EMSTrauma Performance

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EMS/Trauma Performance

• Healthcare Safety Net Initiatives Conference
• February 9, 2007
• Charles Begley and Munseok Seo for the H-GAC
  Emergency/Trauma Care Data Committee

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Project Background

• The H-GAC Emergency/Trauma Care Policy Council
  created 2003
• Members from 13 H/GAC counties in southeast Texas
  
• Emergency physicians, trauma surgeons, hospital
  administrators, EMS providers and representatives
  from the two local trauma regional advisory
  councils
• Mission
• Develop plans and policies for improving regional
  emergency/trauma care
• Create system for monitoring regional performance
• A data committee was charged to develop
  monitoring system
• HHSRC is supporting this effort

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Data Committee Activities

• Developing integrated database
• Hospital ER Visit data
• Texas Trauma Registry
• Texas Health Care Information Collection hospital
  discharge database
• EMSystem hospital diversion database. 
• Monitoring performance indicators
• Number and type of ER visits
• Hospital hours on diversion
• EMS response times and triage
• Trauma morbidity and mortality
• Changes in trauma system capacity
• Changes in the level of uncompensated care
• Conducting special studies
• ED algorithm study
• Impact of hospital diversion
• Relationship between trauma care capacity and
  outcomes

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Todays Presentation

• Monitoring data on
• Regional hospital diversion
• EMSystem data on the latest trends in hospital
  diversion
• Morbidity and mortality in Houston hospitals
• THCIC data on latest trends in trauma cases,
  morbidity, and mortality
• Patient triage in Houston hospitals
• THCIC data on latest trends in trauma patients
  being triaged to appropriate hospitals

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Hospital Diversion

• EMSystems data on hours that hospitals are on
• Divert unable to provide level of care demanded
  by trauma patients.
• Caution a shortage situation that should be
  noted but does not warrant Divert.
• ER Saturation ER heavily saturated and
  non-critical patients will have to wait an
  excessively long period of time.
• Examining these data for 2003-06, it is apparent
  that
• The overall amount of hospital diversion has
  stayed the same
• Diversion has gotten worse among Level I
  hospitals
• ER saturation diversion is rising less rapidly
  than total diversion

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Mortality and Morbidity

• THCIC hospital discharge data from 1999-2003
• Trauma cases are defined by ICD-9 Code
• Injury severity is measured by ISS score which is
  derived using the ICDMAP-90 software developed by
  MacKenzie
• Mortality is defined at discharge
• Examination of 99-03 trends indicate
• The number of Houston trauma cases declined
• The severity of cases is stable
• The mortality rate is rising, particularly for
  the most severe cases

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Triage

• THCIC hospital discharge data from 1999-2003
• Trauma cases are defined by ICD-9 Code
• ISS scores are derived using the ICDMAP-90
  software developed by MacKenzie
• Undertriage ISSgt16 treated at non-designated
  hospital
• Overtriage ISS 1-9 treated at Level I hospital
• Examination of the data indicate
• Undertriage is improving and approaching standard
• Overtriage is stable but not reaching standard

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Conclusion

• Hospital diversion continues at a high level
• ER saturation-caused diversion may be improving
  at Level Is
• Mortality is rising for most severe cases
• Related to high level of diversion, overtriage,
  other system and/or other pre-hospital/hospital
  factors?
• Undertriage is fairly good but overtriage may be
  a problem