Current Trauma Status Report - Southern Nevada Health District

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All payers indicated a significant concern about quality of care and their desire to play a role in the system design and issue resolution. Of clear concern to these payers was the current ED saturation, ambulance diversion and long ambulance off-load times which the payers were surprisingly knowledgeable about. One payer indicated an interest in providing financial support to further study the problem and provide best practice interventions to mitigate the problem. Among the insurer/payer trauma center/system comments were suggestions that surgeons should be employees of hospitals because of the medical malpractice issue, and that funding should come from community taxes (like fire and police). It was felt by at least one insurance payer that over-triage is an issue. As for the location of an additional trauma center or centers, one respondent commented that an additional trauma center should be in the south, at St. Rose Dominican-Siena or de Lima, rather than at Sunrise. Others did not have an opinion. It was recommended that governance be provided by the ACS or the State and to seek the governance characteristics of independence and objectivity. At least one respondent was skeptical of the concept of self-government. Ranked Questions Three questions were asked that required all participants to provide a numerical ranking. The following are the results in the aggregate for all hospitals (including UMC Trauma Center and hospitals with EDs) and all EMS providers (fire, ambulance, air). One of the questions asked participants to rank the importance of the National Highway Traffic Safety Administration (NHTSA) trauma system components identified in their publication Trauma System Agenda For The Future. Each component was ranked from one to five (where one was least important and five was critical). The hospitals stakeholder group ranked Professional Resources (staffing resources) as the most important component, followed by Acute Care Facilities and then Finances. The component ranked least important was Injury Prevention. Exhibit 10 – Trauma System Components Ranked for All Hospitals Trauma System Components - Average Rated Importance by Rank for All Hospitals Component All Hospitals Rank Professional Resources 4.91 1 Acute Care Facilities 4.89 2 Finances 4.59 3 Leadership 4.53 4 Pre-Hospital Care 4.48 5 Education and Advocacy 4.30 6 Rehabilitation 4.27 7 Disaster Preparedness and Response 4.18 8 Information Management 4.03 9 Research 3.92 10 Technology 3.92 10 Injury Prevention 3.74 12 Notes: Importance was rated on a scale of 1 (least important) to 5 (most important). All hospitals includes UMC Trauma Center. Source: Interviews with The Abaris Group. Page 27
EMS providers ranked Acute Care Facilities and Pre-Hospital Care most important, followed by Leadership and Professional Resources (staffing resources). Injury Prevention was again ranked last. Exhibit 11 – Trauma System Components Ranked for EMS Providers Trauma System Components - Average Rated Importance by Rank for EMS Providers Component EMS Providers Rank Acute Care Facilities 4.86 1 Pre-Hospital Care 4.86 1 Leadership 4.57 3 Professional Resources 4.57 3 Disaster Preparedness and Response 4.46 5 Finances 4.43 6 Education and Advocacy 4.21 7 Rehabilitation 4.00 8 Research 3.86 9 Technology 3.86 9 Information Management 3.79 11 Injury Prevention 3.50 12 Note: Importance was rated on a scale of 1 (least important) to 5 (most important). Source: Interviews with The Abaris Group. Respondents were asked to rank three aspects of the trauma triage criteria. These criteria determine which patients are directed to the trauma center for specialized trauma care. First, respondents rated the overall appropriateness of the criteria. Second, they rated the effectiveness of the criteria at limiting over-triage (patients unnecessarily categorized as trauma). Third, respondents rated the effectiveness of the criteria at limiting under-triage (patients not categorized as trauma when they should have been). The overall “Appropriateness of the Criteria” (prior to April 1, 2004 change) was ranked similarly by hospitals and EMS providers, at 3.64 and 3.50, respectively. Hospitals had a less favorable view of the “Effectiveness of the Criteria to Minimize Over-triage” (2.70), while EMS providers rated it the same as the criteria’s overall “Appropriateness” (3.50). Both hospitals and EMS providers felt the triage criteria were better at “Ensuring Minimum Under-Triage” than “Minimum Over-Triage”, with under-triage ratings of 3.30 for hospitals and 3.86 for EMS providers. Exhibit 12 – Trauma Triage Criteria Ranking Trauma Triage Criteria Average Ratings by Provider Type Component All Hospitals EMS Providers Overall 3.64 3.50 Minimum Over-Triage 2.70 3.50 Minimum Under-Triage 3.30 3.86 Notes: Rated on a scale of 1 (least effective) to 5 (most effective); based on triage criteria prior to 4/1/04. Source: Interviews with The Abaris Group. Page 28
Page 1 and 2: SOUTHERN NEVADA CURRENT TRAUMA STAT
Page 3 and 4: Table of Contents Executive Summary
Page 5 and 6: Chronology of Trauma Care in Southe
Page 7 and 8: Exhibit 33 - Map Displaying Trauma
Page 9 and 10: • From January through April 2004
Page 11 and 12: Clearly trauma center staffing and
Page 13 and 14: A series of focus groups was also c
Page 15 and 16: • Information Management • Fina
Page 17 and 18: (This study did not attempt to meas
Page 19 and 20: County Health District Board of Hea
Page 21 and 22: on an average length of stay of 3.4
Page 23 and 24: Exhibit 8 - Projected Population Ch
Page 25 and 26: Trauma Stakeholder Interview Result
Page 27: three years, and felt that a Level
Page 31 and 32: Town Hall Meeting Comments A series
Page 33 and 34: (CAAS) and the air ambulance provid
Page 35 and 36: Triage Criteria The determination o
Page 37 and 38: With the exception of the year 2000
Page 39 and 40: Exhibit 20 - Trauma Patients by Age
Page 41 and 42: The following chart shows that abou
Page 43 and 44: Exhibit 27 - Trauma Ground Transpor
Page 45 and 46: E codes enable the classification o
Page 47 and 48: The day of the week with the greate
Page 49 and 50: A different view of the 2002 trauma
Page 51 and 52: As part of The Abaris Group’s tra
Page 53 and 54: The table below summarizes the key
Page 55 and 56: All EMS and ED stakeholders appear
Page 57 and 58: Exhibit 43 - Specialty Physician Co
Page 59 and 60: Clark County Health District has id
Page 61 and 62: Trauma Center Standards by Level Th
Page 63 and 64: Nevada Trauma Registry Submission R
Page 65 and 66: Trauma Center Capacity Benchmark Da
Page 67 and 68: ED Diversion Hours by Hospital ED D
Page 69 and 70: • This region would not pass a ta
Page 71 and 72: • Instead of calling it a tax, we
Page 73 and 74: Mesquite Town Hall Meeting The foll
Page 75 and 76: North Las Vegas Town Hall Meeting T
Page 77 and 78: Las Vegas Town Hall Meeting The fol
Page 79 and 80:
Trauma Center Funding Comparison St
Page 81 and 82:
Los Angeles County, CA Los Angeles
Page 83 and 84:
Chronology of Trauma Care in Southe
Page 85 and 86:
January 22, 1999 December 10, 2001
Page 87 and 88:
List of Trauma System Assessment St
Page 89 and 90:
Southern Nevada Trauma System Asses
Page 91 and 92:
to hospitals that accept Medicare r
Page 93 and 94:
ehabilitation - services that seek
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Current Trauma Status Report - Southern Nevada Health District

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