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Rural Emergency Medicine

Time-Sensitive Emergencies (TSE) Idaho Project - Update

Ken Gramyk
Rural EM Section Chair-Elect
Idaho ACEP Councilor

The Idaho TSE system is modeled on evidence-based care that addresses public education and prevention, 911 access, response coordination, pre-hospital response, transport, hospital emergency/acute care, rehabilitation and quality improvement. The TSE program creates a seamless transition between each level of care and integrates existing community resources to improve patient outcomes and reduce costs.

The Idaho Legislature approved and funded a plan to develop a statewide Time Sensitive Emergency (TSE) system of care to address 3 of the top 5 causes of deaths in Idaho: trauma, stroke and STEMI. Many studies have concluded that organized systems of care improve patient outcomes, reduce the frequency of preventable death and improve the quality of life for the patient.  There are many barriers to time sensitive care in states where the majority of the population is rural.  Timely transport to specialty care at regional centers maybe limited by many factors including: long transport distances, challenging geographical isolation and terrain, inclement weather, and significant dwell times in the rural emergency department.

The Idaho Department of Health and Welfare provides oversight and support for the day-to-day operation of the program.  A governor-appointed TSE Council, made up of providers, EMS agencies, and administrators of hospitals representing both urban and rural populations, is responsible for establishing Rules and Standards for the TSE system. The Council is the statewide governing authority of the system and approves Hospital designation for Trauma, Stroke and STEMI.

The state has been divided into six regions. Each of these has a Regional TSE Committee, made up of EMS providers, hospital providers and administrators, and public health agencies. The regional committees are the venues in which a wide variety of work is conducted such as education, technical assistance, coordination, and quality improvement. The Regional TSE Committees establish guidelines that best serve the uniqueness of their specific community, as well as providing a feedback loop for EMS and hospital providers.

Idaho continues to move forward, creating the framework for a comprehensive statewide system of care for TSE. Hospitals are in the process of completing their applications for Hospital designations of care for Trauma, Stroke, STEMI.  Over the past year, the TSE Council has approved and designated many facilities.  Additional applications are currently pending review and on-site inspections. Here are a few milestones to date since the Idaho TSE system has been developed:

  • Idaho Legislature approved the final rules for Time Sensitive Emergency system in January 2016.
  •  Saint Alphonsus Regional Medical Center Boise, ID became the first Idaho TSE designated center in February 2016. 
  •  Lost Rivers Medical Center in Arco, ID became the first Critical Access Hospital in Idaho to become a TSE designated center in July 2016.

Approved Designated Trauma Centers

  • II - 3
  • III - 5
  • IV

Approved Designated Stroke Centers

  • I - 3
  • II - 1
  • III

Approved Designated STEMI Centers

  • I - 4
  • II - 3

What’s going on in your state? Share with the Section your statewide projects designed to improve Emergency services care delivered to rural areas. Our section serves a clearing house for ideas and resources to help you implement the best programs in your state – see the past newsletters for the many ideas that have been featured over the years. Use the leverage of your State ACEP chapter to introduce projects and ideas to your state legislature, state EM residency programs and EP communities (especially focus on collaboration between rural and urban shops).

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