Healthcare System Stress Pulse Query

The Hospital Preparedness Program

0990-0391Ongoing Collection Pulse Survey 9-28-15

Healthcare System Stress Pulse Query

OMB: 0990-0391

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Form Approved

OMB No. 0990-0391

Exp. Date 05/31/2018


(Ongoing Collection: Up to four times annually, the voluntary panel participants will receive a standard survey that addresses potential healthcare issues, such as staffing, availability of resources, and changes in standard of care.)


SYSTEM TEST: A PULSE For U.S. Hospitals' Stress Level



Background: On a daily basis, we know that the healthcare system is often stretched beyond its conventional capacity and capability. Surge capacity occurs across a continuum that is often based on resource availability and demand for health services. One end of the continuum is defined by conventional responses - the maximal utilization of service usually provided in healthcare facilities; at the other end of the continuum is crisis care, when the care provided is the best possible given very limited resource availability. When disaster events or incidents occur, Hospitals and Emergency Departments may be further challenged with even more resource imbalances than their normal conventional or contingency status. To that end, it is useful to periodically query frontline clinicians to assess how stressed their current healthcare delivery setting is. The USCIIT Program for Emergency Preparedness (USCIIT-PREP) asks for your responses to the questions below.

Individual site data are not reported; only AGGREGATE DATA BY REGION are reported.

Please DO NOT forward this email.

Please complete by [DATE AND TIME]

Please provide your participant information


  1. Institution

  2. City

  3. State or Territory

  4. HHS Region (Automatically completed)

  5. I would like to receive the results of this query:

Yes

No


Your Primary Role


  1. What is your primary practice setting?

ED and ICU

Emergency Department (ED)

Intensive Care Unit (ICU)

Other (please select and define below, free text box will appear


  1. Are your patients primarily pediatric?

Yes

No



Variable Questions, based on participant response to question: What is your primary practice setting?


Emergency Department (ED) Setting


  1. TODAY, is the ED bed capacity in the primary hospital that you serve:

Under capacity

Appropriate balance

Over capacity

On diversion


  1. TYPICALLY, is the ED bed capacity in the primary hospital that you serve:

Under capacity

Appropriate balance

Over capacity

On diversion


  1. At the time that you are responding to this poll, what is the number of ICU patients in the ED waiting for ICU beds?



Intensive Care Unit (ICU) Setting


  1. TODAY, what is the ICU (Med-Surg) bed capacity in the primary unit that you serve:

Under capacity

Appropriate balance

Over capacity

On diversion


  1. TYPICALLY, what is the ICU (Med-Surg) bed capacity in the primary unit that you serve:

Under capacity

Appropriate balance

Over capacity

On diversion


  1. At the time you are responding to this poll, is the number of patients requiring mechanical ventilation in your unit (demand versus supply):

Under capacity

Appropriate balance

Over capacity

On diversion


  1. At the time you're responding to this poll, what is the total number of patients in your ICU on invasive mechanical ventilation?


  1. At the time you're responding to this poll, what is the total number of patients in your ICU?



Resources


  1. In your primary role setting, are you experiencing any of the following resource shortfalls? (If information not available, please leave blank)

Staffing

Supplies

Space

Other type of resource shortfall

No resource shortfalls

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0391. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

File Typeapplication/msword
File TitleForm Approved
AuthorDHHS
Last Modified ByBonny Bloodgood
File Modified2015-09-29
File Created2015-09-29

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