Alabama Department of Public Health

The meeting addressed several key updates regarding the Alabama Trauma System (ATS). ATS re-inspections for Flowers Hospital and Jackson Hospital were noted, and the awarding of a regular Level I ATS Designation to Children's Hospital by the Statewide Trauma and Health Systems Advisory Council (STHSAC) was discussed. Regional Directors were reminded to conduct Level III trauma center re-designations. The Workgroup reviewed proposed changes to the Regional Trauma Plans, which will be incorporated into the ATS Manual. The QA/QI Issue form has been revised for conciseness, removing personal comments. Communication efforts were highlighted, including quarterly meetings with Trauma Managers, and discussions focused on ATS training for new hires, transfers, and non-compliance issues. Updates on the Alabama Trauma Registry (ATR) indicated that some trauma centers have significant data submission delays. Regional discussions covered ongoing Level III re-inspections, successful engagement of service Medical Directors in the QI process, securing additional funding for the Alabama Trauma Communications Center (ATCC) due to the impending ATS activation of Region Five, site inspections for Northwest Regional Medical Center and Vaughn Regional Medical Center, and operational updates from the various regions.

Key discussions included improving the entry process for out-of-state patients routed to hospitals in partner states, necessitating contact with neighboring states to disseminate the Alabama Trauma Communications Center (ATCC) contact information. Trauma managers were reminded to update their contact lists. Several Quality Assurance/Quality Improvement (QA/QI) issues concerning air medical services transporting ATS patients to non-designated trauma centers were reviewed; the practice of sending appropriate out-of-state transfer QA/QI issues to the Office of Emergency Medical Services (OEMS) for further review was discontinued, though data monitoring continues. Progress on hospital entry criteria posters in Region Six showed positive impact, and updates were provided on the Alabama Trauma Registry, noting ongoing efforts to improve ATCC number compliance, as only one third of patients are currently entered correctly. The workgroup finalized details for the regional trauma plan update, which will be submitted to the Statewide Trauma and Health Systems Advisory Council (STHSAC) after regional approval. Regional discussions noted difficulties in hospital/doctor participation in Region One and an increase in out-of-state QA/QI issues in Region Four, while Region Five reported 325 patients entered into the stroke system. Finally, the workgroup confirmed that updated protocols, approved by the State Committee of Public Health, will become effective on February 1, 2014.

The meeting focused on several key aspects of the trauma and health systems. Discussions included welcoming new workgroup members and reporting outcomes from the recent Trauma Surgeons Meeting, which established a quarterly schedule for guidance on system operations, data collection, and review. The trauma registry compliance report for 2016 was presented, noting various factors affecting data submission timeliness and accuracy, and a request was made to refine data capture by removing non-emergency medical services transports. Regional discussions covered updates on stroke system participation, scheduled Stroke System Activation Trainings for Regions One, Two, and Six, and actions taken regarding stroke plan revisions in Region Three. Region Three also addressed the overuse of spine boards, prompting plans for targeted education for emergency department personnel. Region Four reported on discussions with Meridian, Mississippi, about integrating into state health systems, and Region Five reported progress on computer installations for the stroke system at Midtown Medical Center.

Key discussions included the Trauma System Update, focusing on the need for pre-hospital provider education regarding Trauma System Overload (TSO) and Trauma Brain Overload (TBO). It was agreed that training materials would be developed to clarify hospital availability status. A Quality Improvement (QI) issue concerning an extended delay in definitive patient care was reviewed, leading to lessons learned about proper patient routing. Erlanger Children Hospital expressed interest in joining the trauma system, pending approval as an extension of Erlanger main hospital until it becomes a standalone facility. The USA Children Evaluation Center Emergency Department is scheduled to become a full Pediatric Emergency Department in August 2017. A suggestion was made for regional directors to manage and submit monthly patient outcome reports. Separately, the Stroke System Update indicated progress, with the Stroke Committee receiving final state stroke plans and rules, and a meeting scheduled with the Alabama Hospital Association for finalization.

The meeting covered several updates and discussions across trauma and stroke systems. Key topics included welcoming new members, announcing the retirement of a long-standing member who will be acknowledged at a future council meeting, and updates on Regional Advisory Council (RAC) compositions. Discussions detailed ongoing challenges with physicians being comfortable providing pediatric trauma care and compliance issues with air medics regarding trauma system protocols. The stroke system expansion implementation is progressing, with a planned press conference. Concerns were raised regarding tPA stocking costs and funding shortfalls in the West Region, as well as QI issues related to returning patient care reports (PCR) and tPA administration rates in other regions. Rule modifications for stroke and STEMI would be presented for approval. Regional discussions covered ongoing education programs, data reporting, hospital capability upgrades, and interest from a hospital in Georgia regarding participation in the Alabama system. Specific attention was given to the overuse of spine boards, with a draft report on usage distributed for review.