Tenn. Comp. R. & Regs. 1200-08-30-.03 - ADMINISTRATION

(1) The hospital administration shall provide the following:
(a) Adequate and properly trained personnel to provide the services expected at the designated Pediatric Emergency Care Facility classification.
(b) The financial resources to provide the emergency department or the pediatric emergency department with the equipment necessary to provide the level of services of the designated PECF classification.
(c) Facilities designed for easy access and appropriate for the care of pediatric patients at the designated PECF classification.
(d) Access to emergency care for all urgent and emergent pediatric patients regardless of financial status.
(e) Participation in a network of pediatric emergency care within the region where it is located by linking the facility with a regional referral center to:
1. guarantee transfer and transport agreements;
2. refer seriously and critically ill patients and special needs patients to an appropriate facility; and
3. assure the support of agreements to receive or transfer appropriate patients.
(f) A collaborative environment with the Emergency Medical Services and Emergency Medical Services for Children systems to educate pre-hospital personnel, nurses and physicians.
(g) Participation in data collection to assure that the quality indicators established by the regional resource center are monitored, and make data available to the regional resource center or a central data monitoring agency.
(h) Linkage with pre-hospital care and transport.
(i) Public education regarding access to pediatric emergency care, injury prevention, first aid and cardiopulmonary resuscitation.
(j) Incorporation into the hospital existing quality assessment and improvement program, a review of the following pediatric issues and indicators:
1. deaths;
2. incident reports;
3. child abuse cases;
4. cardiopulmonary or respiratory arrests;
5. admissions within 48 hours after being discharged from the emergency department.;
6. surgery within 48 hours after being discharged from an emergency department;
7. quality indicators requested by the Comprehensive Regional Pediatric Center or state/local Emergency Medical Services for Children authority regarding nursing care, physician care, pre-hospital care and the medical direction for pre-hospital providers of Emergency Medical Services systems;
8. pediatric transfers; and
9. pediatric inpatient illness and injury outcome data.
(2) In a Comprehensive Regional Pediatric Center, hospital administration shall also:
(a) Provide assistance to local and state agencies for Emergency Medical Services and Emergency Medical Services for Children in organizing and implementing a network for providing pediatric emergency care within a defined region that:
1. provides transfer and transport agreements with other classifications of facilities;
2. provides transport services when needed for receiving critically ill or injured patients within the regional network;
3. provides necessary consultation to participating network hospitals;
4. provides indirect (off-line) consultation, support and education to regional pre-hospital systems and supports the efforts of regional and state pre-hospital committees;
5. provides medical support to assure quality direct (on-line) medical control for all pre-hospital systems within the region;
6. organizes and implements a network of educational support that:
(i) trains instructors to teach pediatric pre-hospital, nursing and physician-level emergency care;
(ii) assures that training courses are available to all hospitals and health care providers utilizing pediatric emergency care facilities within the region;
(iii) supports Emergency Medical Service agencies and Emergency Medical Services Directors in maintaining a regional network of pre-hospital provider education and training;
(iv) assures dissemination of new information and maintenance of pediatric emergency skills;
(v) updates standards of care protocols for pediatric emergency care;
(vi) assures that emergency departments and pediatric intensive care units within the hospital shall participate in regional education for emergency medical service providers, emergency departments and the general public;
(vii) provides for public education and promotes family-centered care in relation to policies, programs and environments for children treated in emergency departments.
7. assists in organizing and providing support for regional, state and national data collection efforts for EMSC that:
(i) defines the population served;
(ii) maintains and monitors pediatric specific quality indicators;
(iii) includes injury and illness epidemiology;
(iv) includes trauma/illness registry (this shall include severity, site, mechanism and classification of injury/illness, plus demographic information, outcomes and transport information);
(I) Each CRPC shall submit TRACS Registry data electronically to the state trauma registry on all closed patient files no less often than quarterly for the sole purpose of allowing the board to analyze causes and medical consequences of serious trauma while promoting the continuum of care that provides timely and appropriate delivery of emergency medical treatment for people with acute traumatic injury.
(II) TRACS data shall be transmitted to the state trauma registry and received no later than one hundred twenty (120) days after each quarter.
(III) Failure to timely submit TRACS data to the state trauma registry for three (3) consecutive quarters shall result in the delinquent facility's necessity to appear before the Board for any disciplinary action it deems appropriate, including, but not limited to, citation of civil monetary penalties and/or loss of CRPC designation status.
(IV) CRPC's shall maintain documentation to show that timely transmissions have been submitted to the state trauma registry on a quarterly basis.
(v) is adaptable to answer questions for clinical research; and
(vi) supports active institutional and collaborative regional research.
(b) Organize a structured quality assessment and improvement program with the assistance and support of local/state Emergency Medical Services and Emergency Medical Services for Children agencies that allows ongoing review and:
1. reviews all issues and indicators described under the four classifications of Pediatric Emergency Care Facilities emergency departments;
2. provides feedback, quality review and information to all participating hospitals, emergency medical services and transport systems, and appropriate state agencies;
3. develops quality indicators for the review of pediatric care which are linked to periodic continuing education and reviewed at all participating institutions;
4. reviews all trauma-related deaths, including those that are primary admitted patients versus secondary transferred patients. This review should include a morbidity and mortality review;
5. assures quality assessment in the Emergency Department and the Pediatric Intensive Care Unit to include collaborative quality assessment, morbidity and mortality review, utilization review, medical records review, discharge criteria, planning and safety review; and
6. evaluates the emergency services provided for children for emphasis on family-centered philosophy of care, family participation in care, family support during emergency visits and transfers and family information and decision-making.
(c) Have an organized trauma training program by and for staff physicians, nurses, allied health personnel, community physicians and pre-hospital providers;
(d) Have an organized organ donation protocol with a transplant team or service to identify possible organ donors and assist in procuring for donation, consistent with state and federal law;
(e) Have a pediatric intensive care unit and emergency department (ED) in which the staff train health care professionals in basic aspects of pediatric emergency and critical care and serve as a focus for continuing education programs in pediatric emergency and critical care. In addition, staff workers in the pediatric intensive care unit and ED shall routinely attend or participate in regional and national meetings with course content pertinent to pediatric emergency and critical care.
(f) Assure training for pediatric intensive care unit and ED nurses in the following required skills: recognition, interpretation and recording of various physiological variables, drug administration, fluid administration, resuscitation (including cardiopulmonary resuscitation certification), respiratory care techniques (chest physiotherapy, endotracheal suctioning and management, tracheotomy care), preparation and maintenance of patient monitors, family-centered principles and psychosocial skills to meet the needs of both patient and family. PICU nurse-to-patient ratios vary with patient needs, but should range from 4 to 1 to 1 to 3.
(g) Establish within its organization a defined pediatric trauma/emergency service program for the injured child. The pediatric trauma/emergency program director shall be a pediatric surgeon, certified "or eligible for certification" in pediatric surgery, with demonstrated special competence in care of the injured child. The director shall have full responsibility and authority for the pediatric trauma/ emergency service program.
(h) Provide the following pediatric emergency department/trauma center personnel:
1. an emergency physician on duty in the emergency department;
2. a pediatric trauma surgeon promptly available within 30 minutes;
3. two registered nurses with pediatric emergency, pediatric critical care or pediatric surgical experience as well as training in trauma care;
4. a cardiothoracic surgeon who is promptly available or a transfer agreement to Level 1 trauma center;
5. an orthopedic surgeon who is promptly available;
6. an anesthesiologist who is promptly available. An anesthesia resident post graduate year 3 capable of assessing emergency situations and initiating proper treatment or a certified registered nurse anesthetist credentialed by the chief of anesthesia may fulfill this requirement, but a staff anesthesiologist must be available within 30 minutes;
7. a neurosurgeon who is promptly available;
8. a pediatric respiratory therapist, laboratory technician and radiology technician;
9. a computer tomography technician in-house (or on-call and promptly available if the specific clinical needs of the hospital make this necessary and it does not have an adverse impact on patient care);
10. available support services to the emergency department to include social services, chaplain support, and a child and sexual abuse team that are promptly available. These support services shall include family counseling and coordination with appropriate services to support the psychological, financial or other needs of families;
11. a pediatric nursing coordinator who is responsible for coordination of all levels of pediatric trauma/emergency activity including data collection, quality improvement, nursing education and may include case management;
12. the pediatric trauma committee chaired by the director of the pediatric trauma program with representation from pediatric surgery, pediatric emergency medicine, pediatric critical care, neurosurgery, anesthesia, radiology, orthopedics, pathology, respiratory therapy, nursing and rehabilitation therapy. This committee shall assure participation in a pediatric trauma registry. There must be documentation of the subject matter discussed and attendance at all committee meetings. Periodic review should include mortality and morbidity, mechanism of injury, review of the Emergency Medical Services system locally and regionally, specific care review, trauma center/system review, and identification and solution of specific problems including organ procurement and donation;
13. a trauma register function shall be provided in organizations that have 500-1000 trauma admissions/observations per year; and
14. a CRPC coordinator position whose responsibilities include:
(i) acting as a regional liaison and coordinator for the statewide EMSC project;
(ii) planning and providing educational activities to meet the needs of the emergency network hospitals and pre-hospital providers; and
(iii) maintaining and updating the CRPC Pediatric Facility Notebook.


Tenn. Comp. R. & Regs. 1200-08-30-.03
Original rule filed November 30, 1999; effective February 6, 2000. Amendment filed October 15, 2002; effective December 29, 2002 Amendment filed August 16, 2006; effective October 30, 2006. Amendment filed December 4, 2007; effective February 17, 2008.

Authority: T.C.A. ยงยง 4-5-202, 4-5-204, 68-11-202, 68-11-209, and 68-11-251.

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