Transcript Florida Trauma System

OFFICE OF TRAUMA
REPORT
October 29, 2010
Recognition
State Trauma Medical Director
Karanbir Gill, M.D.
State Trauma Medical Advisor
Patricia Byers, M.D.
2010 Session
Trauma System Legislative
Update
2010 Session
Trauma System Legislative
Update
• SB 768 Enrolled
Relating to Luis Rivera Ortega Street Racing Act
Status: Signed by the Governor on 6/3/2010.
Trauma System Legislative
Update
• HB 325 Enrolled
Uniform Traffic Control/Mark Wandall Traffic Safety
Program – Traffic Infraction Detectors
Status: The bill was signed in to law by the Governor on
5/13/2010. This bill provides additional funding for
Florida’s Trauma Centers. Rule Hearing scheduled for
October 13, 2010.
Trauma System Legislative
Update
Continued
HB 5311 Enrolled - Relating to Department of Health
Reorganization and Conforming Bill
Status: Approved by Governor on 5/28/2010. Office of
Trauma staff have been working with the department
leadership with specific assignments related to
restructuring and reorganization.
Rule Promulgation
• Apportionment of Trauma Centers within a Trauma Service Area
(TSA) – 64J-2.010, F.A.C. – . C. Rule hearing held October 13, 2010
• Surgical and Nonsurgical Specialists- Rule development workshop
held August , 2010
• Future rule development workshops to be held:
Trauma Center Application- 64J-2010, F.A.C. Rule language being
developed
2010 Trauma Center
Application Process
Applications Submitted 4/1/10
• Bay Medical Center, Level II (Withdrawn 9/2010)
• University of Miami Hospital, Level II (Withdrawn
4/12/10)
• Kendal Regional Medical Center, Level II
• Orange Park Medical Center, Level II
• Blake Medical Center, Level II
• Fort Walton Medical Center, Level II (Withdrawn
9/2010)
• Regional Medical Center Bayonette Point, Level II
Letter of Intent, Effective
10/1/10
Delray Medical Center – Level I
Saint Mary’s Medical Center- Level l
Bay Medical Center – Level ll
Ft Walton Beach Medical Center- Level ll
Major Accomplishments
1998 - Present
Injury Prevention:
• 282 prevention and outreach programs
• EMS grant funding was renewed to continue
implementing WalkSafe™, an evidenced
based program
Outcome: 21 trauma centers participated
• “Prom Night,” “Prom-Promise,” and Shattered
Dreams”
Outcome:
• In 1998, there were 50 deaths statewide on prom night.
• In 2006, 2007, 2008, 2009 and 2010 there were no deaths.
Major Accomplishments
1998 – Present
continued
Research:
Currently, there are approximately 235 research
projects, including pharmaceutical clinical trials;
Total: $288M
Major Accomplishments
1998 – Present
continued
New Programs and Studies:
• First Ventilator-Dependent Rehabilitation Program
May 2008
• Implementation of the Preventive Ulcer Program standards in
all 21 trauma centers 2009 – Present
• BSCIP Standards for Preventative Ulcer Program (PUP)
implemented – April 2009
Outcome: Third quarter statistics in 2010 with the
implementation of the program for Trauma and BSCIP
patients indicated a 10% decrease in pressure ulcers of spinal
cord patients.
Adopted in Rule – April, 2010
Major Accomplishments
1998 – Present
Continued
• Diaphragmatic Pacer Program
Outcome: First Diaphragmatic Pacing Surgery in Florida.
Implemented May 2009
YTD – 9 patients on program
Major Accomplishments
1998 – Present
Continued
• Trauma Centers Verified - two additional trauma centers
were verified in 2009 and 2010
• Legislatively Mandated Trauma Center Payments
• Funding Source - From 2005 to December 31, 2009, the
Office of Trauma had distributed a total of $20.6 million to
Florida’s trauma centers
• Improving Trauma Center Compliance - In 2007, the
Office of Trauma and the Brain and Spinal Cord Injury
Program conducted eight combined site surveys in 2007.
These combined surveys delivered a cost savings of
$45,000 per survey for the residents of Florida.
Major Accomplishments
1998 – Present
Continued
• Traumatic Brain Injury Grant Outcomes - Number of
registered nurses and other healthcare professionals
educated on the Mild TBI Curriculum from March 2004 to
December 2009: 8,100
• Mass Casualty Events and Mild TBI Grant Outcomes From the implementation of this grant in 2005 to
December 31, 2009, 4,125 emergency room nurses from
acute care hospitals and trauma centers have received the
training
Major Accomplishments
1998 – Present
Continued
HRSA / ASPR Burn Care Grants
• Bombs, Burns and Blast DVD Second Education - As
of December 2009, the 21 trauma centers and 60 nontrauma centers have used this DVD to train a total of
48,000 EMTs and paramedics, and 26,000 healthcare
providers.
• Phase II Burn Grant for Physician Training
• Phase III - Web-Based Training Program “Burn Center”
- Since the release of “Burn Center” video game in midOctober 2008, over 260 trauma physicians,
residents/fellows, and trauma nurses have completed the
training
Major Accomplishments
1998 – Present
Continued
Florida Trauma Telemedicine Networks
Implemented
• Phase I: In FY 2008-2009 - Phase I was completed in
2009, which linked two Level I trauma centers (Jackson
Memorial Hospital/Ryder Trauma Center and the Shands
at the University of Florida in Gainesville) with community
and rural hospital emergency rooms in each of their
respective trauma service areas
Major Accomplishments
1998 – Present
Continued
Florida Trauma Telemedicine Networks
Implemented
• Phase II - Orlando Regional Medical Center, Sacred Heart
Hospital and Tampa General Hospital are participating
trauma telemedicine centers in FY 2009-2010. This grant
also provided some limited sustainment funds for the
current participating facilities. Phase II has been
implemented in the Phase II trauma centers and in
additional rural facilities to each of the participating pilot
trauma centers established in Phase I
Major Accomplishments
1998 – Present
Continued
Florida Trauma Telemedicine Networks
Implemented
• Phase III - Link Lee Memorial, Tallahassee Memorial
Healthcare, and Holmes Regional Medical Center trauma
centers with their satellite community or rural hospitals
Major Accomplishments
1998 – Present
Continued
• American College of Surgeons’ Disaster Management
Course Implemented - Since the initiation of the course
in 2007, there have been a total of 18 classes conducted
throughout the state, educating approximately 450 health
care providers from the 21 trauma centers, and
approximately 19 other hospitals
• Trauma Transport Protocols Reviewed Annually – No
adverse outcomes from 2007 to 10/10
Major Accomplishments
1998 – Present
Continued
• Florida Department of Transportation Motorcycle
Safety Grant - The Office of Trauma was the recipient of a
$250,000 Florida Department of Transportation grant for a
statewide motorcycle safety education project through the
Florida's trauma centers from 10/10 through 10/11
Strategic Plan
• As of June, 2010, approximately 90% of the goals and
objectives of the current five-year strategic plan have been
accomplished
• Recognized the “Florida Trauma System Plan Committee”
to include additional partners and stakeholders needed to
complete the current plan and develop the next five-year
strategic plan
• Completed SWOT analysis – November 2009
• Strategic Planning Session was held on February 25, 2010
• Conference calls have been held from April – June to
review each goal, objectives, and strategies
• Strategic Plan reviewed and approved June 30, 2010
Sterling Scorecard
Evaluations
• The Office of Trauma staff has initiated benchmarks for
evaluating effectiveness based on Sterling models.
• These benchmarks include the following:
• product service outcomes
• access to trauma care
• trauma centers’ mandated quarterly data
• customer focused results
• financial market results
• human resources
• organizational effectiveness
• leadership and social responsibility
Indicators
Access to Trauma Care:
• Increase access to a trauma center for
definitive trauma care within the “Golden
Hour” to 99% of Florida’s population by 2010
Indicators
Continued
Trauma Centers’ Mandated Quarterly Data:
• The number of deaths . Outcome- Florida’s mortality rate has decreased from 6% in
2004 to 4.8 % in 2009.
• The number of unplanned, trauma-related re-admissions to the hospital within 30
days of discharge
• Outcome: JCAHO standard 3-4%, from -2007-2009- range 1.7%- 1.6%
• The number of unplanned admissions or re-admissions to an intensive care unit
• Outcome: JCAHO standard 4-5%, from 2007-2009- range 2.6-1.7%
Customer Focused Results:
• % satisfaction with site visit process – trauma centers (CEO, TMD, TPM)
• Outcome: overall satisfaction 95%, major request for change process included
electronic presurvey questionnaire was needed. This has been developed, and
implemented 8/2010.
• # complaints regarding trauma office 1/2010- present, no complaints reported
Indicators
Continued
Financial Market Results:
• Notification of spending plan completion
• % prompt payments - 99% - Office of Trauma
Human Resources:
• Turnover rate- 5%
Organizational Effectiveness
• % of trauma centers in compliance with standards (21
trauma centers)
• Registry minimum data set quality/completeness (DOH staff
send quarterly reports and reviews with trauma center staff)
Indicators
Continued
Leadership and Social Responsibility
• % compliance with strategic action plans (90%)
• % compliance with fiscal audits (100%)
• FDOT Grant of $107,000 deliverables for Motorcycle
Safety and Injury Prevention (100% compliance)
• ASPR funding for telemedicine , OR supplies/equipment
and ACS Disaster Course (100% compliance)
• HRSA Rural Health Grant for ACS Rural Health Course
( 100% Compliance)
Disaster Response
Operation Haiti
Disaster Response
Operation Haiti
Lessons Learned
• Telemedicine was effective and efficient for patient
transport
• 519 patients transported from Haiti to trauma centers
and acute care hospitals
• No reported patient deaths while being transported
Contact Information
Office of Trauma Website:
http://www.doh.state.fl.us/demo/Trauma
State Trauma Medical Director:
Karanbir Gill, M.D., F.A.C.S.
2005 – 2010 Trauma State Plan update
reports by planning teams
Goal 1
Leadership
Executive Committee of the Florida Trauma System
Plan Committee
Membership
DOH Trauma Leadership Team
State Trauma Medical Director
State Trauma Medical Advisor
Chair (FTSPC)
Vice Chair (FTSPC)
Planning team leads
Goal 2
Injury Prevention and Control
Lead:
Olumide Sobowale, M.D.
Goal 3
Disaster Response:
Emergency/ Disaster Preparedness Planning
Lead:
Dr. John Armstrong – MCI
Co-Leads:
Dr. Eric Frykberg - Mass Casualty & Training
Dr. David Mozingo - Burn Care
Dr. Antonio Marttos - Telemedicine
Goal 4
Pre-Hospital Care and
Transport
Co-Leads:
Dr. Joseph Nelson, Dr. Laurie Romig, and
Dr. Andrew Kerwin
Goal 5
Trauma Center Care
Lead:
Patricia Byers, M.D.
Standards
Lead:
Ernest Block, M.D.
Goal 6
Rehabilitation:
Medical Rehabilitation for Trauma Patients
Co-Leads:
Dr. Gillian Hotz
Dr. Cynthia Beaulieu
Dr. John Kuluz
Goal 7
Quality Improvement
Lead:
Lianne Brown, R.N., M.B.A.
Staff Liaisons
Dianna Liebnitzky
Michael Lo
Carma Harvey
Goal 8
System Evaluation
Leads:
Dr. Rodney Durham – Systems Evaluations
Dr. Lawrence Lottenberg – Systems Evaluations
Dr. Karanbir Gill – Rural Trauma Health
Dr. Winston Richards – Hand Surgery
Goal 9
Trauma Registry/Research
Co-Leads:
Dr. Joseph Tepas
Dr. Drew Mikulaschek
Dr. Carl Schulman
Trauma Registry Consultants:
Barbara Orban, Ph.D., Etienne Pracht, Ph.D, and
Pam Pieper, Ph.D.
Next Generation Trauma Registry
(NGTR)
Project Update
9/6/2010
Receive Test Files
in New File Format
per FTR 2008
from Vendors for
2009-2010
Submissions
NGTR
11/9/2010
Complete
Testing
of New
File Format
NGTR Target
Database
2009 & 20010 File
Submissions
Current
Trauma
Registry
State
8/8/2010
Test
Imports
for
Data
Warehouse per
2009-2010
Submissions
6/1/2010
Develop imports for
Data Warehouse
2009-2010
Submissions
1/18/2011
Submit F.A.C
Rule Change
for XML-based
NGTR Data
Dictionary 2011
10/20/2010
Complete review
of Draft
NGTR
Data Dictionary
2011;
Design XML
12/29/2010
Load Data into
Data Warehouse;
Begin Data
Verification
Interim
Trauma
Registry
Solution
Long
Term
Trauma
Registry
Solution
3/10/2011
F.A.C
Rule Change
In Effect
for XML-based
NGTR Data
Dictionary 2011
4/4/2011
Approve data
in Data
Warehouse;
Promote
Data Warehouse
to Production
Improved Data
Quality
Efficient Manual
Imports
5/24/2011
Develop
Cubes in
Data
Warehouse
NGTR Target
Database
7/20/2011
Evaluate
Cubes
2011 File
Submissions
Improved Data
Quality
7/13/2010
Evaluate
RFI
Responses
10/10/2010
Complete
Business
Case
12/3/2010
Complete
Business
And
System
Analysis
for
Procurement
Solution
3/1/2011
Begin
Implementation
of Solution
Automated
Imports
9/1/2011
NGTR
Go-Live
2/15/2011
Procurement
Completed
for
Solution
8/1/2011
Begin
Testing
Solution
11/1/2010
Update
Governance
Business Case
Architecture
Funding
Planning
Implementation
7/1/2010
6/1/2010
10/1/2010
1/1/2011
4/1/2011
7/1/2011
10/1/2011
11/1/2011
Current State
• Current Pain Points
– Lack of standardization of file formats between:
•
•
•
•
•
NTRACS (11 trauma centers)
TraumaOne (8 trauma centers)
TraumaBase (1 trauma center)
TraumaBridge (1 trauma center)
Custom (1 trauma center)
– Overwhelming number of files to integrate each year
• NTRACS: __T, __PRE, __DAG, __USE, etc. x 11 TC x 4 quarters
• TraumaOne: up 5 Excel tabs in state dumps x 8 TC x 4 quarters
• Patient Age, LOS, etc. can be numeric in one quarter, alpha in
another – these fields must be standardized before integration
• Pain Points must be addressed to enable:
– More efficient calculation of ICISS for payments
– Release of raw data for research/analysis, QI, grants, etc
– Linkage to other data: EMS, BSCIP, AHCA, DHSMV, etc.
Major Actions/Accomplishments
• Since July 2010:
– Interim Solution (to address current pain points)
• Performed initial testing of standardized file submission
formats for files submitted in 2009 and 2010 from vendors/TC
• Completed review of sections within draft of FL Trauma
Registry (FTR) Data Dictionary 2011 with FL Trauma Data
Group
• Designed NGTR SQL database in DOH DEMO Enterprise
Data Warehouse
• Developed imports of files into DOH DEMO Enterprise Data
Warehouse for each file format (NTRACS, TraumaOne, etc.)
– Long-Term Solution (to better meet trauma needs)
• Buy vs. Build: Determination to Buy the Solution
– Evaluated vendor responses to Request for Information (RFI) for
potential trauma registry software applications for NGTR
– Reviewed software product demonstrations by vendors
– Contacted peer state organizations for advice/vendor references
• Completed initial draft of core Business Case for review and
approval by DOH IT Governance Committee
Interim Solution
• Scope of 1st phase (Development)
– In-Progress
• Integration and testing of imports
• Basic validation reports
• Estimated completion: January 2011
• Scope of 2nd phase (Linkage evaluation - Not yet started)
•
•
•
•
•
Evaluation of data quality
Analysis of linkage to EMS
Development of linkage reports and cubes for aggregate reporting
Development of imports for NGTR XML files to be submitted in 2011
Estimated completion: July 2011
Long-Term Solution
• Planning Phase
– In-Progress
• Completion of Business and System analysis for Business
Case
• Development of Invitation to Negotiate (ITN) requirements
• Estimated Completion of Planning Phase: May 2011
Next Steps
• October 2010
– Imports for 2009-2010 data completed for DOH DEMO
Enterprise Data Warehouse
• January 2011
– Trauma data loaded for 2009-2010 DOH DEMO Enterprise
Data Warehouse
• Testing of imports
– Design of XML schema for FTR 2011 XML Data Dictionary
– ITN advertised
• March 2011
– ITN awarded
– Rule change completed for FTR 2011 XML Data Dictionary