Be objective, clear, and concise. Always use constructive language, even in criticism, to work toward the goal of positive progress. Submit your responses in the Discussion Area.
Review your lectures. Then:
- Compare the difference between ER/Trauma units Designation and Verification.
- What agency is responsible for these functions?
- List detailed requirements for Level 1, 2, and 3 Trauma units as outlined by the ACS (American College of Surgeons).
- Search your state (Florida) and identify how many Trauma units are designated in your own state.
To support your work, use your course and textbook readings As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Your initial posting should be addressed at 300-500 words. Submit your document to this Discussion Area by the due date assigned. Be sure to cite your sources using APA format.
comment on two of your classmates’ responses. You can ask technical questions or respond generally to the overall experience.
WEEK 3 DISCUSSION
Contains unread posts
Gina Lugo posted May 4, 2023 3:53 PM
First, (n.d.) I will compare the difference between ER/Trauma unit's Designation and verification. To further explain the differentiation of the two an ER'S classification types are two by adult or pediatric trauma centers.
Typically, ERs have different designations for each group for example: a.) level 1 Adult facility b.) level 2 pediatric facility. Different levels mean different types of care or treatment available. They are set to determine levels in a hospital to meet the state standards. Both categories can change from state to state it's not something consistent. Possibly through legislative or regulatory authority are the agencies responsible for their functions.
Moreover, (n.d.) I will list detailed requirements for level 1, 2, and 3 Trauma units as outlined by ACS (American College of Surgeons). Verification at a trauma center is done by the ACS (American College of Surgeons) on ways to modify and improve the quality of care pertinent to trauma care. This verifies resources that the hospital has available for a patient to be provided optimal care with a focus on: a.) readiness b.) resources c.) policies d.) patient care e.) performance improvement.
Essentially, (n.d.) in the state of Florida pertinent to ACS let's identify how many trauma units are designated. Level 1: should be able to provide total care (prevention through rehabilitation). Elements of Level I Trauma Centers Include per ACS a.) twenty-four-hour in-house coverage b.) meeting the requirement for volume of severely injured patients. Level 2: a.) tertiary care needs like cardiac, and hemodialysis b.) per ACS comprehensive quality assessment program. Level 3: providing 24-hour coverage again, involved with prevention efforts for the community. Level 4: the ability to provide advanced life support efforts and per ACS active efforts for the community. Level 5: evaluation, stabilization implementation of ATLS protocols, and transfer agreements for patients who need more than levels one through three.
Furthermore, (n.d.) the designation of trauma centers is the responsibility of the ACS to oversite and regulate the regional trauma system and lead and oversee various trauma units. Ultimately, the state of Florida is home to about twenty-seven trauma centers.
Trauma Centers | Florida Committee on Trauma. (n.d.). https://floridacot.org/florida-trauma-centers#:~:text=The%20state%20of%20Florida%20is%20home%20to%2027%20trauma%20centers.
Trauma Center Levels Explained – American Trauma Society. (n.d.). https://www.amtrauma.org/page/traumalevels
VRC 2014 Standards Q&As. (n.d.). ACS. https://www.facs.org/quality-programs/trauma/quality/verification-review-and-consultation-program/trauma-verification-qas/vrc-2014-standards-qas/#:~:text=CD%202%2D4%3A%20A%20Level,a%20Level%20I%20trauma%20center.
Analysis of ER/Trauma Unit Designations and Verification in California
Contains unread posts
Dominador Mansat posted May 8, 2023 8:49 AM
Dear Professor Dr. David Witt and Peer-Classmates
Based on the latest online materials, the provided online lectures from our Professor Dr. Witt, and our online course textbooks, please find my answers (in BLACK) on this Week 3 discussion questions (in PURPLE) in the following sections:
Review the online lectures, then: compare the difference between ER/Trauma units Designation and Verification. What agency is responsible for these functions? List detailed requirements for Level 1, 2, and 3 Trauma units as outlined by the ACS (American College of Surgeons). Search your state (i.e., California for this graduate-level student) and identify how many Trauma units are designated in your own state (of CA). Use resources from the Week 1 Assignment and South University Library as necessary.
An effective and organized system for handling emergencies cannot exist without the designation and verification of Emergency Rooms (ERs) and Trauma Units (TUs). According to their capacity and resources, ERs and TUs are divided into different levels based upon the guidelines established by the American College of Surgeons (ACS). This discussion post compares the distinctions between ER/Trauma unit designation and verification, identifies the accountable organizations, and outlines the standards for Level 1, 2, and 3 trauma units as established by the ACS. Specifically, this graduate-level student will analyze California's trauma units.
Contrast between Designation and Verification
A Trauma Center (a TC made up of ERs and TUs) is designated when a state authority, taking into account its resources and capabilities, assigns it a certain level (ACS, 2021). On the other hand, verification is the procedure by which the ACS assesses and confirms that a TC satisfies the requirements set forth for a specific level (ACS, 2021). And to belabor a very important point explained in the assigned course textbook: while verification is an ACS function, designation is a state function (Griffith and White, 2019).
Organization in Charge
Corollary to and consistent with the concepts explained in the previous section and specific to this student’s state, the California Department of Public Health (CDPH) is the organization in charge of designating trauma centers in California, while the American College of Surgeons (ACS) is in charge of confirming the trauma centers (Griffith & White, 2019).
Level 1, 2, and 3 Trauma Unit Requirements
Trauma surgeons, emergency medical doctors, anesthesiologists, and other critical personnel must be readily available around-the-clock in Level 1 Trauma Units (ACS, 2021). Additionally, they must act as a leader in research, prevention, and public education (Griffith & White, 2019). Although they might not have the same level of resources or research activities, Level 2 Trauma Units must meet requirements similar to those of Level 1 units (ACS, 2021). Additionally, these units must offer their staff ongoing training and maintain 24/7 access to critical specialists (Griffith & White, 2019).
Prior to being moved to higher-level facilities, patients primarily receive stabilization care at Level 3 Trauma Units (ACS, 2021). These facilities must have access to surgical and critical care services, as well as emergency physicians and nurses who are available around-the-clock (Griffith & White, 2019).
California trauma centers
California has 72 designated trauma centers as of 2021, including thirteen (13) Level 1 TCs, thirty-one (31) Level 2 TCs, and twenty-eight (28) Level 3 facilities TCs (CDPH, 2021).
Emergency Care in California and the Effect of TUs and ERs
In California, designated and verified TUs and ERs are essential for providing patients with organized, specialized, and effective emergency care. The American College of Surgeons (ACS) has established standards for the classification of TUs/ERs making up the TCs, ensuring that Healthcare Organizations (HCOs) have the tools and the expertise required to cater to the differing levels of needs of trauma patients (Griffith & White, 2019). Emergency care requires the use of ERs and TUs, and their importance in terms of how patients fare should be emphasized and not be understated.
The Function of Trauma Units in California's Emergency Care
In California, TUs with their designated levels offer an organized approach to emergency care, ensuring that patients get the right level of care based on their requirements. With their extensive resources and highly qualified staff, level 1 TUs serve as regional referral hubs for patients who have sustained severe injuries, providing cutting-edge diagnostic and therapeutic services (ACS, 2021). The majority of trauma cases can be managed by Level 2 TCs, but they may refer patients with extremely complex injuries to Level 1 TCs (Griffith & White, 2019). When necessary, patients are transferred to higher-level facilities from Level 3 TCs, which are frequently located in rural or remote areas.
HCOs in California can efficiently distribute personnel and resources by putting in place a tiered system of TUs and ERs, ensuring that patients get the right care when they need it. Within TCs, the designation and verification process promotes a culture of continuous improvement and helps maintain high standards (Griffith & White, 2019).
The significance of California's trauma unit distribution
To maximize emergency care and lessen disparities in access to specialized care in California, a network of TUs and ERs that is evenly distributed is essential. The availability of adequate trauma care in rural and remote areas is frequently hampered by a lack of resources and personnel (Griffith & White, 2019). HCOs can offer a crucial stabilization point for patients before transferring them to higher-level facilities by setting up Level 3 TCs in these locations.
In order to make sure that HCOs in California offer patients appropriate and effective emergency care, the CDPH and the ACS, respectively, designate and verify TCs (ERs and TUs). The distribution of TCs aids in reducing disparities in access to specialized care, while the tiered system of TUs and ERs ensures that patients receive care according to their needs. The ongoing creation and upkeep of TCs must continue to be a top priority as HCOs in California work to enhance patient outcomes.
For California's trauma system to operate effectively, it is essential to understand the difference between designation and verification. Designation is handled by the CDPH, and verification is handled by the ACS. For Level 1, Level 2, and Level 3 TCs, the ACS has established requirements, with each having a unique resource availability and capability. The provision of appropriate and effective emergency care to patients in California by HCOs depends on this information.
Finally, as an endcap to my Week 3 discussion post, I wanted to share this latest threat called the “Tripledemic” that can impact TCs to the point of being overrun because of the cyclical nature of RSV (Respiratory Syncytial Virus) and the common flu, not to mention COVID-19 (ABC10, 2022):
ABC10. (29 November 2022). “Tripledemic” California health officials warn of COVID-19, flu and RSV. ([Video]. YouTube. https://www.youtube.com/watch?v=hAP3pl3lbuE
American College of Surgeons. (2021). ACS COT verification, review, and consultation program. https://www.facs.org/quality-programs/trauma/quality/verification-review-and-consultation-program/process/
California Department of Public Health. (2021). Designated Trauma Centers. https://emsa.ca.gov/trauma/
Griffith, J. R., & White, K. R. (2019). The Well-Managed Healthcare Organization (9th ed.). Health Administration Press. https://digitalbookshelf.southuniversity.edu/books/9781640550599
As the name implies, the Outpatient Department (OPD) is the area of a hospital where outpatient services are carried out. Unlike the ER, patients are scheduled for appointments ahead of time. Any medical specialty might render care, including surgical specialties. Hospitals embrace their OPDs because, unlike the ER, all patient visits are precertified and preapproved—payment is more likely to be collected. The concept of a large and inclusive OPD also attracts doctors to have their own medical practices located on a hospital campus. The main reason is that they can refer patients "next door" for necessary testing and procedures. This saves time for the physician, especially when patients need to be admitted.
The final level of service we'll discuss is the Intensive Care Unit (ICU). These are usually very small units ranging from six to twelve beds and are staffed around the clock with highly trained medical professionals. Life-stabilizing care and patient monitoring is done continuously while the patient is in the unit.
All patients are continually monitored, sometimes as often as every fifteen minutes, in compliance with physician orders. Procedures can be done at the bedside when needed, depending on the patient's condition. Visiting hours may be restricted as well. Common types of ICUs are: medical, cardiac, surgical, neonatal, and burn units. It is important to note that not every hospital has every type of ICU.
In the future, we can expect to see fewer hospitals and more outpatient care facilities. However, be mindful that largely the healthcare insurance industry, rather than the physician is promoting this trend. As a future leader in the healthcare industry, you must decide whether you will support and promote this trend.
Lastly you have explored the intensive care and outpatient service lines. While there are more service organizations your learning this week gives you a strong foundation. Reflect on these various services and the ones you have engaged in other than those noted this week. The next part of your journey will include understand the Board of Directors and its governance responsibilities.
Emergency departments (EDs) are stratified in levels on the basis of the ability to provide specific care as an integral part of the healthcare organization (HCO). The ED presents a conundrum to the HCO, being both an asset and a liability. The ED traditionally commands the highest level of reimbursement for healthcare services and functions as a conduit for hospital admissions. Conversely, the ED also has the ability to generate non-compensable care, also known as bad debt servicing to uninsured or underinsured patients.
Many EDs across the nation experience overcrowding and systematic abuse of services in providing nonemergency care to patients. The problem of inappropriate use of ED services is fueled by a number of factors. Many primary care physicians (PCP) limit access to care; are overburdened, requiring patients to wait for extended periods of time for appointments; and have reduced hours of operation, which might make it difficult for an employed patient to schedule appointments. These factors and others drive patients seeking nonemergency care away from EDs.
The main issue is that more people than ever, for a variety of reasons, are using the emergency room (ER) as a source for primary medical care. Combined with the increasing numbers of uninsured patients and undocumented aliens seeking care, many ERs are on life support themselves. As a result, costs are skyrocketing. Volume and wait time are increasing, while the revenue plummets.
Many health care policies limit the number of ED visits through financial disincentives. A number of programs are directed at health literacy and redirect nonemergency care to urgent care or less priority level of care. While many believe health services are essentially a guarantee due to the Emergency Medical Treatment and Leave Act (EMTALA), the specter of fines and litigation only reinforces the misunderstanding of the legislation.
As you continue you learning you will now have a foundation of service understanding about the emergency room. Its challenges are many. Next you will entertain information about services outside of the hospital and emergency room, being exposed to information about the services provided in outpatient and specialty areas. Review the material below for more information of these topics.
Terp, S., Seabury, S. A., Arora, S., Eads, A., Lam, C. N., & Menchine, M. (2017). Enforcement of the emergency medical treatment and Labor act, 2005 to 2014. Annals of Emergency Medicine, 69(2), 155-162.e1. doi:10.1016/j.annemergmed.2016.05.021
Zuabi, N., Weiss, L. D., & Langdorf, M. I. (2016). Emergency medical treatment and labor act (EMTALA) 2002-15: Review of office of inspector general patient dumping settlements. The Western Journal of Emergency Medicine, 17(3), 245-251. doi:10.5811/westjem.2016.3.29705
McDonnell, W. M., Gee, C. A., Mecham, N., Dahl-Olsen, J., & Guenther, E. (2013). Does the emergency medical treatment and labor act affect emergency department use? The Journal of Emergency Medicine, 44(1), 209. doi:10.1016/j.jemermed.2012.01.042
Levels of Service.html
Levels of Service
This lecture will focus on key areas of service and organization within hospitals. While the intent is not to discuss all available service areas, some of the more prominent areas will be highlighted.
First, let us examine the ways in which forces external to the hospital shape the way patient services evolve. Among these external forces are the payors, such as private indemnifiers, managed care plans, and public entitlement programs (Medicare and Medicaid). Over the past twenty years, these payors have systematically rewarded providers for performing more procedures in outpatient settings. As a result, a shift toward outpatient surgeries has ensued. The other external influence has been publication of recognized medical research indicating that inpatient stays increase the risk of exposure to infectious organisms. Patients may become more ill than they were when admitted. Avoiding the inpatient environment when possible has health advantages.
From the perspective of the insurance company, it is far more economical to have the service provided on an outpatient basis. The reduction of even a single overnight admission, multiplied by all of the members of an HMO plan, for example, may save hundreds of million of dollars annually. Decreased morbidity and reduced costs combine to motivate hospitals to offer an outpatient option when feasible.
In this first lecture you were exposed key areas of service and organization within hospitals. Continuing in this theme you will next explore the emergency room and its service commitments and challenges. Reflect on your experiences with hospitals over the years, has it changed?
Special Section: The Newest Frontier: Ethical Landscapes in Electronic Healthcare
Ethical Challenges of Telemedicine and Telehealth
BONNIE KAPLAN and SERGIO LITEWKA
As healthcare institutions expand and vertically integrate, healthcare delivery is less constrained by geography, nationality, or even by institutional boundaries. As part of this trend, some aspects of the healthcare process are shifted from medical centers back into the home and communities. Telehealth applications intended for health promotion, social services, and other activities—for the healthy as well as for the ill—provide services outside clinical settings in homes, schools, libraries, and other governmental and community sites. Such develop- ments include health information web sites, on-line support groups, automated telephone counseling, interactive health promotion programs, and electronic mail exchanges. Concomitant with these developments is the growth of consumer health informatics, in which individuals seeking medical care or information are able to find various health information resources that take advantage of new information technologies.
These shifts are motivated by a sense that it is better for people to be able to stay in familiar and friendly environments and have more control over their lives and health. However, as the population ages, it seems that the demands for home care will outpace the economic and human resources to meet those demands. The rapid growth of these applications is, therefore, also fueled by the growth in the information technology industry and encouraged through governmental initia- tives under the assumption that telecare home services might be less expensive than institution-based alternatives.
Often a distinction is made between telehealth and telemedicine. Telemedicine has a clinician as at least one of the participants, whereas telehealth is any use of information technology for health purposes.1 Both involve using electronic information and communication technologies for healthcare when distance separates the participants. They span a spectrum of applications, from the relatively simple—like linking telephone, video, facsimile, home computers, and other low-cost technologies to various devices so that health-related information can be sent to clinicians from individuals’ homes—to clinical consultations conducted at sites remote from each other and, therefore, convenient to both clinicians and patients, to complicated procedures, such as telesurgery, performed remotely. Rather than the cumbersome phrase ‘‘telehealth and telemedicine,’’ sometimes we will use one of these terms to stand for both of them. We also may
Bonnie Kaplan gratefully thanks the participants in discussions following her presentations of some of this material at the Kay-Claremont Graduate University Symposium on Pacific Edge E-Health Innovations, December 2006; University of Miami and VA Health care System Dialogues in Research Ethics, January 2007; and at the Conference on Education and Health Professionals in the New Millenium: Technological Advances, Multicultural Competence, Documented Outcomes and Evi- dence-Based Practice, in Celebration of the Tenth Anniversary of the College of Education and Health Professions, Sacred Heart University, March 2007.
Cambridge Quarterly of Healthcare Ethics (2008), 17, 401–416. Printed in the USA. Copyright � 2008 Cambridge University Press 0963-1801/08 $20.00 doi:10.1017/S0963180108080535 401
use the broader term ‘‘e-health,’’ more common in the United Kingdom, which refers to ‘‘the emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies,’’2 though we mean this to include mainly consultation, communication, and intervention.3
Potential benefits of telehealth and telemedicine include greater availability of services and access to healthcare providers (including specialty services that may not be located near to those needing them), reduced disparities in healthcare accessibility, less travel time for both patient and clinician, lower costs, and quality improvements presumed to derive from access to more timely and accurate data and improved information flow available any time or any place.4
These improvements also could lead to changes in infrastructure that would provide seamless and continuous care available on a more equitable basis by allowing interorganizational cooperation and ready flow of information between wherever patients and providers may be.5
These new developments seem to provide what people want: personalized relationships with providers, information targeted to their concerns and needs, and interactive tools for health and disease management.6 It is thought that patients and others needing healthcare services will benefit from use of these technologies in several ways commonly considered ‘‘empowering.’’ First, they would be able to stay in their own homes rather than be institutionalized, with fewer intrusions by healthcare workers and more control over their privacy, health management, schedule, and activities. Individuals may even obtain care from providers from whom they are physically distant and whom they may not have met in person. Moreover, knowing that patients’ conditions are being monitored could offer some reassurance for both patients and their loved ones. Further, the power differential between patients and clinicians would be reduced through patients’ access to health-related information and by providing a means for the like- minded to connect, possibly set up their own healthcare organizations, and thereby leading to increased democratization.7 It is thought likely that the care paradigm would shift from crisis intervention to promoting wellness, prevention, and self-management.8
Using these new technologies, then, has the potential for great good. Although neither their clinical nor cost effectiveness has been well established,9 it, therefore, is likely that governments and healthcare institutions will provide more and more healthcare services using these new tele-technologies. We, too, are enthusiastic. Mixed with our enthusiasm is our recognition that these advantages come combined with ethical tensions. E-health is not only a techno- logical improvement, but a reengineering of healthcare processes requiring consideration of sociotechnical aspects of their design and development. It is mea