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Performance Improvement Hospital

1.Quarter Reporting
2.Name of Entity:
3.Person Completing Report:
4.Number of Trauma Patients sedated in the field with mechanism of injury conducive for head injury? 
5.Total number of diversion occurrences for your facility this quarter
6.Total number of hours on diversion for your facility this quarter.
7.Number of patients that met the RAC-D definition of “Major Trauma” that were transferred to hospitals outside of RAC-D this quarter.
8.Trauma patient transferred for higher leve of care > 2 hours after arrival this quarter
9.Number of transfer delays due to EMS Transportation
10.Number of transfer delays due tobed availability
11.Other (list out other reasons for delay
12.Number of trauma related pediatric resuscitations.
13.Number of trauma transfer denials (denied acceptance for transfer from your facility)
14.Number of transfer denials due to bed availability
15.Number of transfer denials due to speciality unavailable
16.Other (list out reasons for denial)
17.Number oftrauma transfers from your facility whoe acceptance time exceeds 30 minutes
18.Number of trauma admits (> 24 hours) to your facility this quarter.
19.Number of traumapatients admitted to your ICU this quarter
20.Number of trauma admissions with ISS > 9 this quarter.
21.Number of trauma related deaths at your facility this quarter.
22.Number of trauma-related deaths with opportunity for improvement this quarter.
23.Number of trauma-related deathes without opportunity for improvement this quarter
24.Number of patients admitted from the ER directly to the OR this quarter
25.Patient Care to be Reviewed by RAC-D PI Committee:
Age:
26.Gender:
27.Chart Identification #:
28.Mechanism of Injury:
29.Identified injuries and pertinent information:

30.Patient Outcome:
31.Reason for RAC-D PI Review:
32.Contributing Factors: