Copy of Emergency Dept. Transfer Communication Tool 4Q2016

Emergency Department Transfer Communication Data (EDTC)

The Federal Office of Rural Health Policy asks for completion of 45 records, no more than that or total number of transfers if not equaling 45. Please input the data from your EDTC Hospital Report into the boxes below. Remember to use the numerator (N) and NOT the percentage when entering data. No entry should be greater than 45 and no letters, decimals or percentages.

There are additional resources on the ICAHN Home Page under the Resource tab: www.icahn.org/resources/mbqip

Thank you in advance,

Angie

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* 1. Hospital Data

Hospital Name

CCN Number (6 digits)

Person Entering Data

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* 2. Number Records Reviewed (Required N=45 or all transfers in this quarter)

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* 3. EDTC-1: Administrative Data

1. Nurse to Nurse Communication

2. Physician to Physician Communication

All EDTC-1 Data Elements

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* 4. EDTC-2 Patient Information

1. Patient Name

2. Patient Address

3. Patient Age

4. Patient Gender

5. Patient Contact Information

6. Patient Insurance Inforamtion

All EDTC-2 Data Elements

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* 5. EDTC-3 Vital Signs

1. Pulse

2. Respiratory Rate

3. Blood Pressure

4. Oxygen Saturation

5. Temperature

6. Neurological Assessment

All EDTC-3 Data Elements

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* 6. EDTC-4 Medication Information

1. Medications Given in ED

2. Allergies/Reactions

3. Medication History

All EDTC-4 Data Elements

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* 7. EDTC-5 Physician/Practitioner Generated Information

1. History and Physical

2. Reason for Transfer/Plan of Care

All EDTC-5 Data Elements

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* 8. EDTC-6 Nurse Generated Information

1. Nursing Notes

2. Sensory Status

3. Catheters/IV

4. Immobilizations

5. Respiratory Support

6. Oral Restrictions

All EDTC-6 Data Elements

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* 9. EDTC-7 Procedures and Tests

1. Tests/Procedures Performed

2. Tests/Procedures Results

All EDTC-7 Data Elements

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* 1. Hospital Data

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* 2. Number Records Reviewed (Required N=45 or all transfers in this quarter)

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* 3. EDTC-1: Administrative Data

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* 4. EDTC-2 Patient Information

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* 5. EDTC-3 Vital Signs

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* 6. EDTC-4 Medication Information

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* 7. EDTC-5 Physician/Practitioner Generated Information

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* 8. EDTC-6 Nurse Generated Information

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* 9. EDTC-7 Procedures and Tests

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* 10. All EDTC Measures