Performance Improvement Hospital Question Title * 1. Quarter Reporting Jan - Mar Apr - June July - Sept Oct - Dec Question Title * 2. Name of Entity: Question Title * 3. Person Completing Report: Question Title * 4. Number of Trauma Patients sedated in the field with mechanism of injury conducive for head injury? Question Title * 5. Did any of the patients sedated pre-hospital require additional testing or hospitalization due to sedation? Yes No Question Title * 6. Diversion:# of diversion occurrences this quarter Question Title * 7. Total # of hours on diversion this quarter. Question Title * 8. Number of patients that met the RAC-D definition of “Major Trauma” that were transferred to hospitals outside of RAC-D this quarter. Question Title * 9. 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? Question Title * 10. Trauma patient transferred for higher level of care > 2 hours after arrival this quarter. Question Title * 11. Performance Improvement Criteria / IndicatorsNumber of trauma related pediatric resuscitations. Question Title * 12. Number of trauma transfer denials this quarter from lead facility. (Transfers out) Question Title * 13. If transfer wasn't denied but delayed acceptance how long was the delay for each patient (for each patient list time) Question Title * 14. If transfer was denied above, why? (List out denial reason for each) Question Title * 15. Number of trauma admits (> 24 hours) to your facility this quarter. Question Title * 16. Number of trauma admissions with ISS > 9 this quarter. Question Title * 17. Number of trauma related deaths at your facility this quarter. Question Title * 18. Number of non-preventable trauma deaths this quarter. Question Title * 19. Number of potentially preventable trauma deaths this quarter. Question Title * 20. Number of preventable trauma deaths this quarter. Question Title * 21. Number of trauma patients admitted to your ICU this quarter. Question Title * 22. Specific Occurrence ReportAge: Question Title * 23. Gender: Male Female Question Title * 24. Chart Identification #: Question Title * 25. Mechanism of Injury: Question Title * 26. Identified injuries and pertinent information: Question Title * 27. Patient Outcome: Question Title * 28. Provider Discussion: Question Title * 29. Contributing Factors Inadequate system guidelines/ protocols Multiple patients Extrication Hospital diversion Other (please specify) Done