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