HOSPITAL
SCREENER
|
INTRO_SCR
|
This
is (Name of field representative) from the U.S. Census Bureau. I'm
calling for the Centers for Disease Control and Prevention
concerning their study of hospital emergency
departments.
You
should have received a letter from Brian C. Moyer, the Director of
the National Center for Health Statistics, describing the study.
You've probably also received a letter from the U.S. Census
Bureau, which is
collecting
the data for this study.
Did
you receive the letter(s)?
1=’Yes’
2=’No’
3=’Don’t
Know’
|
LETTER
|
If
the respondent does not recall receiving the letter, offer to read
or mail another copy
|
NAMECHEK
|
Let
me verify that I have the correct name and address for your
hospital.
Is
the correct name [Facility Name]?
1='Yes'
(Skip to ADDCHEK)
2='No'
|
HSP_NAME
|
What
is the name of your hospital?
|
ADDCHEK
|
Is
your hospital located at (Facility Address)?
1='Yes'
(Skip to MAILADD)
2='No'
|
HSP_ADDRESS
|
What
is the correct address?
|
MAILADD
|
Is
this also the mailing address?
1='Yes'
(Skip to INTRO_AB)
2='No'
|
MHSP_STRET
|
What
is the correct mailing address? Enter the number and street or
press enter if same
|
INTRO_AB
|
(Although
you have not received the letter,) I'd like to briefly explain the
study to you at this time and answer any questions about it. The
National Center for Health Statistics of the Centers for Disease
Control and Prevention is conducting its annual study of
hospital-based ambulatory care. (Intro for the survey) Before
discussing the details, I would like to verify our basic
information about (facility name) to be sure we have correctly
included this hospital in the study. First, concerning licensing:
|
LICHOSP
|
Is
facility a licensed hospital?
1='Yes'
(Skip to OWN101)
2='No'
|
THANK_B1
|
Thank
you, but it seems that our information is incorrect. Since
(facility name) is not a licensed hospital, it should not have
been chosen for our study. Thank you very much for your
cooperation.
(Hospital
is out of scope. Exit instrument)
|
OWN101
|
Is
hospital non-profit, government or proprietary?
Read
answer categories out loud
1=Nonprofit
(includes church-related, nonprofit corporation, other nonprofit
ownership)
2=State
or local government (includes state, county, city, city-county,
hospital district or authority)
3=Proprietary
(includes individually or privately owned, partnership or
corporation)
|
OWNHCC
|
Is
hospital owned, operated, or managed by a health care corporation
that owns multiple health care facilities?
1='Yes'
2='No'
3='Unknown'
|
TEACHOSP
|
Is
this a teaching hospital?
1='Yes'
2='No'
|
MERGER
|
Did
this hospital either merge or separate from any OTHER hospital in
the past 2 years?
1=’Merged
or separated’
2=’No’
(Skip to conglomerate questions)
3=’Unknown’
(Skip to conglomerate questions)
|
MERSEP
|
Was
this a merger or a separation?
1='Merger'
2='Separation'
|
MERGMEDR
|
Does
your hospital share its electronic health records system with any
other hospital?
1='Yes'
(Skip to MEDRSEPT)
2='No'
(Skip to MERGER)
3='Unknown'
(Skip to MEDRSEPT)
|
MEDRSEPT
|
Can
the medical records from the sample hospital be separated from all
OTHER hospitals within the group or conglomerate?
1='Yes'
(Skip to MERGNUM)
2='No'
3='Unknown'
|
MERGNUM
|
If
yes, how many other hospitals? (Specify
number)
|
OTHNAME
|
What
is the name and address of this OTHER hospital?
Enter
name of hospital
|
OTHSTRET
|
What
is the name and address of this OTHER hospital?
Enter
number and street
|
OTHSTRET2
|
What
is the name and address of this OTHER hospital?
Enter
the second line of address or press enter if same/none
|
OTHCITY
|
What
is the name and address of the OTHER hospital?
Enter
city
|
OTHSTATE
|
What
is the name and address of this OTHER hospital?
Enter
state
|
OTHZIP
|
What
is the name and address of this OTHER hospital?
Enter
zip code
|
THANK_MERGSEP
|
Since
your hospital has merged or separated within the last 2 years, I
need to get further instructions from the Centers for Disease
Control and Prevention (CDC) on how to proceed. I will call you
back within a week and let you know which parts of your hospital
will be in the survey. Thank you for your cooperation.
|
CALLRO_MERGSE
|
Call
your RO and inform them of the situation. Await resolution from
the RO before continuing with this case.
(Exit
instrument and contact RO for further instructions)
|
If the sampled hospital does not have
a conglomerate on the sample file:
|
CONG
|
Is
this facility part of a conglomerate or group?
1='Yes'
(Skip to CONGNM)
2='No' (Go to ESA24)
|
CONGNM
|
Enter
conglomerate or group name
|
If the sampled hospital has a
conglomerate on the sample file:
|
CONGID
|
We
have identified you as part of the [FILL GROUPNAME] conglomerate
or group. Is that true?
1='Yes'
(Go to ESA24)
2='No' (Skip to CONGNM)
|
CONGNM
|
Enter
conglomerate or group name
|
ESA24
|
Does
this hospital provide emergency services that are staffed 24 HOURS
each day either here at this hospital or elsewhere?
1='Yes'
(Skip to TRAUMA)
2='No'
|
ESANOT24
|
Does
this hospital operate any emergency service areas that are not
staffed 24 HOURS each day?
1='Yes'
2='No'
|
THANK_B2
|
Thank
you, but it seems that our information is incorrect. Since
(facility name) does not have 24-hour emergency services, it
should not have been chosen for our study. Thank you very much for
your cooperation.
(ED
is out of scope. Exit instrument)
|
TRAUMA
|
What
is the trauma level rating of this hospital?
1='Level
I'
2='Level II'
3='Level III'
4='Level IV'
5='Level V'
6='Other/unknown'
7='None'
|
ELIGREQ
|
Eligibility
Requirements
1=’ED
meets requirements’
2=’Hospital
not licensed’
3=’Hospital
does not have an ED’
|
STUDY_DESC
|
Thank
you. Explain the following ONLY if this is a new hospital. Provide
the administrator or other hospital representative with a brief
description of the study. Cover the following points - Now I would
like to provide you with further information on the study.
(1)
NHAMCS is the only source of national data on health care provided
in hospital emergency departments.
(2)
NHAMCS is endorsed by the: American College of Emergency
Physicians, Emergency Nurses Association, American Health
Information Management Association.
(3)
Nationwide sample of about 600 hospitals.
(4)
Four-week data collection period
(5)
Brief form completed for a sample of patient visits. As one of the
hospitals that has been selected for the study, your contribution
will be of great value in producing reliable, national data on
ambulatory care.
|
SCREENER_THK
|
Thank
you for your cooperation. I am looking forward to our meeting.
|
HOSPITAL
INDUCTION
(The
following questions pertain to entire ED)
|
INDUCTION_APPT
|
I
would like to arrange a meeting with you so that I can better
present the details of the study.
Is
there a convenient time within the next week or so that I could
contact you or your representative? Record day, date and time of
appointment.
(Enter
999 if the respondent wants to continue with the induction now)
|
REVIEW
|
I
would like to begin with a brief review of the background for this
study. Provide the administrator or other hospital representative
with a brief introduction to the study and a general overview of
procedures.
(Press
F1 for points to be covered)
|
SURGDAY
|
How
many days in a week are inpatient elective surgeries scheduled?
(data
range: 0-7)
|
BEDCZAR
|
Does
your hospital have a bed coordinator, sometimes known as a bed
czar?
1='Yes'
2='No'
3='Unknown'
|
BEDDATA
|
How
often are hospital bed census data
available?
1='Instantaneously'
2='Every
4 hours'
3='Every 8 hours'
4='Every 12 hours'
5='Every
24 hours'
6='Other'
7='Unknown'
|
HLIST
|
Does
your hospital have hospitalists on staff?
A
hospitalist is a provider whose primary professional focus is the
general care of hospitalized patients. He/she may oversee ED
patients being admitted to the hospital.
1='Yes'
2='No'
(Skip to EMEDRES)
3='Unknown' (Skip to EMEDRES)
|
HLISTED
|
Do
the hospitalists on staff at your hospital admit patients from
your ED?
1='Yes'
2='No'
3='Unknown'
|
EMEDRES
|
Does
hospital have Emergency Medicine residency program?
1='Yes'
2='No'
3='Unknown'
|
COVID_INTRO
|
Now
I would like to ask you a few questions about characteristics of
your emergency department, including the utilization of
telemedicine. After these questions, I will then ask a few
questions about the coronavirus disease (COVID-19) and the impact
it had on operations in your emergency department and on your
staff.
|
TELEMED_USE
|
During
the past four weeks, did your emergency department use
telemedicine technology (e.g., audio, audio with video, web
videoconference) for patient visits?
1=
‘Yes’
2=
‘No (Skip to COVID_TURNAWAY)’
3=
‘Don’t know’ (Skip to COVID_TURNAWAY)’
|
TELEMED_TYPE
|
During
the past four weeks, what type(s) of telemedicine tool(s) did you
use for patient visits? (Select all that apply)
=
‘Telephone audio’
=
‘Videoconference software with audio (e.g., Zoom, Webex,
Facetime)’
=
‘Telemedicine platform NOT integrated with Electronic
Health Record (EHR) (e.g., Doxy.me)’
=
‘Telemedicine platform integrated with EHR (e.g., update
clinical documentation during telemedicine visit)’
=
‘Other tool(s):’_____
=
‘Don’t know’
|
TELEMED_PERCENT
|
During
the past four weeks, what percentage of this hospital’s
emergency department patient visits were through telemedicine
technology?
1=
‘Less than 25%’
2=
‘25% to 49%’
3=
‘50%to 74%’
4=
‘75% or more’
5=
‘Don’t know’
|
TELEMED_STOP
|
Does
your emergency department plan to discontinue using telemedicine
visits in the next year?
1=
‘Yes’
2=
‘No’
3=
‘Don’t know’
|
COVID_TURNAWAY
|
During
the past four weeks, did your emergency department need to turn
away or refer elsewhere any patients with confirmed or suspected
COVID-19 infection?
1
= ‘No COVID-19 patients were turned away or referred
elsewhere’
2
= ‘Some COVID-19 patients were turned away or referred
elsewhere’
3
= ‘Most COVID-19 patients were turned away or referred
elsewhere’
4
= ‘All COVID-19 patients were turned away or referred
elsewhere’
5
= ‘Not applicable – the emergency department did not
have any COVID-19 patients.’
6
= ‘Don’t know’
|
COVID_REQUIRED
|
Has
your
hospital ever
required or mandated COVID-19 vaccination for healthcare
personnel/staff?
=
‘Yes’
=
‘No’
=
‘Don’t know’
|
COVID_OFFER
|
Did
your
hospital ever
offer COVID-19 vaccinations to healthcare personnel/staff?
=
‘Yes’
=
‘No’ (Skip to PERMPART)
=
‘Don’t know’
|
COVID_VACCINE
|
Which
COVID-19 vaccine were ever
offered
to healthcare personnel/staff at your hospital? (Select all that
apply)
1
= ‘Moderna’
2
= ‘Johnson & Johnson/Janssen’
3
= ‘Pfizer’
4
= ‘AstraZeneca’
5
= ‘Other (Specify):’
6
= ‘Don’t know’
|
PERMPART
|
As
I mentioned earlier, I would like to discuss the plan for
conducting the study. This hospital has been assigned to a 4- week
data collection period beginning on Monday, (Reporting period
begin date). First, I would like to discuss the steps needed to
obtain approval for the study. Are there any additional steps
needed to obtain permission for the hospital to participate in the
study?
1=’Yes’
2=’No’
(Skip to VSREPPER)
|
PERMPARTSPEC
|
Specify
the necessary steps needed to obtain permission for the hospital
to participate in the study. Include the name, address, phone and
title of the person(s) who can grant approval
|
PERM_THANK
|
Thank
you for your help.
|
RO_PERMISSION
|
Call
the Regional Office to inform them of the additional steps needed
to obtain permission
|
VSREPPER
|
Now
I would like to make arrangements to obtain the information needed
for sampling. I will need to (know/verify) how your (emergency
department) (is/are) organized and obtain an estimate of the
number of patient visits expected during the 4-week reporting
period. Would you prefer I (get/verify) this information from you
or someone else?
1=’Respondent’
(Skip to TWICELY)
2=’Someone
else’
|
CINFO
|
What
is the name of the person with whom I should speak? Enter 1 to
enter/update hospital contact information Enter 2 to enter/update
department contact information
1=’Hospital
level contact’
2=’Department
contact’
3=’Continue
interview’
|
THANK_RESP
|
Thank
current respondent for his/her time and cooperation
|
INTRO_ED
|
(At
this stage in the induction interview, the field representative
collects the name, type (Adult, Pediatric etc.), and visit
characteristics of each of the 24-hour Emergency Service Areas in
the ED.)
If
necessary, introduce yourself and explain the survey. Provide the
administrator with the introductory letter and ensure you obtained
verbal consent before proceeding with the interview.
Explain
that in order to develop a sampling plan, you would like to
collect more specific information about this hospital's emergency
department.
|
ESA_MANY
|
How
many emergency service areas at this hospital are open 24 hours a
day? Remind
the respondent to include satellite (off-site) locations that are
also open 24 hours a day. Ensure those locations meet the ROOFS
criteria.
(enter
number)
|
TWICELY
|
(only
asked if the instrument detects a significant difference between
the current and previous visit volumes)
Is
the number of visits to any of the ESAs more than twice the number
shown on the previous sampling plan?
1='Yes'
2='No'
|
TWICELY_SPEC
|
(only
asked if the instrument detects a significant difference between
the current and previous visit volumes)
Specify
why visits have increased this year or were too low the last time
the ED participated
|
HALFLY
|
(only
asked if the instrument detects a significant difference between
the current and previous visit volumes)
Is
the number of expected visits to any of the ESAs less than half
the number shown on the previous sampling plan?
1='Yes'
2='No'
|
HALFLYSPEC
|
(only
asked if the instrument detects a significant difference between
the current and previous visit volumes)
Specify
why visits have decreased this year or were too high the last time
the ED participated
|
EDPRIM
(after
EHRINSE)
|
When
patients with identified primary care providers arrive at the
Emergency Department, how often do you electronically send
notifications to the patients' primary care providers?
1='Always'
2='Sometimes'
3='Rarely'
4='Never'
5='Unknown'
|
EDINFO
|
When
patients arrive at the Emergency Department, are you able to query
for patients' healthcare information electronically (e.g.,
medications, allergies) from outside sources?
1='Yes'
2='No'
3='Don’t
Know'
|
OBSCLIN
|
Does
your ED have an observation or clinical decision unit?
1='Yes'
2='No'
(Skip to BOARD)
3='Unknown' (Skip to BOARD)
|
OBSSEP
|
Is
this observation or clinical decision unit physically separate
from the ED?
1='Yes'
2='No'
3='Unknown'
|
OBSDECMD
|
What
type of providers make decisions for patients in this observation
or clinical decision unit? Enter all that apply, separate with
commas
1=ED
physicians, APRN, PA
2=Hospitalists
3=Other
physicians, APRN, PA
4=Unknown
|
BOARD
|
Are
admitted ED patients ever "boarded" for more than 2
hours in the ED or the observation unit while waiting for an
inpatient bed?
1='Yes'
2='No'
3='Unknown'
|
BOARDHOS
|
Does
your ED allow some admitted patients to move from the ED to
inpatient corridors while awaiting a bed ('boarding') - sometimes
called 'full capacity protocol'?
1='Yes'
2='No'
3='Unknown'
|
AMBDIV
|
Did
your ED go on ambulance diversion in [last year]?
1='Yes'
2='No'
(Skip to NUMSTATX)
3='Unknown' (Skip to NUMSTATX)
|
TOTHRDIV
|
What
is the total number of hours that your hospital's ED was on
ambulance diversion in [last year]?
(Enter
number of diversions)
|
REGDIV
|
Is
ambulance diversion actively managed on a regional level versus
each hospital adopting diversion if and when it chooses?
1='Yes'
2='No'
3='Unknown'
|
ADMDIV
|
Does
your hospital continue to admit elective or schedule surgery cases
when ED is on ambulance diversion?
1='Yes'
2='No'
3='Unknown'
|
NUMSTATX
|
As
of last week, how many standard treatment spaces did your ED have?
Standard
treatment spaces are beds or treatment spaces specifically
designed for ED patients to receive care, including asthma chairs.
Enter
CTRL-D if data not available
|
NUMOTHTX
|
As
of last week, how many other treatment spaces did your ED have?
Other
treatment spaces are other locations where patients might receive
care in the ED, including chairs, stretchers in hallways that may
be used during busy times.
Enter
CTRL-D if data not available
|
EDSPACES
|
In
the last two years, did your ED increase the number of standard
treatment spaces?
1='Yes'
2='No'
3='Unknown'
|
PHYSSPACE
|
In
the last two years, did your ED's physical space expand?
1='Yes'
2='No'
3='Unknown'
|
EXPAND
|
Do
you have plans to expand your ED's physical space within the next
two years?
1='Yes'
2='No'
3='Unknown'
|
BEDREG
|
Does
your ED use bedside registration?
1='Yes'
2='No'
3='Unknown'
|
KIOSELCHK
|
Does
ED use kiosk self-check-in
1='Yes'
2='No'
3='Unknown'
|
CATRIAGE
|
Does
your ED use computer-assisted triage?
1='Yes'
2='No'
3='Unknown'
|
IMBED
|
Does
your ED use immediate bedding (no triage when ED is not at
capacity)?
1='Yes'
2='No'
3='Unknown'
|
ADVTRIAG
|
Does
your ED use advanced triage (triage-based care) protocols?
1='Yes'
2='No'
3='Unknown'
|
PHYSPRACTRIA
|
Does
your ED use physician, APRN, PA at triage?
1='Yes'
2='No'
3='Unknown'
|
FASTTRAK
|
Does
your ED use separate fast track unit for non-urgent care?
1='Yes'
2='No'
3='Unknown'
|
EDPTOR
|
Does
your ED use separate operating room dedicated to ED patients?
1='Yes'
2='No'
3='Unknown'
|
DASHBORD
|
Does
your ED use electronic dashboard?
1='Yes'
2='No'
3='Unknown'
|
RFID
|
Does
your ED use radio frequency identification (RFID) tracking?
1='Yes'
2='No'
3='Unknown'
|
WIRELESS
|
Does
ED use wireless communication devices by providers?
1='Yes'
2='No'
3='Unknown'
|
ZONENURS
|
Does
your ED use zone nursing?
1='Yes'
2='No'
3='Unknown'
|
POOLNURS
|
Does
your ED use pool nurses?
1='Yes'
2='No'
3='Unknown'
|
ELECTRONIC
HEALTH RECORDS (EHR): ED (E)
(Questions
pertain to Emergency Service Area (ESA) with most visits)
|
EMEDRECE
(after
HALFLYSPEC)
|
Does
your ED use an electronic health record (EHR) system? Do not
include billing record systems?
1=‘Yes,
all electronic’
2=‘Yes, part paper and part
electronic’
3=‘No’
4=‘Unknown’
|
EHRINSYRE
|
In
which year did your ED install the EMR/EHR system?
|
HHSMUE
|
Does
your current system meet meaningful use criteria as defined by the
Department of Health and Human Services?
1='Yes'
2='No'
3='Unknown'
|
EHRNAME
|
What
is the name of your current EMR/EHR
system?
1='Allscripts'
2='athenahealth'
3='Cerner'
4='eClinicalWorks'
5='e-MDs'
6='Epic'
7=’Modernizing
Medicine’
8='NextGen'
9='Practice
Fusion'
10=Greenway Medical'
11='Other - Specify' (Go to
EHRNAMOTHE)
|
EHRNAMOTHE
|
Other
- specify name of EHR/EMR system
(Enter
name of EHR system)
|
EHRINSE
|
Does
your ED have plans for installing a new EHR/EMR system within the
next 18 months?
1='Yes'
2='No'
3='Maybe'
4='Unknown'
|
