2014 Trauma Registry Report

Transcription

1 2014 Trauma Registry Report STATEWIDE TRAUMA SYSTEM

2 2014 Trauma System Report Minnesota Department of Health Statewide Trauma System P.O. Box 64882, St. Paul, MN (651) ( As requested by Minnesota Statute 3.197: This report cost approximately $1,800 to prepare, including staff time, printing and mailing expenses. Upon request, this material will be made available in an alternative format such as large print, Braille or audio recording. Printed on recycled paper. 2

3 Contents Executive Summary... 4 Key Findings... 4 About the Data... 5 Limitations of the Data... 5 Generating Local and Regional Benchmarking Reports... 6 Distribution of Trauma Hospitals... 7 Drive Time to Designated Trauma Hospitals and Minnesota Population Distribution... 7 Drive Times to Designated Level 1 & 2 Trauma Hospitals and Minnesota Population Distribution... 8 Drive Times to Designated Pediatric Trauma Hospitals and Minnesota Population Distribution... 9 Data and Analysis Case Information Demographic Information Location of Injury Cause of Injury Injury Severity Trauma Team Activations Emergency Department Length of Stay Before Transfer Inter-facility Transfer Disposition Hospital Length of Stay Appendix A: Trauma System Overview Appendix B: Hospitals Designated During Calendar Year Appendix C: State Trauma Advisory Council Members Appendix D: Trauma Registry Inclusion Criteria Appendix E: Regional Trauma Advisory Committees

4 Executive Summary The goal of the Statewide Trauma System is to reduce death and disability from traumatic injuries across the state. (See Appendix A for a description of the trauma system.) One essential method to achieve this goal is through the collection and analysis of trauma care data. To that end, the 2014 Trauma System Report presents demographic and clinical trauma data submitted to the Minnesota trauma registry (MNTrauma) by Minnesota s designated trauma hospitals. (See Appendix B for a listing of Minnesota s designated hospitals in 2014.) The purpose of this report is to establish a baseline of trauma care data from which to develop clinical and system quality improvement, injury prevention, treatment and rehabilitation programs (M.S , Subd. 1 and 7). The State Trauma Advisory Council (STAC) will continue to develop quality metrics to measure the trauma system s progress toward its goals. (See Appendix C for a listing of current STAC members.) Ambulance services licensed in Minnesota are required to transport major trauma patients to a designated trauma hospital in accordance with the service s trauma triage and transport guideline. This requirement safeguards victims of major trauma by directing them to a hospital that has made a commitment to achieving and sustaining a level of trauma hospital designation. Key Findings Almost every Minnesotan (99%) lives within 60 minutes of a designated trauma hospital. Falls were the most common cause of major trauma for all ages, followed by motor vehicle crashes. Falls were the leading cause of death for ages 65 and older. Vehicle-related injuries were the leading cause of death for ages Homicide and injuries intentionally inflicted by others were the leading causes of pediatric death. Elderly patients were disproportionately represented in the trauma registry data. Twenty-eight (28) percent of cases involved activation of the trauma team. Forty-nine (49) percent of trauma team activations reported were performed by Level 3 and 4 trauma hospitals. Of all patients transferred from the emergency department of Level 3 and 4 trauma hospitals after a trauma team activation, 27 percent occurred within 60 minutes of arrival and 57 percent within 120 minutes. When patients were transferred from the emergency department of a Level 3 or 4 trauma hospital, the average length of stay in the emergency department decreased when the trauma team was activated versus when it was not. Only three (3) percent of major trauma cases transferred to a Level 1 or 2 trauma hospital were subsequently discharged from the emergency department of that hospital. 4

5 About the Data Trauma data in this report includes all incidents reported by designated trauma hospitals that occurred during calendar year 2014 and met the MNTrauma inclusion criteria (Appendix D). Generally, the inclusion criteria describes cases in which the patients primary diagnosis was a traumatic injury and the trauma team was activated or the patient was admitted, transferred or died. This report includes only cases that: 1) arrived at a designated trauma hospital in Minnesota; 2) met the trauma registry inclusion criteria; and 3) were reported by the treating hospital. (Appendix B) Patients who died from a traumatic injury but were not transported to a hospital are not included in these data. Limitations of the Data Since Level 2 trauma hospitals exist just across the borders of Minnesota in North Dakota, South Dakota and Wisconsin, some patients injured in Minnesota are transported directly to those trauma hospitals. Those cases are recorded in the respective states trauma system registries, and are not included in MNTrauma. Similarly, patients may be transferred to an out-of-state trauma hospital from one of Minnesota s Level 3 or 4 trauma hospitals. In such cases, the record from the Level 3 or 4 trauma hospital is included in this report, but the corresponding out-of-state hospital record is not included. Many of Minnesota s Level 1 and 2 trauma hospitals also receive trauma patients transferred from out-of-state hospitals. The records from those hospitals are included in this report, even though the patients were not injured in Minnesota. Cases treated initially in one Minnesota trauma hospital and then transferred to another Minnesota trauma hospital result in two distinct MNTrauma records: one from each facility that provided care. Thus, one patient could be counted twice in these data. Not all trauma cases that meet the registry inclusion criteria are reported. The exact number of missing cases is unknown. When cases are reported but required data fields are left blank, the record may be excluded from this report because the missing data precludes its identification as an included case. Injury severity scores 1 (ISS) from Level 1 and 2 trauma hospitals are considered accurate; however, ISSs from Level 3s and 4s have not yet been validated. Therefore, only injury 1 The Injury Severity Score is a summary measure used to characterize the condition of patients with multiple injuries. The standard industry definition of major trauma is an ISS > 15, which makes it useful for comparison; however, the clinical significance of that definition is a question still being debated in the academic community. 5

6 severity scores from records submitted by Level 1 and 2 trauma hospitals are reported in this document. Trauma registry records are created by either entering data directly into MNTrauma from a web-based interface, or importing data from an export file generated by a third-party vendor. The latter could result in the loss of some data because of importing errors or mapping inconsistencies. Despite these limitations, this report was developed using the data in its current state and can be considered indicative or representative of the trauma system, but not necessarily definitive. Data in this report will serve to inform those that contributed the data about the completeness and accuracy of those records. As data collection improves, future reports will be capable of better describing the status of major trauma in Minnesota. Since each report in this compendium was created at a distinct moment in time, the number of total cases may vary slightly from report to report. Generating Local and Regional Benchmarking Reports Designated hospitals and the state s six Regional Trauma Advisory Committees (RTACs) can use MNTrauma to generate their own comparative reports to benchmark their data and performance against each aggregate report contained in this compendium. MNTrauma users should follow these instructions to generate a comparative report: 1. Log in to MNTrauma and select the Report Writer 2. In the left margin under All Reports open the 2014 Annual Report folder. 3. Select the report that corresponds with the number and title of the chart or table in this document to which you would like to compare. (These reports are specific to calendar year 2014 and cannot be modified.) Since this is the first trauma registry report to be produced using the trauma registry data exclusively, hospitals and RTACs should use their local and regional comparative reports to assess the accuracy and completeness of their own data by reproducing these reports using local and regional data. A significant disparity between the actual and expected results suggests problems with the way the data is entered or imported. 6

7 Distribution of Trauma Hospitals Drive Time to Designated Trauma Hospitals and Minnesota Population Distribution 2 Almost every Minnesotan lives within 60 minutes of a designated trauma hospital. 2 Data Sources: Minnesota Department of Health, as of January 2016; 2010 US Census Redistricting Data P.L Map by MDH Cardiovascular Health Unit, January

8 Drive Times to Designated Level 1 & 2 Trauma Hospitals and Minnesota Population Distribution 3 Most Minnesotans live within 60 minutes of a Level 1 or 2 trauma hospital. 3 Data Sources: Minnesota Department of Health, as of January 2016; 2010 US Census Redistricting Data P.L Map by MDH Cardiovascular Health Unit, January

9 Drive Times to Designated Pediatric Trauma Hospitals and Minnesota Population Distribution 4 The majority of children live within 60 minutes of a designated Level 1 or 2 pediatric trauma hospital. 4 Data Sources: Minnesota Department of Health, as of January 2016; 2010 US Census Redistricting Data P.L Map by MDH Cardiovascular Health Unit, January

10 Data and Analysis 2014 Case Information 10

11 Minnesota hospitals collectively reported 27,550 major trauma cases during calendar year Cases that were transferred from a Minnesota hospital to a Minnesota hospital are likely doublecounted. Only records that were complete enough to identify them as a major trauma case were counted, resulting in some hospital under-reporting their major trauma cases. Records of patients injured in Minnesota but treated in a bordering state s hospital are not counted here. Level 3 and 4 trauma hospitals cared for half of Minnesota s major trauma patients. Designation Level Number of Cases Level 1 9,942 Level 2 4,099 Level 3 7,396 Level 4 6,046 Not Reported 53 Non-Trauma 14 11

12 Most major trauma cases were treated at a trauma hospital in the metropolitan region. This is, in part, because major trauma patients are often transferred to metro-area hospitals from hospitals in other regions. Trauma hospitals in the southwest region of the state reported the fewest major trauma cases. Region Number of Cases Metro (MMRTAC) 15,662 Southern (SMRTAC) 3,855 Central (CENTRAC) 3,217 Northeast (NERTAC) 2,955 Northwest (WESTAC) 990 Southwest (SWRTAC)

13 In 46% of the major trauma cases reported, the arrival mode was not identified. Of the cases in which the arrival mode was known, 53% arrived by private vehicle or walked in (i.e., self-presented) to the hospital; 37% arrived by ground ambulance and 9% arrived by helicopter. Arrival Mode Number of Cases Not Reported 12,093 Private/Public Vehicle/Walk-In 7,940 EMS/Ground Ambulance 5,453 Helicopter Ambulance 1,273 Not Applicable 377 Not Known 148 Fixed-wing Ambulance 119 Police 79 Other 61 -Select

14 Private insurers (private/commercial insurance and BlueCross/Blue Shield) were the most common primary payers (31%), followed by Medicare (28%). Self-payers were represented in 5% of the major trauma cases. Primary Payer Number of Cases Medicare 7,570 Private/Commercial Ins. 6,450 Not Known 3,130 Medicaid 2,313 Blue Cross/Blue Shield 2,037 No Fault Automobile 1,756 Self-Pay 1,336 Not Applicable 1,205 Worker's compensation 631 Other 517 Other Government 415 Not Available 45 Not Billed (for any reason) 4 14

15 2014 Demographic Information 15

16 Fifty-six percent of the major trauma cases reported were males. Gender Number of Cases Male 15,465 Female 12,042 Not Known 35 -Select- 3 Not Reported 1 16

17 Colby 2DColby 2D The number of cases generally increases as patient age increases. However, there is a noticeable increase in the number of cases between birth and age three, 17 and 24, 50 and 55, and again from 78 to 90 years of age. There is a direct relationship between increasing age and comorbid conditions. Younger patients tend to have shorter hospital stays or may not require admission at all. As such, they may not be included in the trauma registry. As patients age, their comorbid conditions may cause a traumatic injury; or their injury could exacerbate an existing comorbid condition, resulting in complications and/or a longer hospitalization. Note: Hospitals and RTACs replicating these data for benchmarking purposes should use Report to return the Patient Age report and to return the Patient Age Range report. Age Range Number of Cases < , , , , , , , , ,886 Not Reported 1 17

18 Most patients that die from major trauma do not die in the hospital. Patients that died outside of the hospital (i.e., those that were not transported or died after discharge) are not counted in these numbers.) There were 636 cases in which the patient s discharge disposition indicated death. Patients over the age of 75 accounted for 45% of the fatalities. The elderly are more likely to die from a traumatic injury than younger patients. Children (under age 15) accounted for 4% of traumatic fatalities treated in Minnesota s trauma hospitals. Note: Hospitals and RTACs replicating these data for benchmarking purposes should use Report to return the Mortality by Patient Age report and to return the Mortality by Patient Age Range report. Age Range Number of Cases <

19 2014 Location of Injury 19

20 Most patients were injured at a home or residence (46%). Twenty-two percent were injured on a street or highway. Incident Location Number of Cases Home/Residence 12,807 Street or Highway 6,086 Place of Recreation or Sport 1,645 Public Building (schools, gov., offices) 1,613 Other Specified Location 1,390 Undetermined 1,376 Residential Institution (nursing home, jail/prison) 1,015 Not Known 728 Industrial Place and Premises 626 Farm 277 Not Available 28 Mine or Quarry 19 Not Reported 10 Not Applicable 7 Not Reported 1 20

21 2014 Cause of Injury 21

22 The majority (55%) of major trauma cases were caused by falls. Vehicle-related injuries accounted for 26% of the cases. (Patients that were not transported to a hospital are not counted in these results.) Cause Of Injury Number of Cases Accidental Falls 14,754 Motor Vehicle Traffic Accidents 4,938 Other Accidents 2,681 Homicide And Injury Purposely Inflicted By Other Persons 1,468 Motor Vehicle Non-traffic Accidents 1,203 Other Road Vehicle Accidents 793 Suicide And Self-Inflicted Injury 339 Accidents Due To Natural And Environmental Factors 306 Accidents Caused By Fire And Flames 195 Injury Undetermined Whether Accidentally Or Purposely Inflicted

23 Of the 627 fatalities reported, 55% resulted from falls. Vehicle-related injuries accounted for 23% of the reported fatal cases that were transported to a hospital. (Fatalities not transported to a hospital are not counted in these results.) Cause Of Injury Number of Cases Accidental Falls 342 Motor Vehicle Traffic Accidents 123 Suicide And Self-Inflicted Injury 61 Homicide And Injury Purposely Inflicted By Other Persons 28 Other Accidents 24 Motor Vehicle Non-traffic Accidents 16 Injury Undetermined Whether Accidentally Or Purposely Inflicted 10 Accidents Caused By Submersion, Suffocation, And Foreign Bodies 6 Other Road Vehicle Accidents 5 Accidents Caused By Fire And Flames 4 Legal Intervention 2 Accidental Poisoning By Other Solid And Liquid Substances, Gases, And 1 Accidents Due To Natural And Environmental Factors 1 Air And Space Transport Accidents 1 Drugs, Medicinal And Biological Substances Causing Adverse Effects In 1 Late Effects Of Accidental Injury 1 Water Transport Accidents 1 23

24 Of the 2,840 trauma registry records for patients younger than 15 years of age, falls were the leading cause of injury (47%). Vehicle-related injuries collectively represented 27% of the pediatric cases. (Children that were not transported to a hospital are not counted in these results.) Cause Of Injury Number of Cases Accidental Falls 1,331 Other Accidents 505 Motor Vehicle Traffic Accidents 342 Other Road Vehicle Accidents 221 Motor Vehicle Non-traffic Accidents 190 Accidents Due To Natural And Environmental Factors Homicide And Injury Purposely Inflicted By Other Persons Accidents Caused By Submersion, Suffocation, And Foreign Bodies Accidents Caused By Fire And Flames 27 Injury Undetermined Whether Accidentally Or Purposely Inflicted

25 Pediatric fatalities are rare compared to other age groups, accounting for only 23 records in Of the pediatric fatalities, Injuries purposely inflicted by others accounted for 35% of the cases. Cause Of Injury Homicide and Injury Purposely Inflicted by Other Persons Accidents Caused by Submersion, Suffocation, And Foreign Bodies Number of Cases Motor Vehicle Traffic Accidents 4 Suicide and Self-Inflicted Injury 4 Accidental Falls 1 Injury Undetermined Whether Accidentally or Purposely Inflicted Motor Vehicle Non-Traffic Accidents

26 Of the 13,880 trauma registry records of patients between the ages of 14 and 65, vehicle-related injuries were the leading cause of injury, collectively accounting for 37% of the cases. (Patients that were not transported to a hospital are not counted in these results.) Falls accounted for 35% of the cases. Injury intentionally inflicted by other persons accounted for 10% of cases. Cause Of Injury Number of Cases Accidental Falls 4,831 Motor Vehicle Traffic Accidents 3,836 Other Accidents 1,765 Homicide And Injury Purposely Inflicted By Other Persons 1,361 Motor Vehicle Non-traffic Accidents 883 Other Road Vehicle Accidents 491 Suicide And Self-Inflicted Injury 307 Accidents Due To Natural And Environmental Factors 176 Accidents Caused By Fire And Flames 135 Injury Undetermined Whether Accidentally Or Purposely Inflicted 95 26

27 Vehicle-related injuries were the leading cause of fatalities in the middle age group. Of the 252 deaths, 37% resulted from vehicle-related injuries. (Fatalities not transported to a hospital are not counted in these results.) Falls caused 22% of the fatalities. Suicide and Self-inflicted injury caused 21% of the fatalities Injury intentionally inflicted by other persons caused 8% of the fatalities. Cause Of Injury Number of Motor Vehicle Traffic Accidents 76 Accidental Falls 55 Suicide And Self-Inflicted Injury 52 Homicide And Injury Purposely Inflicted By 20 Motor Vehicle Non-traffic Accidents 14 Other Accidents 13 Injury Undetermined Whether Accidentally 8 Other Road Vehicle Accidents 4 Accidents Caused By Fire And Flames 3 Accidents Caused By Submersion, 2 Legal Intervention 2 Accidents Due To Natural And Environmental 1 Late Effects Of Accidental Injury 1 Water Transport Accidents 1 27

28 Of the 10,134 trauma registry records for patients older than 64, falls were the leading cause of injury (85%). Vehicle-related injuries accounted for 10% of the geriatric cases. (Patients that were not transported to a hospital are not counted in these results.) Cause Of Injury Number of Cases Accidental Falls 8,591 Motor Vehicle Traffic Accidents 760 Other Accidents 411 Motor Vehicle Non-traffic Accidents 130 Other Road Vehicle Accidents 81 Accidents Due To Natural And Environmental Factors 44 Accidents Caused By Fire And Flames 33 Drugs, Medicinal And Biological Substances Causing Adverse Effects In Therapeutic Use Homicide And Injury Purposely Inflicted By Other Persons Not Reported 22 28

29 Accidental falls were by far the leading cause of geriatric injury resulting in fatality. Of the 352 deaths in this age group, 81% resulted from accidental falls. Cause Of Injury Number of Cases Accidental Falls 286 Motor Vehicle Traffic Accidents 43 Other Accidents 11 Suicide And Self-Inflicted Injury 5 Accidental Poisoning By Other Solid And Liquid 1 Accidents Caused By Fire And Flames 1 Air And Space Transport Accidents 1 Drugs, Medicinal And Biological Substances Causing 1 Injury Undetermined Whether Accidentally Or 1 Motor Vehicle Non-traffic Accidents 1 Other Road Vehicle Accidents 1 29

30 2014 Injury Severity 30

31 Of those cases in which the Injury Severity Score (ISS) was reported, the majority of the 13,259 trauma cases treated at Level 1 and 2 trauma hospitals (55%) had an ISS less than 9. 29% had an ISS from % had an ISS from % had an ISS of 25 or greater. Of the 861 cases with an ISS of 25 or greater, Level 1 trauma hospitals treated 76%; Level 2 trauma hospitals treated the remaining 24%. Injury Severity Score Level 1 Level ,243 2, , Not Reported

32 Of the 451 cases at Level 1 and 2 trauma hospitals in which the ISS was reported and the discharge disposition indicated death, 280 (62%) had an ISS of 25 or greater and 9% had an ISS less than 9. Injury Severity Score Level 1 Level Not Reported

33 2014 Trauma Team Activations 33

34 Trauma hospitals may organize their trauma team response into tiers corresponding to the number of resources deployed based on the patient s presenting condition. While the trauma system has established minimum criteria for the highest tier (tier-one) at Level 3 trauma hospitals, each hospital largely establishes its own criteria for the activation of each tier. Generally, tier-one and two trauma teams are activated for the most seriously injured patients. There were 7,685 reported trauma team activations, representing 28% of the total number of trauma registry cases. Level 3 and 4 trauma hospitals were responsible for 49% of the trauma team activations. Level 1 trauma hospitals activated the trauma team for 32% of their total cases. Level 2s activated their team for 18% of cases. Level 3s activated the team for 30% of cases and Level 4s for 26%. Designation Level Tier 1 Tier 2 Level 1 2, Level Level ,819 Level 4 1,

35 Of the 104 cases in which the emergency department discharge disposition was died, 14 (13%) did not involve a trauma team activation. All of these occurred at a Level 3 or 4 trauma hospital. Of the remaining emergency department fatalities, all but six were activated as a tier-one trauma team activation. Designation Level Not Activated Tier 1 Tier 2 Level Level Level Level

36 The metropolitan region reported the most trauma team activations (57%). The southwest region reported the fewest activations (4%). The northwest region had the most activations as a percentage of total cases submitted by that region (39%). The northeast region had the fewest number of activations as a percentage of total cases submitted by that region (19%). Region Tier 1 Tier 2 Central (CENTRAC) Metro (MMRTAC) 2,020 2,362 Northeast (NERTAC) Northwest (WESTAC) Southern (SMRTAC) Southwest (SWRTAC) Note: The slight variation between this report and Trauma Team Activations by Designation Level (above) is due to the few cases reported by nondesignated hospitals. 36

37 Of the 104 cases in which the emergency department discharge disposition indicated death, 14 (13%) did not involve a trauma team activation. These were distributed across five of the six regions, the northeast region reporting none. Of the remaining emergency department fatalities, six cases were activated as a tier-two trauma team activation. Region Not Activated Tier 1 Tier 2 Central (CENTRAC) Metro (MMRTAC) Northeast (NERTAC) Northwest (WESTAC) Southern (SMRTAC) Southwest (SWRTAC)

38 2014 Emergency Department Length of Stay Before Transfer 38

39 The early transfer of trauma patients to a hospital capable of definitively managing the patients injuries is important because survivability improves when patients time out of definitive care is minimized. For those cases in which the emergency department discharge disposition was transferred to another hospital, the average length of stay in the emergency department before transfer was was very similar between Level 3 and Level 4 trauma hospitals. Note: Length of stays greater than 360 minutes were excluded from this analysis. Designation Level Level 3 Level 4 Average Length of Stay (Minutes)

40 For those cases in which the emergency department discharge disposition was transferred to another hospital, the average length of stay in the emergency department was shorter when the trauma team was activated. (See Average Emergency Department Length of Stay Before Transfer Levels 3 & 4, #14-31 above.) Level 4 trauma hospitals reported a 27% decrease in patients average length of stay when the tierone trauma team was activated; Level 3 trauma hospitals reported a 40% decrease. Trauma Team Activation Tier Level 3 Level 4 Tier Tier Note: Length of stays greater than 360 minutes were excluded from this analysis. 40

41 For those cases in which the emergency department discharge disposition was transferred to another hospital, the average length of stay in the emergency department was longest in trauma hospitals in the metro region and shortest in trauma hospitals in the southwest region. Note: Length of stays greater than 360 minutes were excluded from this analysis. Region Average Length of Stay Central (CENTRAC) 149 Metro (MMRTAC) 171 Northeast (NERTAC) 160 Northwest (WESTAC) 141 Southern (SMRTAC) 139 Southwest (SWRTAC)

42 All regions reported a decrease in the average length of stay when a tier-one trauma team was activated over a tier-two activation. Collectively, the regions reported an average 19% difference in patients average length of stay. The central region reported the greatest difference (334%) when the tier-one trauma team was activated. The northwest region reported the smallest difference (<1%). Note: Length of stays greater than 360 minutes were excluded from this analysis. Region Tier 1 Tier 2 Central (CENTRAC) Metro (MMRTAC) Northeast (NERTAC) Northwest (WESTAC) Southern (SMRTAC) Southwest (SWRTAC)

43 120 Minutes 60 Minutes Length Of Stay (Minutes) Level Level Length Of Stay (Minutes) >= Not Reported Level Level When the patient was transferred from the emergency department of a Level 3 or 4 trauma hospital, 10% were transferred within 60 minutes of arrival. Thirty-five (35) percent were transferred within 120 minutes. 43

44 60 Minutes 120 Minutes Length Of Stay (Minutes) Level Level Length Of Stay (Minutes) Not Reported Level Level When a tier-one or tier-two trauma team was activated at a Level 3 or 4 trauma hospital and the patient was transferred, 26% of patients were transferred from the emergency department within 60 minutes. Fifty-five (55) percent were transferred within 120 minutes. Note: The goal of the trauma system is for major trauma patients requiring transfer to be rapidly identified and transferred within 60 minutes of arrival in the emergency department. 44

45 2014 Inter-facility Transfer 45

46 There were 5,396 inter-facility transfers reported in The metro region reported the most (26%), while the northwest region reported the fewest (9%). Region Number of Cases Central (CENTRAC) 1,096 Metro (MMRTAC) 1,394 Northeast (NERTAC) 675 Northwest (WESTAC) 462 Southern (SMRTAC) 1,198 Southwest (SWRTAC)

47 Of the 5,396 trauma patients transferred, the majority were transferred from Level 4 trauma hospitals (62%). Three percent were transferred from a Level 1 or 2 trauma hospital. Designation Level Number of Cases Level 1 51 Level Level 3 1,803 Level 4 3,347 Undesignated 64 47

48 Of the 5,150 cases transferred from the initial hospital s emergency department to another hospital for definitive care, the mode of transportation is undefined in 19% of the cases. Of the known modes of transfer, 72% were transferred by ground ambulance and 15% were transferred by helicopter. Transfer Mode Number of Cases Ground Ambulance 3,006 Not Known 633 Helicopter Ambulance 612 Private Vehicle 522 Not Applicable 153 Not Reported 153 Fixed-wing Ambulance 36 -Select- 28 Other 4 Not Available 3 48

49 Of the 5,396 transfers, 195 (4%) were first admitted to the initial hospital before being transferred to another hospital. 48% of the cases were admitted to a Level 4 trauma hospital before being transferred. Designation Level Number of Cases Level 1 7 Level 2 28 Level 3 67 Level

50 Injury Severity Score Number of Cases Not Reported 1, Of the 2,409 major trauma cases in which the ISS was reported and that Level 1 and 2 trauma hospitals indicated arrived from a referring hospital, 45% had an injury severity score (ISS) of less than 9. Nine percent had an ISS of 25 or greater. 50

51 Of the 2,409 major trauma cases reported by Level 1 and 2 trauma hospitals in which the ED discharge disposition is known and that arrived from a referring hospital, 4% were discharged from the emergency department of those hospitals; and 84% of those discharged from the emergency department were discharged home without services. ED Discharge Disposition Not Reported Home with services Home without services Other (jail, institutional care, mental health, etc.)

52 2014 Disposition 52

53 65% of the major trauma cases presenting to the emergency room resulted in an admission to the hospital. 19% were transferred to another hospital for definitive care. 10% were discharged from the emergency department or left against medical advice. ED Discharge Disposition Number of Cases Floor bed (general admission, non-specialty unit bed) 11,100 Transferred to another hospital 5,144 Intensive Care Unit 2,926 Home without services 2,574 Operating room 2,140 Not Applicable 1,309 Telemetry/step-down unit (less acuity than ICU) 1,114 Observation unit (unit that provides < 24 hour stays) 497 Not Known 169 Home with services 84 Other (jail, institutional care, mental health, etc.) 75 Left AMA / Eloped 34 Labor & Delivery 3 Not Available 2 53

54 Of those cases resulting in an admission to the hospital from the emergency department, 62% were admitted to a floor bed. 16% were admitted to the intensive care unit. 12% went to the operating room from the emergency department. ED Discharge Disposition Floor bed (general admission, non-specialty unit bed) Number of Cases 11,100 Intensive Care Unit 2,926 Operating room 2,140 Telemetry/step-down unit (less acuity than ICU) 1,114 Observation unit (unit that provides < 24 hour stays) 497 Labor & Delivery 3 54

55 ED Discharge Disposition Level 1 Level 2 Level 3 Level 4 Floor bed (general admission, non-specialty unit bed) 4,392 1,827 4, Intensive Care Unit 1, Operating room 1, Telemetry/step-down unit (less acuity than ICU) Observation unit (unit that provides < 24 hour stays) Labor & Delivery Of the patients admitted to the hospital from the emergency department at Level 1 and 2 trauma hospitals, 54% were admitted to a floor bed, 20% were admitted to the intensive care unit and 15% went directly to the operating room. At Level 3 and 4 trauma hospitals, 77% were admitted to a floor bed, 9% were admitted to the intensive care unit and 7% went directly to the operating room. 55

56 ED Admission Disposition Injury Severity Score Floor bed (general admission, nonspecialty unit bed) Not Reported 3,776 1, Intensive Care Unit Observation unit (unit that provides <24 hour stays) Operating room Telemetry/step-down unit (less acuity than ICU) The majority of patients admitted to Level 1 and 2 trauma hospitals with an injury severity score of 25 or greater were admitted to the intensive care unit or went directly to the operating room (86%). Only 14% were admitted to a floor, observation or telemetry bed. 56

57 Of the known hospital discharge dispositions, the majority (52%) were discharged to home. 20% were discharged to a skilled nursing, hospice, intermediate or rehabilitation facility. 2% died. Hospital Discharge Disposition Number of Cases Discharged to home or self-care (routine discharge) 11,790 Skilled Nursing Facility 5,109 Acute care hospital 4,514 Not Applicable 2,285 Home with Home Health Services 1,146 inpatient rehab or designated unit 1,050 Deceased/Expired 558 Long Term Care Hospital (LTCH) 252 Hospice care 211 Psychiatric hospital or psychiatric distinct part unit of a hospital 137 Intermediate Care Facility 134 AMA 114 Rehabilitation or long-term facility 98 Court/law enforcement 61 Another type of institution not defined elsewhere 44 Not Known 18 Not Available 10 -Select- 5 Not Reported 5 Discharged/Transferred to a short-term general hospital for inpatient care 3 57

58 Of the known hospital discharge dispositions, Level 1 and 2 trauma hospitals reported that 65% of patients were discharged home compared to 38% reported by Level 3 and 4 trauma hospitals. Levels 1 and 2 trauma hospitals transferred 0.4% of patients to another acute care hospital compared to 35% reported by Levels 3 and 4. Hospital Discharge Disposition Level 1 Level 2 Level 3 Level 4 Discharged to home or self-care 5,793 1,891 2,960 1,205 Skilled Nursing Facility 1, , Acute care hospital ,130 3,268 Not Applicable Home with Home Health Services inpatient rehab or designated unit Not Reported Deceased/Expired Long Term Care Hospital (LTCH) Hospice care Psychiatric hospital or psychiatric Intermediate Care Facility AMA Rehabilitation or long-term facility Court/law enforcement Another type of institution not defined Not Known Not Available Select Discharged/Transferred to a short Detoxification Facility Other Transfer out of State

59 2014 Hospital Length of Stay 59

60 Generally, as age increases, so does the length of a patient s hospitalization. Patients that were not admitted to the intensive care unit and discharged within 48 hours are not included in this analysis. Average Hospital Age Length of Stay (Days) <

61 Of the 15,173 cases admitted to the hospital from the emergency department in which the length of stay is known, the majority (67%) stayed three or fewer days. Ninety percent stayed one week or less. Three percent stayed longer than two weeks. Hospital Length Of Stay (Days) Number of Cases 0 1, , , , , > Not Reported

62 Generally, as injury severity increased, so did patients length of stay in Level 1 and 2 trauma hospitals. The length of stay decreased with an ISS of 75. At such a high ISS level, most patients are not expected to survive their injury. The decrease in length of stay likely reflects patients who died early in their hospitalization. Injury Severity Score Average Hospital Length of Stay (Days)

63 Hospital Length Of Stay (Days) Injury Severity Score Not Reported 1,385 1, Not Reported Length of stay did not correlate with injury severity at Minnesota s Level 1 and 2 trauma hospitals. Several patients (6%) with an injury severity score less than 15 remained in the hospital longer than one week. This suggests that many patients are being treated for other comorbid conditions in addition to their injury. 63

64 ICU Length Of Stay (Days) Number of Cases ICU Length Of Stay (Days) Number of Cases ,119 1, Of the 4,427 patients who were admitted to the intensive care unit, the majority (69%) stayed three or fewer days. Thirteen percent (13) stayed longer than a week. 64

65 Appendix A: Trauma System Overview Minnesota established its statewide trauma system in 2005 to ensure that people who experience major trauma are promptly transported and treated at trauma hospitals appropriate to the severity of their injuries. Major trauma is defined by Minnesota Statues , Subdivision 3 as sudden severe injury or damage to the body caused by an external force that results in potentially life-threatening injuries or that could result in the following disabilities: (1) impairment of cognitive or mental abilities; (2) impairment of physical functioning; or (3) disturbance of behavioral or emotional functioning. Before the statewide trauma system was established, pockets of coordinated trauma care existed only in the more-densely populated areas of the state. But much of rural Minnesota lacked a coordinated system of trauma care. At that time, there were only six verified trauma hospitals in a state of over 5 million people. Now, after ten years of development, there are 124 designated trauma hospitals in the state, some with two levels of designation (both adult and pediatric). These hospitals are networked together, all committed to providing trauma care in a systematic fashion and working together for the betterment of their trauma patients. This system approach to trauma care is the most effective means of reducing death and disability resulting from severe injury. For the severely injury person, the time between sustaining an injury and receiving definitive care is the most important predictor of survival. A trauma system ensures that the necessary infrastructure is in place to deliver the right patient to the right hospital and that emergency medical and hospital resources are effectively coordinated to optimize the delivery of trauma care to achieve the best possible outcomes. Trauma systems further reduce death and disability by identifying the causes of injury, promoting prevention initiatives and ensuring that the resources required for optimal trauma care are available when and where they are needed. State Trauma Advisory Council Minnesota Statutes Section established the State Trauma Advisory Council (STAC). This multidisciplinary committee of health care and community professionals are appointed by the commissioner of health to advise, consult with and make recommendations to the commissioner on the development, maintenance and improvement of the statewide trauma system. The STAC s vision for the trauma system is that all Minnesota hospitals will participate in a fully funded trauma system that: Is of the highest quality. Is seamless across the continuum of care (prevention, care delivery, rehabilitation). Is safe, timely, efficient, patient-centered, and patient-driven. Uses outcome data and continuous clinical quality improvement to evolve. 65

66 Allows many trauma patients to be treated in their own communities. Eliminates all delays in transfers to definitive care. Is embraced and valued by citizens and policymakers. Is fully integrated into the disaster preparedness and public health systems. Regional Trauma Advisory Committees To accommodate specific regional needs within the trauma system, the Commissioner of Health, in consultation with the Emergency Medical Services Regulatory Board, has appointed six regional trauma advisory committees (RTACs) to advise, consult with and make recommendation to the STAC. Regional trauma advisory committees assess the regional performance of the trauma system and support the performance improvement activities of their member hospitals. See Appendix D for a listing of the counties included in each RTAC. Trauma Hospitals The statewide trauma system designates six levels of trauma hospitals. These designations distinguish the availability of resources needed to resuscitate and care for an injured patient; Level 1s have more resources than Level 4s. Designation levels are not meant to imply a ranking of the quality of care provided at these hospitals. In Minnesota, Level 1 and 2 trauma hospitals voluntarily undergo a verification process by the American College of Surgeons to substantiate the presence of the required resources. Most Level 3 and all Level 4 trauma hospitals voluntarily undergo a verification process administered by the Minnesota Department of Health. (Level 3 hospitals may elect to verify via the American College of Surgeons; however, most use the state pathway.) Once a hospital s resources are verified, the commissioner of health designates the facility as a trauma hospital. The facility must repeat the verification process every three years. Following is an explanation of each designation level. A Level 1 trauma hospital can provide definitive care for virtually any trauma patient. Injured patients have access to the most comprehensive resources for treatment of their injury. Many specialized services are available 24 hours a day, including anesthesiology, critical care, emergency medicine, internal medicine, neurosurgery, oral and maxillofacial surgery, orthopedic surgery, plastic surgery and radiology. An emergency physician and general surgeon are immediately available to the trauma patient while other specialties may be on call off site. The Level 1 trauma hospitals provide a training ground for resident physicians and conduct trauma-related research. They must meet minimum trauma patient volume requirements in order to maintain their status. Level 1 trauma hospitals often receive severely injured patients transferred from Level 3 and 4 trauma hospitals. 66

67 A Level 1 pediatric trauma hospital has similar resource requirements as Level 1 trauma hospitals above but must admit a minimum number of pediatric (<15 years of age) trauma patients annually and dedicate pediatric-specific clinical and administrative resources. A Level 2 trauma hospital provides definitive care for many complex and severely injured patients. Like the Level 1 trauma hospital, the emergency physician and general surgeon are immediately available to the trauma patient. But while many specialized services are available, fewer are required than for Level 1 facilities. Level 2 trauma hospitals are not required to provide residency training programs or to engage in trauma-related research. Level 2 trauma hospitals also receive severely injured patients transferred from Level 3 and 4 trauma hospitals. A Level 2 pediatric trauma hospital has similar resource requirements as Level 2 trauma hospitals above but must admit a minimum number of pediatric (<15 years of age) trauma patients annually. Level 2 pediatric trauma hospitals also have dedicated pediatric-specific clinical and administrative resources. A Level 3 trauma hospital can provide initial resuscitation and stabilization of the trauma patient. A general surgeon is available within 30 minutes to assist with the resuscitation and to provide surgical interventions. Patients with complex and multi-system injuries are typically transferred to a Level 1 or 2 trauma hospital. A Level 4 trauma hospital provides initial resuscitation to the severely injured patient. Surgical services are not typically available so trauma patients requiring admission or more comprehensive evaluation are routinely transferred to a Level 1 or 2 trauma hospital. 67

68 Appendix B: Hospitals Designated During Calendar Year 2014 Level 1 Trauma Hospitals Hennepin County Medical Center, Minneapolis Mayo Clinic Rochester Hospital, Saint Marys Campus North Memorial Medical Center, Robbinsdale Regions Hospital, St. Paul Level 1 Pediatric Trauma Hospitals Children's Hospitals and Clinics, Minneapolis Regions Hospital/Gillette Children's Specialty Healthcare, St. Paul Hennepin County Medical Center, Minneapolis Mayo Clinic Rochester Hospital, Saint Marys Campus Level 2 Trauma Hospitals Essentia Health St. Mary's Medical Center, Duluth Mercy Hospital, Coon Rapids St. Cloud Hospital St. Luke's Hospital, Duluth University of Minnesota Medical Center, Fairview, Minneapolis Level 2 Pediatric Trauma Hospitals Essentia Health St. Mary's Medical Center, Duluth North Memorial Medical Center, Robbinsdale Level 3 Trauma Hospitals Abbott-Northwestern Hospital, Minneapolis Avera Marshall Regional Medical Center Children's Hospitals and Clinics, Saint Paul Cuyuna Regional Medical Center, Crosby Douglas County Hospital, Alexandria Essentia Health St. Joseph's Medical Center, Brainerd Essentia Health St. Mary's Hospital Detroit Lakes 68

69 Fairview Lakes Medical Center, Wyoming Fairview Range Medical Center, Hibbing Fairview Ridges Hospital, Burnsville Fairview Southdale Hospital, Edina Glencoe Regional Health Services Grand Itasca Clinic and Hospital, Grand Rapids Hutchinson Health Lake Region Healthcare, Fergus Falls Lakeview Hospital, Stillwater Lakewood Health System, Staples Mayo Clinic Health System in Red Wing Mayo Clinic Health System in Mankato Park Nicollet Methodist Hospital, St. Louis Park Rice Memorial Hospital, Willmar Ridgeview Medical Center, Waconia Riverwood Healthcare Center, Aitkin Sanford Worthington Medical Center St. Francis Regional Medical Center, Shakopee St. John's Hospital, Maplewood St. Joseph's Hospital, St. Paul United Hospital, St. Paul Unity Hospital, Fridley University of Minnesota Masonic Children's Hospital, Minneapolis Woodwinds Health Campus, Woodbury Level 4 Trauma Hospitals Albany Area Hospital Appleton Area Health Services Bigfork Valley Hospital Buffalo Hospital Cambridge Medical Center CentraCare Health Long Prairie CentraCare Health Melrose 69

70 CentraCare Health Monticello CentraCare Health Paynesville CentraCare Health Sauk Centre Chippewa County-Montevideo Hospital Community Memorial Hospital, Cloquet Cook Hospital District One Hospital, Faribault Ely-Bloomenson Community Hospital Essentia Health Ada Essentia Health Deer River Essentia Health Fosston Essentia Health Graceville Essentia Health Sandstone Essentia Health Virginia Essentia Health Northern Pines Fairview Northland Medical Center, Princeton FirstLight Health System, Mora Glacial Ridge Health System, Glenwood Granite Falls Municipal Hospital Hendricks Community Hospital Association Johnson Memorial Health Services, Dawson Lake View Memorial Hospital, Two Harbors LifeCare Medical Center, Roseau Madelia Community Hospital Madison Hospital Mahnomen Health Center Mayo Clinic Health System - Albert Lea & Austin, Albert Lea Mayo Clinic Health System - Albert Lea & Austin, Austin Mayo Clinic Health System in Cannon Falls Mayo Clinic Health System in Fairmont Mayo Clinic Health System in Lake City Mayo Clinic Health System in New Prague Mayo Clinic Health System in Springfield 70

71 Mayo Clinic Health System in St. James Mayo Clinic Health System in Waseca Meeker Memorial Hospital, Litchfield Mercy Hospital, Moose Lake Mille Lacs Health System, Onamia Minnesota Valley Health Center, LeSueur Murray County Medical Center, Slayton New Ulm Medical Center Northfield Hospital Olmsted Medical Center, Rochester Ortonville Area Health Services Owatonna Hospital Perham Health Pipestone County Medical Center, Pipestone Prairie Ridge Hospital and Health Services, Elbow Lake Rainy Lake Medical Center, International Falls RC Hospital & Clinics, Olivia Redwood Area Hospital, Redwood Falls Regina Medical Center, Hastings Ridgeview Emergency Department at Two Twelve Medical Center, Chaska Ridgeview Sibley Medical Center, Arlington River's Edge Hospital, St. Peter RiverView Health, Crookston Saint Elizabeth's Medical Center, Wabasha Sanford Bagley Medical Center Sanford Bemidji Medical Center Sanford Canby Medical Center Sanford Jackson Medical Center Sanford Luverne Medical Center Sanford Thief River Falls Medical Center Sanford Tracy Medical Center Sanford Westbrook Medical Center Sanford Wheaton Medical Center 71