1. TRAUMA DESIGNATION: RAISING THE BAR

2.  MAR was filed Aug. 8 th, published on Aug. 21. The comment period ends on Sept. 18 th and we should be able to file the notice either September 29 th (if we receive no comments) or on October 14, 2014.  Hearing date is scheduled for Sept. 15 th.  New criteria will be effective for designations starting January 1, 2015. This allows approximately 3 months after final rule for facilities to prep for new criteria. NEW Montana Trauma Facility Designation Criteria

3. January: 1 completed visit February: 1 completed visit April: 3 completed visits May: 3 completed visits June: 3 completed visits __________________________________________ July: 4 completed visits Sept-November: 10 requested visits DESIGNATION VISITS YEAR TO DATE

7. LEVELS OF TRAUMA FACILITY DESIGNATION  Regional Trauma Center (equivalent to Level 2)  Capable of providing advanced trauma care for a region, all major surgical services readily available  Area Trauma Hospital (equivalent to Level 3)  Capable of handling most trauma patients within their service area, surgeon always available  Community Trauma Hospital (equivalent to Level 4)  Able to provide limited emergency and intermittent surgical coverage  Trauma Receiving Facility (equivalent to Level 5)  Able to provide limited emergency care with no surgical coverage

8. TRAUMA SITE SURVEY  Onsite review to assess the facility’s:  Commitment  Readiness  Resources  Policies  Patient care  Performance Improvement  Site review team members:  Experienced Trauma Surgeon reviewer  Experienced Trauma Coordinator reviewer  EMS & Trauma Systems representative

9. SITE REVIEW PREPARATION  Care taken to prepare application ◦ Trauma education documentation  Identified representatives at opening meeting ◦ Administration, Dept. Managers, Providers ◦ EMS  Prepare program overview presentation  Staff prepared for facility tour  Medical record and PI preparation  Trauma Coordinator & Medical Director encouraged to participate in entire review (approx. 5-6 hrs) ◦ Honesty is always the best policy

10. MEDICAL RECORD REVIEW  Paper charts, if at all possible  5 mandatory components to include at a minimum:  Trauma Flow Sheet /ED charting  EMS Run-sheet (if applicable)  Dictation/documentation of problem summary/H&P  Transfer/Discharge Summary  Performance Improvement & Peer Review (if applicable)

11. DOCUMENTATION REVIEW  Multidisciplinary Trauma Committee Minutes  Signed interfacility transfer agreements  Trauma Medical Records  Completed trauma registry data  Performance improvement documentation  Peer Review process with minutes  Trauma education  Trauma policies/guidelines  Injury prevention & education program

12. TRAUMA FACILITY DESIGNATION  A key requirement for Montana trauma designation is an ongoing active PI program  The PI program is not just a paper exercise, it provides a forum for review that leads to improved patient care  Patient specific PI documentation must be kept & readily available during the onsite designation survey

13. MONTANA TRAUMA COORDINATOR COURSE 2010  No precise prescription for PI exists  Trauma director must lead  Must be a multidisciplinary effort  Adverse outcome does not always indicate poor care & vise versa  Focus on opportunities for improvement rather than on problems  Most errors are related to system or process issues  Timely accurate collection & analysis of meaningful data is a challenge

14. TRAUMA PEER REVIEW o Multidisciplinary medical providers involved in care for trauma patients o Trauma coordinator must attend o Perform peer review for clinical care issues such appropriateness and timeliness of care o Meets regularly with written minutes that include attendance o Documentation of the sessions should be written carefully but also include candid discussions. o Document trauma performance improvement activities