Trauma Center Requirements, Process for the Approval of Trauma Centers, Extension of Application Period, Certificate of Approval, Process for Renewal of Trauma Centers, Site Visits and Approval, Application by Hospital Denied Approval
DEPARTMENT OF HEALTH
Division of Environmental HealthRULE NO: RULE TITLE
64E-2.023: Trauma Center Requirements
64E-2.024: Process for the Approval of Trauma Centers
64E-2.025: Extension of Application Period
64E-2.026: Certificate of Approval
64E-2.027: Process for Renewal of Trauma Centers
64E-2.028: Site Visits and Approval
64E-2.029: Application by Hospital Denied ApprovalNOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 33 No. 39, September 28, 2007 issue of the Florida Administrative Weekly.
The following changes have been made to the Florida Trauma Center Standards, Department of Health Pamphlet 150-9, which is incorporated by reference in the above referenced rules, based on comments received prior to or during the October 29, 2007 and the January 3, 2008 hearings. A complete copy of the January 2008 Pamphlet 150-9 can be found on the following website: http://www.doh.state.fl.us/demo/Trauma/notices.htm under “Notices and Upcoming Events.”
Chapter One – Definitions
Trauma Nursing Core Course (TNCC): A course developed and presented by the Emergency Nurses Association that in part will meet the minimum educational standard for a nurse requiring trauma specific education
Chapter Two
Standard II – Trauma Service
B. Administrative Requirements
7. The hospital submits trauma data to the state Division of Emergency Medical Operations, Office of Trauma, trauma registry program in accordance with “The Florida Trauma Registry Manual,” December 2005, adopted by reference in Rule 64E-2.018, Florida Administrative Code.
Chapter Three
Standard II – Trauma Service
B. Administrative Requirements
7. The hospital submits trauma data to the state Division of Emergency Medical Operations, Office of Trauma Bureau of EMS trauma registry program in accordance with “The Florida Trauma Registry Manual,” December 2005, adopted by reference in Rule 64E-2.018, Florida Administrative Code.
Chapter Four
Standard II – Trauma Service
B. Administrative Requirements
7. The hospital submits trauma data to the state Division of Emergency Medical Operations, Office of Trauma Bureau of EMS trauma registry program in accordance with “The Florida Trauma Registry Manual,” December 2005, adopted by reference in Rule 64E-2.018, Florida Administrative Code.
Chapters Two, Three and Four
Standard XVI – Psychosocial Support Systems
C. Drug and alcohol counseling and referral services shall be available for patients who are admitted into the trauma service and their families for patients and their families.
Chapter Two
Standard XIX – Trauma Research
A. The trauma service shall conduct ongoing clinical and research programs in trauma patient care and a Level I trauma center program must have:
1. Three articles published in a 3-year period. These articles must result from work related to the trauma center. Of the three articles, at least 1 must be authored or coauthored by members of the general surgery trauma team. Trauma–related articles co-authored by members of other disciplines or work done in collaboration with other trauma centers; sub-specialists involved in trauma care for examples: neurosurgery, emergency medicine, orthopaedics, radiology, anesthesia, and rehabilitation; and participation in multicenter investigations may be included in the remainder, and
The following technical changes have been made to the text of the proposed rules to reference the definition of “department”, which can be found in subsection 64E-2.001(8), F.A.C. The definition for “department” provides the address where documents incorporated by reference in the proposed rules can be obtained. Also, the date of the Trauma Center Standards – DH Pamphlet 150-9 has been changed to January 2008 due to the above changes requested prior to or during the January 3, 2008 hearing.
THE FULL TEXT OF THE PROPOSED RULES IS:
64E-2.023 Trauma Center Requirements.
(1) The standards for Level I, Level II and Pediatric trauma centers are published in DH Pamphlet (DHP) 150-9, January 2008 December 2004, which is incorporated by reference and available from the department, as defined by subsection 64E-2.001(8), F.A.C. Trauma centers must be in full compliance with these standards by January 1, 2009 July 1, 2000.
(2) To be a Level I trauma center, a hospital shall be a state licensed general hospital and shall:
(a) Meet and maintain after receiving provisional status and during the 7 year approval period the standards for a Level I trauma center as provided in DHP 150-9, January 2008 December 2004;
(b) through (d) No change.
(3) To be a Level II trauma center, a hospital shall:
(a) Meet and maintain after receiving provisional status and during the 7 year approval period the standards for a Level II trauma center, as provided in DHP 150-9, January 2008 December 2004;
(b) through (d) No change.
(4) To be a pediatric trauma center, a hospital shall:
(a) Meet and maintain after receiving provisional status and during the 7 year approval period the standards for a pediatric trauma center, as provided in DHP 150-9, January 2008 December 2004;
(b) through (d) No change.
(5) The standards published in DHP 150-9, January 2008 December 2004, are subject to revision at any time through rule promulgation. Any hospital that has been granted Provisional trauma center status or has been granted a 7 year Certificate of Approval as a trauma center shall comply with all revisions to the standards published in DHP 150-9, beginning on the date the amended rule becomes effective.
Specific Authority 395.405 FS. Law Implemented 395.401, 395.4015, 395.402, 395.4025, 395.404, 395.4045, 395.405 FS. History–New 8-3-88, Amended 12-10-92, 12-10-95, Formerly 10D-66.108, Amended 8-4-98, 2-20-00, 6-3-02, 6-9-05,________.
64E-2.024 Process for the Approval of Trauma Centers.
(1) through Table VII – Process for Approval of Trauma Centers.
(a) The department shall accept a letter of intent, DH Form 1840, January 2008 December 2004, “Trauma Center Letter of Intent”, which is incorporated by reference and available from the department, as defined by subsection 64E-2.001(8), F.A.C., postmarked no earlier than September 1 and no later than midnight, October 1, from any acute care general or pediatric hospital. The letter of intent is non-binding, but preserves the hospital’s right to submit an application by the required due date if an available position, as provided in Rule 64E-2.022, F.A.C., exists in the hospital’s TSA. If the hospital does not submit an application by April 1 of the following year, the hospital’s letter of intent is void;
(b) By October 15, the department shall send to those hospitals submitting a letter of intent an application package which will include, as a minimum, instructions for submitting information to the department for selection as a trauma center, DHP 150-9, January 2008 December 2004, Trauma Center Standards, which is incorporated by reference in Rule 64E-2.023, F.A.C. and available from the department, as defined by subsection 64E-2.001(8), F.A.C., and the requested application(s);
(c) No change.
1. To apply for approval as a Level I Trauma Center, applicants must submit all forms contained in the Level I Trauma Center Application Manual, January 2008 December 2004. The manual and the forms contained therein are incorporated by reference and available from the department, as defined by subsection 64E-2.001(8), F.A.C. The manual contains the following forms: DH Form 2032, January 2008 December 2004, General Information for Level I Trauma Center Application; DH Form 2032-A, January 2008 December 2004, Level I Trauma Center Approval Standards Summary Chart; DH Form 2032-B, January 2008 December 2004, Application for Level I Trauma Center Approval Letter of Certification; DH Form 2032-C, January 2008 December 2004, Level I Trauma Center Surgical Specialties Certifications; DH Form 2032-D, January 2008 December 2004, Level I Trauma Center Non-Surgical Specialties Certifications; DH Form 2032-E, January 2008 December 2004, Level I Trauma Center General Surgeons Commitment Statement; DH Form 2032-F, January 2008 December 2004, Level I Trauma Center General Surgeons Available for Trauma Surgical Call; DH Form 2032-G, January 2008 December 2004, Level I Trauma Center Neurosurgeons Available for Trauma Surgical Call; DH Form 2032-H, January 2008 December 2004, Level I Trauma Center Neurological, Pediatric Trauma and Neurological, and Neuroradiology Statements; DH Form 2032-I, January 2008 December 2004, Level I Trauma Center Surgical Specialists On Call and Promptly Available; DH Form 2032-J, January 2008 December 2004, Level I Trauma Center Emergency Department Physicians; DH Form 2032-K, January 2008 December 2004, Level I Trauma Center Anesthesiologists Available for Trauma Call; DH Form 2032-L, January 2008 December 2004, Level I Trauma Center C.R.N.A.s Available for Trauma Call; and DH Form 2032-M, January 2008 December 2004, Level I Trauma Center Non-Surgical Specialists On Call and Promptly Available.
2. To apply for approval as a Level II Trauma Center, applicants must submit all forms contained in the Level II Trauma Center Application Manual, January 2008 December 2004. The manual and the forms contained therein are incorporated by reference and available from the department, as defined by subsection 64E-2.001(8), F.A.C. The manual contains the following forms: DH Form 2043, January 2008 December 2004, General Information for Level II Trauma Center Application; DH Form 2043-A, January 2008 December 2004, Level II Trauma Center Approval Standards Summary Chart; DH Form 2043-B, January 2008 December 2004, Application for Level II Trauma Center Approval Letter of Certification; DH Form 2043-C, January 2008 December 2004, Level II Trauma Center Surgical Specialties Certifications; DH Form 2043-D, January 2008 December 2004, Level II Trauma Center Non-Surgical Specialties Certifications; DH Form 2043-E, January 2008 December 2004, Level II Trauma Center General Surgeons Commitment Statement; DH Form 2043-F, January 2008 December 2004, Level II Trauma Center General Surgeons Available for Trauma Surgical Call; DH Form 2043-G, January 2008 December 2004, Level II Trauma Center Neurosurgeons Available for Trauma Surgical Call; DH Form 2043-H, January 2008 December 2004, Level II Trauma Center Neurological, Pediatric Trauma and Neurological, and Neuroradiology Statements; DH Form 2043-I, January 2008 December 2004, Level II Trauma Center Surgical Specialists On Call and Promptly Available; DH Form 2043-J, January 2008 December 2004, Level II Trauma Center Emergency Department Physicians; DH Form 2043-K, January 2008 December 2004, Level II Trauma Center Anesthesiologists Available for Trauma Call; DH Form 2043-L, January 2008 December 2004, Level II Trauma Center C.R.N.A.s Available for Trauma Call; and DH Form 2043-M, January 2008 December 2004, Level II Trauma Center Non-Surgical Specialists On Call and Promptly Available.
3. To apply for approval as a Pediatric Trauma Center, applicants must submit all forms contained in the Pediatric Trauma Center Application Manual, January 2008 December 2004. The manual and the forms contained therein are incorporated by reference and available from the department, as defined by subsection 64E-2.001(8), F.A.C. The manual contains the following forms: DH Form 1721, January 2008 December 2004, General Information for Pediatric Trauma Center Application; DH Form 1721-A, January 2008 December 2004, Pediatric Trauma Center Approval Standards Summary Chart; DH Form 1721-B, January 2008 December 2004, Application for Pediatric Trauma Center Letter of Certification; DH Form 1721-C, January 2008 December 2004, Pediatric Trauma Center Surgical Specialties Certifications; DH Form 1721-D, January 2008 December 2004, Pediatric Trauma Center Non-Surgical Specialties Certifications; DH Form 1721-E, January 2008 December 2004, Pediatric Center General Surgeons Commitment Statement; DH Form 1721-F, January 2008 December 2004, Pediatric Trauma Center General Surgeons Available for Trauma Surgical Call; DH Form 1721-G, January 2008 December 2004, Pediatric Trauma Center Neurosurgeons Available for Trauma Surgical Call; DH Form 1721-H, January 2008 December 2004, Pediatric Trauma Center Neurological, Pediatric Trauma and Neurological, and Neuroradiology Statements; DH Form 1721-I, January 2008 December 2004, Pediatric Trauma Center Surgical Specialists On Call and Promptly Available; DH Form 1721-J, January 2008 December 2004, Pediatric Trauma Center Emergency Department Physicians; DH Form 1721-K, January 2008 December 2004, Pediatric Trauma Center Anesthesiologists Available for Trauma Call; DH Form 1721-L, January 2008 December 2004, Pediatric Trauma Center C.R.N.A.s Available for Trauma Call; and DH Form 1721-M, January 2008 December 2004, Pediatric Trauma Center Non-Surgical Specialists On Call and Promptly Available.
(d) After considering the results of the local or regional trauma agency’s recommendations, the department shall, by April 15, conduct a provisional review to determine completeness of the application and the hospital’s compliance with the standards of critical elements for provisional status. The standards of critical elements for provisional review for Level I and Level II trauma center applications are specified in DHP 150-9, January 2008 December 2004, as follows:
Level I
STANDARD
I. through XVIII.; No change
XIX. Trauma Research: B;.
XX. Disaster Planning and Management.
Level II
STANDARD
I. through XVII. Outreach Programs: B, C, and E; No change.
XVIII. Quality Management: A through H;.
XIX. Disaster Planning and Management.
Pediatric
STANDARD
I. Administrative: A, E, and F; through XVIII. Quality Management: A through H; No change.
XIX. Trauma Research: B;.
XX. Disaster Planning and Management.
(e) through (m) No change.
Specific Authority 395.405 FS. Law Implemented 395.1031, 395.401, 395.4015, 395.402, 395.4025, 395.404, 395.4045, 395.405 FS. History–New 8-3-88, Amended 12-10-92, 12-10-95, Formerly 10D-66.109, Amended 8-4-98, 2-20-00, 6-3-02, 6-9-05,________.
64E-2.025 Extension of Application Period.
(1) No change.
(2) To be considered for an extension, a hospital must submit an application in accordance with the requirements in Rule 64E-2.024, F.A.C., together with a request for extension. The request for extension must contain the following:
(a) The specific date the hospital desires to have the department begin the provisional review of the hospital’s application;
(b) A reference to each standard, or specific part of a standard, in DHP 150-9, January 2008 December 2004, Trauma Center Standards, which is incorporated by reference in Rule 64E-2.023, F.A.C. and available from the department, as defined by subsection 64E-2.001(8), F.A.C., that the hospital is unable to meet;
(c) through (14) No change.
Specific Authority 395.405 FS. Law Implemented 395.401, 395.4015, 395.402, 395.4025, 395.404, 395.4045, 395.405 FS. History–New 12-10-92, Amended 12-10-95, Formerly 10D-66.1095, Amended 8-4-98, 2-20-00, 6-3-02, 6-9-05,________.
64E-2.026 Certificate of Approval.
Each hospital approved as a trauma center shall be issued a DH Form 2032-Z, January 2008 December 2004, Level I Trauma Center Certificate of Approval, DH Form 2043-Z, January 2008 December 2004, Level II Trauma Center Certificate of Approval, or DH Form 1721-Z, January 2008 December 2004, Pediatric Trauma Center Certificate of Approval, which are incorporated by reference and available from the department, as defined by subsection 64E-2.001(8), F.A.C. The certificates shall include:
(1) The date effective and the date of termination;
(2) The hospital’s name; and
(3) The approved trauma center level.
Specific Authority 395.4025, 395.405 FS. Law Implemented 395.401, 395.4015, 395.402, 395.4025, 395.404, 395.4045, 395.405 FS. History–New 8-3-88, Amended 12-10-92, Formerly 10D-66.110, Amended 2-20-00, 4-15-01, 6-9-05,________.
64E-2.027 Process for Renewal of Trauma Centers.
(1) At least 14 months prior to the expiration of the trauma center’s certification, the department shall send, to each trauma center that is eligible to renew, a blank DH Form 2032R, January 2008 December 2004, Trauma Center Application to Renew, which is incorporated by reference and available from the department, as defined by subsection 64E-2.001(8), F.A.C., in accordance with the provisions of this section. Within 15 calendar days after receipt, the trauma center choosing to renew its certification shall submit to the department the completed DH Form 2032R, January 2008 December 2004.
(2) All renewing trauma centers shall receive an on-site survey after the department’s receipt of the completed DH Form 2032R, January 2008 December 2004. The department shall notify each trauma center of the results of the site survey within 30 working days from completion of the site survey. If the trauma center desires to provide additional information regarding the results of the site survey to the department to be considered, the information must be provided in writing and be received by the department within 30 calendar days of the hospital’s receipt of the department’s notice. If the trauma center elects not to respond to the department’s notice within 30 calendar days, the department shall make the final determination of approval or denial based solely on information collected during the applicant’s site survey.
(3) through (4) No change.
Specific Authority 395.4025, 395.405 FS. Law Implemented 395.401, 395.402, 395.4025, 395.404, 395.4045, 395.405 FS. History–New 8-3-88, Amended 12-10-92, 1-23-96, Formerly 10D-66.111, Amended 3-15-98, 2-20-00, 6-9-05,________.
64E-2.028 Site Visits and Approval.
(1) Each Provisional trauma center shall receive an on-site evaluation to determine whether the hospital is in substantial compliance with standards published in DHP 150-9, January 2008 December 2004, Trauma Center Standards, which is incorporated by reference in Rule 64E-2.023, F.A.C. and available from the department, as defined by subsection 64E-2.001(8), F.A.C., and to determine the quality of trauma care provided by the hospital.
(2) through (3) No change.
(4) The reviewers shall assess each applicant hospital’s compliance with the standards published in DHP 150-9, January 2008 December 2004, by means of direct observation, review of call schedules, and review of patient charts. Reviewers also shall assess the quality of trauma patient care and trauma patient management by reviewing facility trauma mortality data, by reviewing patient charts and by reviewing trauma case summaries and minutes of trauma quality management committee meetings pursuant to Standard XVIII of DHP 150-9, January 2008 December 2004.
(5)(a) through (b) No change.
(c) Patient charts to be reviewed shall be selected by the department from cases meeting the criteria listed in Standard XVIII B.2., published in DHP 150-9, January 2008 December 2004. A minimum of 75 cases shall be selected for review in each facility. If the cases total less than 75, then all cases are subject to review.
(6) The reviewers shall rate a Provisional trauma center which they have reviewed as either acceptable, acceptable with corrections, or unacceptable. The rating shall be based on each facility’s substantial compliance with the standards published in DHP 150-9, January 2008 December 2004, and upon the performance of each Provisional trauma center in providing acceptable trauma patient care and trauma patient management which resulted in acceptable patient outcomes. (d) through (e) No change.
(7) through (12) No change.
Specific Authority 395.4025, 395.405 FS. Law Implemented 395.401, 395.4015, 395.402, 395.4025, 395.404, 395.4045, 395.405 FS. History–New 8-3-88, Amended 12-10-92, 10-2-94, 12-10-95, Formerly 10D-66.112, Amended 8-4-98, 2-20-00, 6-3-02, 6-9-05, ________.
64E-2.029 Application by Hospital Denied Approval.
Any hospital that was not approved as a trauma center based on the application of criteria in Rule 64E-2.028, F.A.C., may submit a completed Letter of Intent DH Form 1840 January 2008 December 2004, which is available from the department, as defined by subsection 64E-2.001(8), F.A.C., postmarked no earlier than September 1 and no later than midnight October 1 of the following year.
Specific Authority 395.4025, 395.405 FS. Law Implemented 395.401, 395.4015, 395.402, 395.4025, 395.404, 395.4045, 395.405 FS. History–New 8-3-88, Amended 12-10-92, 12-10-95, Formerly 10D-66.113, Amended 2-20-00, 6-9-05,________.
