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Performance Improvement Air Medical
*PLEASE SEND INFORMATION WHEN DISCOVERED THROUGHOUT THE QUARTER SO REVIEW CAN BE STARTED PRIOR TO RAC MEETING*
SEND TO: thamilton@fishercountyhospital.com or denid@rpmh.net
1.
Reporting Quarter
Dec, Jan, Feb
Mar, Apr, May
June, July, Aug
Sept, Oct, Nov
2.
Name of Entity:
3.
Person Completing Report:
4.
Performance Improvement Criteria / Indicators
Number of occurrences scene time greater than 20 minutes this quarter.
5.
Why was the scene time > than 20 minutes?
6.
Performance Improvement Criteria / Indicators
Number of occurrences greater than 30 minutes from dispatch to arrival on scene this quarter.
7.
Why was the scene time > than 30 minutes?
8.
Number of occurrences lift off time > 10 minutes from time mission accepted.
9.
Explanation of above:
10.
Number of missed flights this quarter.
11.
Why were there missed flights this quarter?
12.
For each patient above who was transferred out of TSA-D what was the determining diagnosis or factor that led to transfer out of TSA-D?
13.
NUMBER OF STROKE PATIENTS TRANSPORTED BY AIR MED TO A RAC-D FACILITY FROM SCENE?
14.
IF NOT WITHIN RAC-D, WHY AND WHERE?
15.
NUMBER OF STEMI PATIENTS TRANSPORTED BY AIR MED TO A RAC-D FACILITY FROM SCENE?
16.
IF NOT WITHIN RAC-D, WHY AND WHERE?
17.
**LEAVE THIS AREA BLANK IF YOU ARE NOT NEEDING THE PI COMMITTEE TO REVIEW A CHART**
Specific Occurrence Report
Age:
18.
Gender:
Male
Female
19.
Chart Identification #:
20.
Mechanism of Injury:
21.
Identified injuries and pertinent information:
22.
Patient Outcome:
23.
Reason for PI Committee Review
*PLEASE SEND INFORMATION WHEN DISCOVERED THROUGHOUT THE QUARTER SO REVIEW CAN BE STARTED PRIOR TO RAC MEETING*
SEND TO: thamilton@fishercountyhospital.com or denid@rpmh.net