Self-Assessment Survey: System Requirements

CATRAC has organized the DSHS Self-Assessment tool by four categories:

1. Emergency Healthcare Systems Plan

2. Research & Data

3. System Requirements

4. RAC Administrative requirements

The Self-Assessment tool has been broken into four surveys. You are currently taking the System Requirements portion of the Self-Assessment Survey.

The following survey is the exact language from the Self-Assessment tool presented by each category. My apologies. Please score each element according to service line using the 0-5 scale to the best of your ability. The accuracy of identifying gaps in the region relies on the accuracy of this survey.

Question Title

* First and last name

Question Title

* Agency/Facility

Question Title

* What service line are you representing? (check all that apply)

Prehospital- Ground Service Line

Prehospital- Air Medical Service Line

Hospital- Trauma Service Line

Hospital- Cardiac Service Line

Hospital- Stroke Service Line

Hospital- Perinatal Service Line

LTACH/Rehab/Psych/FSED/Specialty facility

Non-designated Hospital

Question Title

* Email address

Question Title

* Element 3: EPIDEMIOLOGY- RISK ASSESSMENT

Collaboration exists between the regional prehospital providers, designated facilities, other health care providers, local jurisdictions, identified public health officials, and regional trauma and emergency health care system leaders to complete trauma, perinatal, stroke, cardiac, and emergency healthcare risk assessments.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. No injury or disease risk assessments are conducted.

2. Regional trauma, perinatal, stroke, cardiac, and emergency healthcare system leaders conduct risk assessments; however, there is no involvement of EMS or public health officials in the assessment and the data is not current.

3. RAC leadership, along with regional trauma, prehospital, perinatal, stroke, cardiac, and emergency healthcare system stakeholders, and public health representatives assist with the completion of an injury and disease risk assessment.

4. In addition to #3, assist with the completion and analysis of a trauma, perinatal, stroke, cardiac, and emergency healthcare risk assessment to define regional priorities.

5. In addition to #4, the trauma and emergency healthcare risk assessments is utilized to identify determinants of care, patterns, and strategies to target prevention programs and public awareness campaigns using evidence-based approaches.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5

Question Title

* Element 6: SYSTEM PLAN

A regional trauma, prehospital, perinatal, stroke, cardiac, and emergency health care system plan is in place and is based on analysis of the regional demographics and assessments and provides opportunities for collaborative stakeholder participation. The regional plan reflects the regional activities specific to each of the self-assessment criteria.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. There is a documented outdated regional trauma and emergency health care system plan.

2. The RAC leadership is developing/revising a regional trauma, prehospital, perinatal, stroke, cardiac, and emergency health care system plan without reference to the regional demographics, resource assessments, data analyses, and regional stakeholder participation.

3. The RAC leadership, committees, and stakeholders are actively revising the regional trauma, prehospital, perinatal, stroke, cardiac, and emergency health care system plan based on regional demographics, resource assessments, data analyses, that aligns with the defined RAC criteria.

4. In addition to #3, the RAC identifies system priorities, timelines, and integrates public health into the revisions of the system plan.

5. In addition to #4, the emergency preparedness plans are integrated into the system plan. The plan and quarterly performance improvement data are shared with regional stakeholders, the business community, public health, local elected officials, and the department.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5

Question Title

* Element 11: SYSTEM PLAN

As part of the established standards, the region has defined the levels of training for all stakeholders and physicians who routinely participate in system performance improvement activities.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. Performance improvement training standards for stakeholders and physicians who routinely participate in the regional performance improvement activities are not defined.

2. There are opportunities for stakeholders and physicians to attend performance improvement education, but regional standards are not defined for participation in the system performance improvement process.

3. Regional educational standards for stakeholders and physicians who routinely participate in the system performance improvement activities are defined.

4. In addition to #3, education for system performance improvement participation in the region is fostered.

5. In addition to #4, the region has processes in place to foster new stakeholder participation in the system performance improvement activities have completed the training.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5

Question Title

* Element 13: SYSTEM INTEGRATION

There is a clearly defined, cooperative, and ongoing relationship between the trauma, prehospital, perinatal, stroke, cardiac, and emergency healthcare system specialty physician leaders.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. There is little evidence of physician integration into the regional care system.

2. There is no formally established, ongoing relationship between the trauma, prehospital, perinatal, stroke, cardiac, and emergency healthcare system medical directors; there is no evidence of informal efforts to cooperate and communicate.

3. There are established and ongoing relationships between the trauma, prehospital, perinatal, stroke, cardiac, and other emergency healthcare system medical directors established through the medical advisory structure outlined in the bylaws with minimal integration of specialty services such as neurosurgeons, neurologist, orthopedic surgeons, intensivist, behavioral health providers, and rehabilitation physicians to assist in defining regional guidelines and evidence based practice guidelines for patients served by the region.

4. In addition to #3, some specialty services are integrated to develop specific guidelines. This medical advisory structure outlined in the bylaws may be utilized to review cases referred to the performance improvement committees as necessary.

5. In addition to #4, strong integration of specialty services such as pediatric physicians, geriatricians, neurosurgeons, neurologist, orthopedic surgeons, intensivist, infectious disease physicians, behavioral health providers, and rehabilitation physicians to assist in defining regional guidelines and evidence-based practice guidelines for patients served by the region, when needed. Specialty service physicians are integrated into the development of specific guidelines of their specialty. This includes the integration of advanced practice providers.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5

Question Title

* Element 16: PREHOSPITAL

There is a regional understanding of the legal authority and responsibility for the EMS provider medical director. The RAC integrates this authority into the regional trauma and emergency health care system adopted guidelines.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. There is no relationship between the EMS medical directors and the regional prehospital protocols.

2. There are EMS medical directors; however, the individuals have no specific time allocated to support the regional medical advisory activities.

3. The regional plan defines an EMS medical director committee or an appropriate EMS medical advisory process with a written charge and responsibilities identified in the bylaws. This EMS advisory process is responsible for the regional prehospital guidelines and defining the prehospital performance improvement elements of review.

4. In addition to #3, this process is written in the regional bylaws and functions.

5. In addition to #4, there are written guidelines using evidence-based practice implemented which are monitored through the regional performance improvement process. These performance improvement reports are reviewed by the EMS medical advisory process to identify trends and opportunities for improvement, then shared in the regional annual report with regional stakeholders, local officials, and business community stakeholders.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5

Question Title

* Element 19: PREHOSPITAL

The region evaluates access to transportation resources and prehospital providers.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. There is no coordination of transportation resources within the region.

2. There is a system in place for sending transportation resources to the scene.

3. System capabilities are sufficient to routinely evaluate transport of the patient to the correct facility by the correct transportation mode, within the right time.

4. In addition to #3, outcome data for review is available or developing.

5. In addition to #4, the system has developed quarterly reports to review the performance improvement initiative related to prehospital transport to include outcome reviews.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5

Question Title

* Element 21: DEFINITIVE CARE FACILITIES

The regional trauma and emergency health care system identifies and tracks the number, levels, and distribution of designated facilities.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. There is no regional trauma and emergency health care system plan to identify and track the number, levels, and distribution of trauma centers for the system.

2. The regional trauma and emergency health care system plan does not identify or track the number, levels, or distribution of designated facilities for the region.

3. The regional trauma and emergency health care system plan uses national standards when available and regional information to identify and track the number, level of designation, and distribution of designated facilities within the region and integrates this information into the regional plan. For trauma designation, the American College of Surgeons’ Needs-Based Assessment of Trauma System (NBATS) Tool is used to assess the number of trauma centers needed per capita in the region.

4. In addition to #3, this information is integrated into the regional trauma and emergency healthcare system plan.

5. In addition to #4, this process evaluates rural facilities access to timely, transfer acceptance. This is monitored through the system performance improvement process.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5

Question Title

* Element 22: SYSTEM COORDINATION AND PATIENT FLOW

There are regional guidelines and expectations to expedite interfacility transfers of patients with acute trauma, maternal, neonatal, stroke, cardiac, and other time-sensitive disease processes.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. Regional processes to expedite interfacility transfers of acute patients are not in place.

2. The interfacility transfer guidelines and processes are defined by each facility, but no regional process is established.

3. Regional guidelines for interfacility transfer to expedite patients with acute trauma, maternal, neonatal, stroke, cardiac, and other time sensitive disease processes are established.

4. In addition to #3, these guidelines and processes are monitored through the system performance improvement process.

5. In addition to #4, the region has implemented a transfer coordinating center and measures to facilitate the sharing of patient images and patient records from the transferring facility to the receiving facility to expedite the accepting team’s decision-making. This may include telehealth and telemedicine capabilities. Software to track the transport agency's location and estimated time of arrival at the transferring facility is in place and integrated into the transfer decision scheme. These guidelines are monitored through the system performance improvement process to evaluate transfer timeliness, transport appropriateness, and monitor the “out of RAC” transfers. Performance improvement reports are shared quarterly with stakeholders. The medical advisory committee reviews all transfers delays.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5