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

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

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

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

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

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15. 15 Mortality and Morbidity THCIC hospital discharge data from 1999-2003 THCIC hospital discharge data from 1999-2003 Trauma cases are defined by ICD-9 Code 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 Injury severity is measured by ISS score which is derived using the ICDMAP-90 software developed by MacKenzie Mortality is defined at discharge Mortality is defined at discharge Examination of 99-03 trends indicate: Examination of 99-03 trends indicate: The number of Houston trauma cases declined The number of Houston trauma cases declined The severity of cases is stable The severity of cases is stable The mortality rate is rising, particularly for the most severe cases The mortality rate is rising, particularly for the most severe cases

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20. 20 Triage THCIC hospital discharge data from 1999-2003 THCIC hospital discharge data from 1999-2003 Trauma cases are defined by ICD-9 Code Trauma cases are defined by ICD-9 Code ISS scores are derived using the ICDMAP-90 software developed by MacKenzie ISS scores are derived using the ICDMAP-90 software developed by MacKenzie Undertriage = ISS>=16 treated at non-designated hospital Undertriage = ISS>=16 treated at non-designated hospital Overtriage = ISS 1-9 treated at Level I hospital Overtriage = ISS 1-9 treated at Level I hospital Examination of the data indicate: Examination of the data indicate: Undertriage is improving and approaching standard Undertriage is improving and approaching standard Overtriage is stable but not reaching standard Overtriage is stable but not reaching standard

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23. 23 Conclusion Hospital diversion continues at a high level Hospital diversion continues at a high level ER saturation-caused diversion may be improving at Level I’s ER saturation-caused diversion may be improving at Level I’s Mortality is rising for most severe cases Mortality is rising for most severe cases Related to high level of diversion, overtriage, other system and/or other pre-hospital/hospital factors? 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 Undertriage is fairly good but overtriage may be a problem