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Performance Improvement Hospital

*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.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 trauma patients transferred to hospitals outside of RAC-D this quarter.
8.Why was the patient transferred out of the RAC-D area?
9.Number of trauma patients with ISS of 9 or less transferred for higher level of care > 2 hours after arrival this quarter
10.Number of severe trauma patients with penetrating injury and ISS of 10 or higher
11.Number of severe trauma patients with penetrating injury and ISS od 10 or higher with transfer log > 2 hours
12.Number of severe trauma patients with blunt trauma and ISS of 10 or higher
13.Number of severe trauma patients with blunt trauma and ISS of 10 or higher with transfer log of > 2 hours
14.Number of severe trauma patients with second or third degree burns and ISS of 10 or higher
15.Number of severe trauma patients with second or third degree burns and ISS of 10 or higher with transfer log of > 2 hours
16.Number of transfer delays due to EMS Transportation
17.Number of transfer delays due to bed availability
18.Other (list out other reasons for delay
19.Number of trauma related pediatric activations.
20.Number of trauma transfer denials (denied acceptance for transfer from your facility)
21.Number of transfer denials due to bed availability
22.Number of transfer denials due to specialty unavailable
23.Other (list out reasons for denial)
24.Number of trauma transfers from your facility whose acceptance time exceeds 30 minutes
25.Number of non ICU trauma admits (> 24 hours) to your facility this quarter.
26.Number of trauma patients admitted to your ICU this quarter
27.Number of trauma admissions with ISS > 9 this quarter.
28.Number of trauma-related deaths with opportunity for improvement this quarter.
29.Number of trauma-related deaths without opportunity for improvement this quarter
30.Number of patients admitted from the ER directly to the OR this quarter
31.How many Stroke transfers were sent to hospitals outside of the RAC-D area?
32.Why were they sent outside of the RAC-D area?
33.Was LYTIC given?
34.Was LYTIC given in less than 60 minutes?
35.If delayed, was the reason for delay, patient centered
36.HOW MANY STEMI TRANSFERS WERE TRANSFERRED TO HOSPITALS OUTSIDE OF RAC-D?
37.WAS LYTIC GIVEN PRIOR TO TRANSFER?
38.IF NEEDING RAC-PI TO REVIEW A CHART, PLEASE COMPLETE INFORMATION BELOW.
Age:
39.Gender:
40.No Names - Chart Identification #:
41.Mechanism of Injury:
42.Identified injuries and pertinent information:

43.Patient Outcome:
44.REASON FOR RAC 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