Performance Improvement Hospital Question Title * 1. Quarter Reporting Dec, Jan, Feb Mar, Apr, May June, July, Aug Sep, Oct Nov Question Title * 2. Name of Entity: Question Title * 3. Person Completing Report: Question Title * 4. Number of Trauma Patients sedated in the field with mechanism of injury conducive for head injury? Question Title * 5. Total number of diversion occurrences for your facility this quarter Question Title * 6. Total number of hours on diversion for your facility this quarter. Question Title * 7. Number of patients that met the RAC-D definition of “Major Trauma” that were transferred to hospitals outside of RAC-D this quarter. Question Title * 8. Trauma patient transferred for higher leve of care > 2 hours after arrival this quarter Question Title * 9. Number of transfer delays due to EMS Transportation Question Title * 10. Number of transfer delays due tobed availability Question Title * 11. Other (list out other reasons for delay Question Title * 12. Number of trauma related pediatric resuscitations. Question Title * 13. Number of trauma transfer denials (denied acceptance for transfer from your facility) Question Title * 14. Number of transfer denials due to bed availability Question Title * 15. Number of transfer denials due to speciality unavailable Question Title * 16. Other (list out reasons for denial) Question Title * 17. Number oftrauma transfers from your facility whoe acceptance time exceeds 30 minutes Question Title * 18. Number of trauma admits (> 24 hours) to your facility this quarter. Question Title * 19. Number of traumapatients admitted to your ICU this quarter Question Title * 20. Number of trauma admissions with ISS > 9 this quarter. Question Title * 21. Number of trauma related deaths at your facility this quarter. Question Title * 22. Number of trauma-related deaths with opportunity for improvement this quarter. Question Title * 23. Number of trauma-related deathes without opportunity for improvement this quarter Question Title * 24. Number of patients admitted from the ER directly to the OR this quarter Question Title * 25. Patient Care to be Reviewed by RAC-D PI Committee:Age: Question Title * 26. Gender: Male Female Question Title * 27. Chart Identification #: Question Title * 28. Mechanism of Injury: Question Title * 29. Identified injuries and pertinent information: Question Title * 30. Patient Outcome: Question Title * 31. Reason for RAC-D PI Review: Question Title * 32. Contributing Factors: No negative outcome Minor negative outcome Significant system performance error Major deviation from desired system performance Standard of care met Standard of care not met RAC-D guidelines followed Minor deviation from RAC-D guidelines Significant deviation from RAC-D guidelines Major Deviation from RAC-D guidelines Unable to determine Done