Washington Administrative Code › Title 246 - Health, Department of › TRAUMA/EMERGENCY MEDICAL SERVICES › Chapter 246-976 - Emergency medical services and trauma care systems › DESIGNATION OF TRAUMA CARE FACILITIES › Section 246-976-800 - Trauma rehabilitation service standards

Current through Register Vol. 24-14, July 15, 2024
WAC
								  246-976-800 Trauma Rehabilitation
								  Service Standards
Levels
A designated trauma rehabilitation service
								  must:
I
II
III
I Pediatric
(1) Be a licensed hospital as defined in chapter
								  246-320 WAC.
X
X
(2) Treat adult and adolescent trauma patients in
								  inpatient and outpatient settings regardless of disability or level of severity
								  or complexity.
X
(3) Treat pediatric and adolescent trauma
								  patients in inpatient and outpatient settings regardless of disability or level
								  of severity or complexity.
X
(4) Treat adult and adolescent trauma patients in
								  inpatient and outpatient settings with disabilities or level of severity or
								  complexity within the facility's capability and as specified in the facility's
								  admission criteria.
X
(5) For adolescent patients (approximately twelve
								  to eighteen years of age), the service must consider whether physical
								  development, educational goals, preinjury learning or developmental status,
								  social or family needs, and other factors indicate treatment in an adult or
								  pediatric rehabilitation service.
X
X
X
(6) Have and retain full accreditation by the
								  Commission on Accreditation of Rehabilitation Facilities (CARF) for inpatient
								  medical rehabilitation programs.
X
X
(7) Have and retain full accreditation by the
								  Commission on Accreditation of Rehabilitation Facilities (CARF) for pediatric
								  inpatient medical rehabilitation programs.
X
(8) House patients on a designated rehabilitation
								  nursing unit.
X
X
(9) House patients in a designated pediatric
								  rehabilitation area, providing an environment appropriate to the age and
								  developmental status of the patient.
X
(10) Provide a peer group for persons with
								  similar disabilities.
X
X
X
(11) Have a medical director who:
X
X
X
(a) Is a physiatrist;
(b) Is responsible for the organization and
								  direction of the trauma rehabilitation service; and
(c) Participates in the trauma rehabilitation
								  service's quality improvement program.
(12) Have a physiatrist in-house or on-call
								  twenty-four hours every day and responsible for the day-to-day clinical
								  management and the treatment plan of trauma patients.
X
X
X
(13) Provide rehabilitation nursing personnel
								  twenty-four hours every day, with:
X
X
X
(a) Management and supervision by a registered
								  nurse;
X
X
X
(b) The initial care plan and weekly update
								  reviewed and approved by a certified rehabilitation registered nurse
								  (CRRN);
X
X
X
(c) An orientation and training program for all
								  levels of rehabilitation nursing personnel;
X
X
X
(d) A minimum of six clinical nursing care hours,
								  per patient day, for each trauma patient;
X
X
X
(e) At least one CRRN on duty, each day and
								  evening shift, when a trauma patient is present;
X
X
(f) At least one CRRN on duty, one shift each
								  day, when a trauma patient is present.
X
(14) Provide the following trauma rehabilitation
								  services with providers who are licensed, registered, certified, or degreed and
								  are available to provide treatment as defined in the patient's rehabilitation
								  plan:
X
X
X
(a) Occupational therapy;
X
X
X
(b) Physical therapy;
X
X
X
(c) Speech/language pathology;
X
X
X
(d) Social services;
X
X
X
(e) Nutritional counseling;
X
X
X
(f) Clinical psychological services, including
								  testing and counseling;
X
X
X
(g) Neuropsychological services.
X
X
X
(15) Provide the following health personnel and
								  consultative services in-house or on-call twenty-four hours every day:
X
X
X
(a) A pharmacist with immediate access to
								  pharmaceuticals and patient medical records and pharmacy data bases;
X
X
X
(b) Respiratory care practitioners;
X
X
X
(c) Pastoral or spiritual care;
X
X
X
(d) A radiologist;
X
X
X
(e) A pediatrician.
X
(16) Provide the following services in-house or
								  through affiliation or consultative arrangements with providers who are
								  licensed, registered, certified, or degreed:
X
X
X
(a) Anesthesiology (anesthesiologist or
								  CRNA);
X
X
X
(b) Audiology;
X
X
X
(c) Communication augmentation;
X
X
X
(d) Dentistry;
X
X
X
(e) Diagnostic imaging, including:
X
X
X
(i) Computerized tomography;
(ii) Magnetic resonance imaging;
(iii) Nuclear medicine; and
(iv) Radiology;
(f) Driver evaluation and training;
X
X
(g) Educational program appropriate to the
								  disability and developmental level of the pediatric or adolescent patient, to
								  include educational screening, instruction, and discharge planning coordinated
								  with the receiving school district;
X
X
X
(h) Electrophysiologic testing, including:
X
X
X
(i) Electroencephalography;
(ii) Electromyography; and
(iii) Evoked potentials;
(i) Laboratory services;
X
X
X
(j) Orthotics;
X
X
X
(k) Prosthetics;
X
X
X
(l) Pediatric therapeutic recreation specialist
								  or child life specialist;
X
(m) Rehabilitation engineering for device
								  development and adaptations;
X
X
X
(n) Substance abuse counseling;
X
X
X
(o) Therapeutic recreation;
X
X
X
(p) Vocational rehabilitation;
X
X
(q) Urodynamic testing.
X
X
X
(17) Have providers with documented special
								  competence in pediatric rehabilitation care. This requirement applies to all
								  pediatric trauma rehabilitation providers.
X
(18) Serve as a regional referral center for
								  patients in their geographical area needing only level II or III rehabilitation
								  care.
X
(19) Have an outreach program regarding trauma
								  rehabilitation care, consisting of telephone and on-site consultations with
								  physicians and other health care professionals in the community and outlying
								  areas.
X
X
X
(20) Have a formal program of continuing trauma
								  rehabilitation care education, both in-house and outreach, provided for nurses
								  and allied health care professionals.
X
X
X
(21) Have an ongoing structured program to
								  conduct clinical studies, applied research, or analysis in rehabilitation of
								  trauma patients, and report results within a peer review process.
X
X
(22) Have a quality improvement program that
								  reflects and demonstrates a process for continuous quality improvement in the
								  delivery of trauma rehabilitation care, with:
X
X
X
(a) An organizational structure and plan that
								  facilitates the process of quality improvement and identifies the authority to
								  change policies, procedures, and protocols that address the care of the trauma
								  patient;
(b) Representation and participation by the
								  interdisciplinary trauma rehabilitation team;
(c) A process for communicating and coordinating
								  with referring trauma care providers as needed;
(d) Development of outcome standards;
(e) A process for monitoring compliance with or
								  adherence to the outcome standards;
(f) A process of internal peer review to evaluate
								  specific cases or problems;
(g) A process for implementing corrective action
								  to address problems or deficiencies;
(h) A process to analyze and evaluate the effect
								  of corrective action; and
(i) A process to ensure that confidentiality of
								  patient and provider information is maintained according to the standards of
								  RCW
								  70.41.200 and
								  70.168.090.
(23) Participate in the regional trauma quality
								  improvement program as defined in WAC
								  246-976-910.
X
X
X
X
(24) Participate in the Washington state trauma
								  registry as defined in WAC
								  246-976-430.
X
X
X
X
(25) Provide a community based program of
								  coordinated and integrated outpatient trauma rehabilitation services,
								  evaluation, and treatment to persons with trauma-related functional limitations
								  who do not need or no longer require comprehensive inpatient rehabilitation.
								  Services may be provided in, but not limited to, the following settings:
X
(a) Freestanding outpatient rehabilitation
								  centers;
(b) Organized outpatient rehabilitation programs
								  in acute hospital settings;
(c) Day hospital programs;
(d) Other community settings.
(26) Treat patients according to admission
								  criteria based on diagnosis and severity.
X
(27) Be directed by a physician with training and
								  experience necessary to provide rehabilitative physician services, acquired
								  through one of the following:
X
(a) Formal residency in physical medicine and
								  rehabilitation; or
(b) A fellowship in rehabilitation for a minimum
								  of one year; or
(c) A minimum of two years' experience in
								  providing rehabilitation services for patients typically seen in
								  CARF-accredited inpatient rehabilitation programs.
(28) Provide the following trauma rehabilitation
								  services with providers who are licensed, registered, or certified according to
								  the frequency as defined in the rehabilitation plan:
X
(a) Occupational therapy;
(b) Physical therapy;
(c) Social services;
(d) Speech/language pathology.
(29) Provide or assist the patient to obtain the
								  following as defined in the rehabilitation plan:
X
(a) Audiology;
(b) Dentistry;
(c) Driver evaluation and training;
(d) Education;
(e) Nursing;
(f) Nutrition counseling;
(g) Orthotics;
(h) Pastoral or spiritual care;
(i) Prosthetics;
(j) Psychology;
(k) Rehabilitation engineering for device
								  development and adaptations;
(l) Respiratory therapy;
(m) Substance abuse counseling;
(n) Therapeutic recreation;
(o) Vocational rehabilitation.
(30) Have a quality improvement program that
								  reflects and demonstrates a process for continuous quality improvement in the
								  delivery of trauma care, with:
X
(a) A process to identify and monitor trauma
								  rehabilitation care and outcome standards and indicators;
(b) An interdisciplinary team, to include the
								  trauma rehabilitation service physician director;
(c) A process to ensure confidentiality of
								  patient and provider information in accordance with
								  RCW
								  70.41.200 and
								  70.168.090.
Statutory Authority:
						RCW
						70.168.050,
						70.168.060, and
						70.168.070. 09-23-085, §
						246-976-800, filed 11/16/09, effective
						12/17/09.