Field GCS -Total

P_17 Inter-Facility Transfer

P_18 Trauma Center Criteria

P_19 Vehicular, Pedestrian, Other Risk Injury

(d) Emergency Department Information

ED_01 ED/Hospital Arrival Date

ED_02 ED/Hospital Arrival Time

ED_03 Initial ED/Hospital Systolic Blood Pressure

ED_04 Initial ED/Hospital Pulse Rate

ED_05 Initial ED/Hospital Temperature

ED_06 Initial ED/Hospital Respiratory Rate

ED_07 Initial ED/Hospital Respiratory Assistance

ED_08 Initial ED/Hospital Oxygen Saturation

ED_09 Initial ED/Hospital Supplemental Oxygen

ED_10 Initial ED/Hospital GCS -Eye

ED_11 Initial ED/Hospital GCS -Verbal

ED_12 Initial ED/Hospital GCS -Motor

ED_13 Initial ED/Hospital GCS -Total

ED_14 Initial ED/Hospital GCS Assessment Qualifiers

ED_15 Initial ED/Hospital Height

ED_16 Initial ED/Hospital Weight

ED_17 Alcohol Use Indicator

ED_18 Drug Use Indicator

ED_19 ED Discharge Disposition

ED_20 Signs Of Life

ED_21 ED Discharge Date

ED_22 ED Discharge Time

(e) Hospital Procedure Information

HP_01 ICD-9 Hospital Procedures

HP_02 ICD-10 Hospital Procedures

HP_03 Hospital Procedure Start Date

HP_04 Hospital Procedure Start Time

(f) Diagnosis Information

DG_01 Co-Morbid Conditions

DG_02 ICD-9 Injury Diagnoses

DG_03 ICD-10 Injury Diagnoses

(g) Injury Severity Information

IS_01 AIS Predot Code

IS_02 AIS Severity

IS_03 ISS Body Region

IS_04 AIS Version

IS_05 Locally Calculated ISS

(h) Outcome Information

O_01 Total ICU Length Of Stay

O_02 Total Ventilator Days

O_03 Hospital Discharge Date

O_04 Hospital Discharge Time

O_05 Hospital Discharge Disposition

(i) Financial Information

F_01 Primary Method Of Payment

(x) Quality Assurance Information

Q_01 Hospital Complications

(3) Additional data elements, not included in the NTDS, to be submitted include:

(a) Demographic Information

A.1 Tracking Number

A.2 Hospital Number

A.10 Medical Record Number

A.11 Social Security Number

(b) Injury Information

B.3 Injury Cause Code

B.4 Trauma Type

B.19 Injury Details

(c) Pre-hospital Information

D.3 EMS Agency

D.4 EMS Origin

D.8 EMS Respond Date

D.7 EMS Respond Time

D.14 EMS Destination Arrival Date

D.13 EMS Destination Arrival Time

D.15 EMS Destination

D.16 EMS Trip Form Received

D.24 Initial Field GCS Assessment Qualifiers

(d) Referring Hospital Information

C.1 Hospital Transfer

C.2 Transport Mode into Referring Hospital

C.3 Referring Hospital

C.4 Referring Hospital Arrival Date

C.5 Referring Hospital Arrival Time

C.6 Referring Hospital Discharge Date

C.7 Referring Hospital Discharge Time

C.8 Referring Hospital Admission Type

C.9 Referring Hospital Pulse

C.10 Referring Hospital Respiratory Rate

C.11 Referring Hospital Systolic Blood Pressure

C.12 Referring Hospital GCS -Eye

C.13 Referring Hospital GCS -Verbal

C.14 Referring Hospital GCS -Motor

C.15 Referring Hospital GCS Assessment Qualifiers

C.16 Referring Hospital GCS Total

C.17 Referring Hospital Procedures

(e) Emergency Department Information

E.1 ED Admit Type

E.2 ED Admit Service

E.6 ED Admission Date

E.5 ED Admission Time

E.14 ED Transferring EMS Agency

E.15 ED Discharge Destination Hospital

(f) Inpatient Information

E.10 Inpatient Admission Date

E.9 Inpatient Admission Time

E.12 Hospital Discharge Date

E.11 Hospital Discharge Time

E.16 Transfer Reason

E.18 Hospital Discharge Destination Hospital

E.19 DC Transferring EMS Agency

(vii) Outcome Information

E.20 Outcome]

(c) The Department adopt by reference the National Trauma Data Standard Data Dictionary for 2016 Admissions published by the American College of Surgeons, and the Utah Trauma Registry State Required Elements for 2016 published by the Department.

 

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

Date of Enactment or Last Substantive Amendment: [August 21, 2015]2016

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