Current Trauma Status Report - Southern Nevada Health District

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ED Diversion Like the rest of the country, ED diversion has been a significant concern for the EMS and hospital system in the Las Vegas region. Diversion hours increased by 36 percent from 2002 to 2003. Even when a hospital was not on diversion, the average off load time for a patient from an ambulance to the hospital bed was 70 minutes. Previous efforts by the community health care providers to resolve this problem have had short term impacts but eventually the problem has grown worse. However, a pilot test was recently implemented to eliminate diversion. The chart below shows the region’s monthly diversion hours for 2002 and 2003. There are additional hours when the hospital is open only because it has been forced open by the diversion protocol. It should be noted that the trauma center at UMC does not divert patients meeting trauma destination criteria. System-wide, EDs were on diversion for over 900 hours per month during ten months in 2003. December 2003 spiked with 1,606 hours. Exhibit 41 – Total ED Diversion Hours by Month ED Diversion by Month for Clark County Month 2002 2003 Percent Change Jan 978 1,147 17.3% Feb 1,059 867 -18.1% Mar 1,418 962 -32.2% Apr 917 972 6.0% May 563 830 47.6% Jun 446 767 72.0% Jul 613 912 48.6% Aug 589 919 56.0% Sep 605 1,102 82.1% Oct 440 861 95.7% Nov 464 1,115 140.1% Dec 754 1,606 112.9% Total 8,846 12,061 36.3% Source: CCHD Clark County ED Diversion Hours, 2002-2003 1,800 1,600 1,400 1,200 1,000 800 600 400 200 - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Source: CCHD 2002 2003 Monthly diversion hours for each hospital for 2002 and 2003 can be found in the Appendix. Page 53
All EMS and ED stakeholders appear frustrated about the problem. The FAB and MAB, in conjunction with the Clark County Health District, have agreed to test eliminating the “emergency department closure” protocol and initiated a 90-day pilot on April 1, 2004. During this period, hospitals will not be able to close for one hour as previously allowed under the protocol. Instead, all patients are to be transported to the facility of their choice or to the closest facility, with the exception of trauma and burn patients. EMS providers will utilize the EMSystem EMS Offload Advisory levels to advise patients about the status of waiting times at the emergency departments when the patient is choosing a facility. Although this pilot project prohibits diversion, if a facility declares an internal disaster, all EMS traffic including inter-facility transfers to that facility will stop. Early indications are that the pilot test is having a positive impact. Information Systems There are two main components that make up a trauma information system: a trauma registry and prehospital data. In the case of Southern Nevada there are two trauma registries, one maintained by the Nevada State Health Division and another registry maintained by UMC. The registry kept by UMC captures more data than what is required by the State. With respect to prehospital data, each provider maintains their own database. The fire providers maintain electronic databases, while the ambulance providers maintain paper databases. In accordance with NRS 450B.810, NAC 450B.620, NAC 450B.645, and NAC 450B.766, State EMS, in cooperation with Clark County Health District EMS office, have adopted standards for prehospital data collection. Computer software and a web-based server have been provided for collecting and storing prehospital run reports and data obtained from all Nevada permitted EMS/Fire agencies. While not every agency is required to install and utilize the provided software, each will be required to submit the required data elements in a format that will allow uploading to the web-based server. The rollout utilizing the web-based server is scheduled for July 2004. Las Vegas Fire and Rescue and local ambulance providers are expected to adopt a new software system called Roam IT allowing for a standardized electronic reporting of the prehospital care report to be in place by April 2004. ED data reporting is voluntary and not conc lusive. However, State regulation does require the reporting by all hospitals of any trauma care provided. While it is mandatory that hospitals report trauma cases to the Nevada Trauma Registry, the reality is that many hospitals find it difficult to meet the requirement due to staffing issues and thus the registry suffers. The data the State does receive is published in an annual report. In addition to the mandatory trauma reporting, all hospitals must submit the Uniform Billing 92 Hospital Discharge data set. Other data sources exist, but there is not a data warehouse for EMS/trauma data in Southern Nevada. State Trauma Registry All hospitals are required by NAC (NRS 450B.120 and 450B.238) to submit data to the State on trauma patients. The State provides the definitions on patient types and data fields for inclusion in the trauma registry. Hospitals must submit quarterly reports to the Nevada State Health Division within 60 days after the end of the quarter. The Nevada State Health Division then publishes an annual report by July 1 for the previous calendar year. The most current report was published on November 12, 2003 and provides data for 2000 through 2002. Page 54
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 and 28: three years, and felt that a Level
Page 29 and 30: EMS providers ranked Acute Care Fac
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: The table below summarizes the key
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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