Categorization, Designation, and Regionalization of Emergency Care: Definitions, a Conceptual Framework, and Future Challenges

Abstract

This article reflects the proceedings of a breakout session, ''Beyond ED Categorization-Matching Networks to Patient Needs,'' at the 2010 Academic Emergency Medicine consensus conference, ''Beyond Regionalization: Integrated Networks of Emergency Care.'' It is based on concepts and areas of priority identified and developed by the authors and participants at the conference. The paper first describes definitions fundamental to understanding the categorization, designation, and regionalization of emergency care and then considers a conceptual framework for this process. It also provides a justification for a categorization system being integrated into a regionalized emergency care system. Finally, it discusses potential challenges and barriers to the adoption of a categorization and designation system for emergency care and the opportunities for researchers to study the many issues associated with the implementation of such a system. ACADEMIC EMERGENCY MEDICINE 2010; 17:1306-1311 ª 2010 by the Society for Academic Emergency Medicine DEFINITIONS W e begin with definitions of key terms used in discussions of regionalization and categorization of emergency care. Definitions assist in research, planning, and political processes by ensuring that the terms used have the same meaning for administrators, investigators, and policy-makers who may be involved in the planning of integrated networks of emergency care. CategorizationCategorization is a process for inventorying, assessing, and cataloguing the emergency care resources, services, capabilities, and capacities of medical care facilities in a community or region, using a criteria-based classification system over a range of emergency care conditions. This process is used to assist physicians, hospitals, health departments, and emergency medical services (EMS) agencies in making informed decisions on how to develop, organize, and appropriately utilize health care resources for the emergency care system. Categorization may be accomplished using self-survey and selfdeclaration by facilities, by external agency survey and verification, or by some combination of the two. DesignationDesignation is a process for granting a charter as a preferred prehospital receiving facility and ⁄ or local or

Pediatric Readiness in Critical Access Hospital Emergency Departments

“…Variables in this analysis followed those described previously in the literature from the NPRP assessment publications . Demographic variables for the analysis included low pediatric volume (annual volume less than 1,800, or fewer than 5 patients a day) or medium (annual volume between 1,800 and 5,000, or between 5 and 14 patients a day); hospital type (standby, basic, general, or comprehensive); and ED type (general, pediatric, freestanding, or standby) . The overall measure of pediatric readiness is the weighted pediatric readiness score (WPRS).…”

“…6 Demographic variables for the analysis included low pediatric volume (annual volume less than 1,800, or fewer than 5 patients a day) or medium (annual volume between 1,800 and 5,000, or between 5 and 14 patients a day); hospital type (standby, basic, general, or comprehensive); and ED type (general, pediatric, freestanding, or standby). 6,27,28 The overall measure of pediatric readiness is the weighted pediatric readiness score (WPRS). This is a summary score, based on the results of a modified Delphi process that resulted in 24 of the 55 questions being weighted to generate a score that was normalized to a 100-point scale.…”

Web-based Morbidity and Mortality Conferencing: A Model for Rural Medical Education

“…Other authors have also emphasized the important role that electronic access to and collaboration with tertiary specialists of an academic center can play in improving regional emergency care. 10,28 The value of our model is also supported by its alignment with physician learning theory, which finds that physicians learn and make practice changes best in an informal setting where interaction and discussion with other providers is facilitated by a skilled peer. 29 We believe that this process could be further improved by including a framework to identify systematic errors and by developing a structured follow-up process to assess whether practice change or process improvement has in fact occurred, as has been described elsewhere in the M&M conference literature.…”

A Pilot Study Describing Access to Emergency Care in Two States Using a Model Emergency Care Categorization System

“…We developed a five‐tier emergency care categorization system using information from a search of peer‐reviewed literature and preliminary qualitative data from semistructured interviews with a broad range of clinical and research professionals . We then developed a 46‐item survey describing hospital staffing, characteristics, resources, and practice patterns pertinent to the practice of emergency medicine (EM) .…”