Indiana Department of Homeland Security One Year Progress Report for “in the process” Level III Trauma Center Hospitals that were granted status as an Trauma Center are asked to provide “in the process” Level III sufficient documentation for the Indiana State Department of Health and the Indiana Department of Homeland Security to demonstrate that your hospital continues to comply with the following requirements: Submission of trauma data to the State Registry. The hospital must be submitting data to the Indiana Trauma Registry following the data dictionary data standard within 30 days of Registry’s application and at least quarterly thereafter. Has your hospital submitted trauma data to the State Registry at least YES NO two out of the last four quarters? Trauma Surgeon response times. Evidence must be submitted that response times for the Trauma Surgeon are as defined by the Optimal Resources document of the American College of Surgeons. Also, there must be a written letter of commitment, signed by the Trauma Medical Director, that is included as part of the must be evidence that a hospital’s application. There trauma surgeon is a member of the disaster committee. hospital’s Have your Trauma a response time as defined by YES NO Surgeon’s maintained the Optimal Resources document of the American College of Surgeons since granted Trauma Center status? “in process” Level III Provide your Trauma Surgeon response times including hospital’s number of responses, response times and percentage within the required timeframe per Trauma Surgeon (documentation tool attached). Diversion policy. The hospital must provide a copy of its diversion policy and affirm that it will not be on diversion status more than 5% of the time. The documentation must include a hospital’s record for the previous year showing dates and length of time for each time the hospital was on diversion. Has your hospital maintained a diversion status of less than 5% of the YES NO time since granted Trauma Center status? “in process” Level III Provide your diversion documentation showing reason for hospital’s diversion and dates and length of time for each time the hospital was on diversion (documentation tool attached).
Indiana Department of Homeland Security One Year Progress Report for “in the process” Level III Trauma Center Hospitals that were granted status as an “in the process” Level III Trauma Center are asked to provide sufficient documentation for the Indiana State Department of Health and the Indiana Department of Homeland Security to demonstrate that your hospital continues to comply with the following requirements: Submission of trauma data to the State Registry. The hospital must be submitting data to the Indiana Trauma Registry following the Registry’s data dictionary data standard within 30 days of application and at least quarterly thereafter. Has your hospital submitted trauma data to the State Registry at least two out of the last four quarters? YES NO Trauma Surgeon response times. Evidence must be submitted that response times for the Trauma Surgeon are as defined by the Optimal Resources document of the American College of Surgeons. Also, there must be a written letter of commitment, signed by the Trauma Medical Director, that is included as part of the hospital’s application. There must be evidence that a trauma surgeon is a member of the hospital’s disaster committee. Have your Trauma Surgeon’s maintained a response time as defined by the Optimal Resources document of the American College of Surgeons since granted “in process” Level III Trauma Center status? Provide your hospital’s Trauma Surgeon response times including number of responses, response times and percentage within the required timeframe per Trauma Surgeon (documentation tool attached). YES NO Diversion policy. The hospital must provide a copy of its diversion policy and affirm that it will not be on diversion status more than 5% of the time. The hospital’s documentation must include a record for the previous year showing dates and length of time for each time the hospital was on diversion. Has your hospital maintained a diversion status of less than 5% of the time since granted “in process” Level III Trauma Center status? Provide your hospital’s diversion documentation showing reason for diversion and dates and length of time for each time the hospital was on diversion (documentation tool attached). YES NO