Chapter 14. Hand and Upper Extremity Trauma Center Standards

“Accreditation Council for Graduate Medical Education (ACGME)” means the private, nonprofit council that evaluates and accredits medical residency programs in the United States.

“Commission on Accreditation of Rehabilitation Facilities (CARF)” means the international independent, nonprofit accreditor of human service providers in the areas of rehabilitation, employment, child, and family.

“Hand and upper extremity physician trauma team” means the physician team required by Regulation .03 of this chapter.

“Hand Therapy Certification Commission (HTCC)” means an independent, nonprofit accrediting body for the testing and credentialing of hand therapists.

Be licensed as an acute care hospital by the hospital licensing authority in the jurisdiction in which it is located;

Be accredited by [the Joint Commission on Accreditation of Health Care Organizations] an organization that has been granted deeming authority by the Centers for Medicare & Medicaid Services and approved by the Maryland Department of Health to accredit hospitals in the State, with a designated hand surgery service;

Have an emergency department which offers comprehensive emergency care 24 hours a day with:

Have a resolution adopted by the Board of Directors of the hospital committing the hospital to:

A medical director;

Appropriately educated nurse leaders and clinical staff to provide care for hand and upper extremity trauma patients;

A fellowship training program in hand surgery accredited by the ACGME;

A comprehensive post-trauma rehabilitation program accredited by CARF;

A quality improvement program which participates in State and regional emergency medical services quality management;

An educational program for physicians, nurses, and therapists who treat trauma patients with single system upper extremity trauma;

A policy committee that oversees the activities of the hand and upper extremity trauma center;

An internal morbidity and mortality conference scheduled to meet at least monthly to record and discuss any complications;

A maintained hand registry; and

Timely submission of data to the MIEMSS State trauma registry.

General surgery;

Plastic surgery; or

Orthopedic surgery.

The American Board of Orthopedic Surgery;

The American Board of Plastic Surgery; or

The American Board of Surgery.

Microsurgery of the upper extremity;

Neurovascular surgery of the upper extremity;

Emergency skeletal reconstruction;

Emergency soft tissue reconstruction; and

Upper limb replantation.

Specific orientation to procedures and protocols for hand and upper extremity emergencies; and

Education in hand and upper extremity emergencies and trauma care that meets the learning outcomes approved by MIEMSS.

A suite of rooms identified and specialized for examination and treatment of hand and upper extremity trauma emergencies in the hospital's emergency department with:

Organized and specialized equipment and supplies to care for hand and upper extremity trauma including specialized prepackaged sterile surgical sets located in the hand trauma rooms to enable the performance of procedures including, but not limited to:

Pneumatic tourniquets;

High intensity light;

Surgical loupes;

Power equipment for skeletal fixation;

Figure traps for fracture reduction;

Casting material in a variety of sizes and compositions;

Metallic malleable splints;

Plastic or prefabricated splits;

Specialized dressings for hand injuries including burns;

Local anesthetics; and

Doppler unit for vascular assessment.

Standard stationary radiography;

Portable C-Arm fluoroscopy;

Diagnostic vascular imaging;

Interventional vascular procedures;

CT and MRI scans;

MR angiography;

Radionuclide scanning; and

Ultrasonography.

SYSCOM;

Prehospital providers; and

Referring hospitals.

Equipment for the treatment of all hand and upper extremity injuries reconstructive procedures;

A specially trained and dedicated operating room team for hand surgery, musculoskeletal care, or both;

Continuous availability of the operating suite with an in-house operating room scrub team 24 hours a day; and

Specialized equipment readily available to enable:

Specially educated and demonstrate competencies in the postoperative evaluation of limb replantation and revascularization;

Able to independently monitor the tissue perfusion of replanted limbs; and

Specially educated in the care and postoperative monitoring of free tissue transfers.

A specialized area for inpatient and outpatient care utilizing individualized occupational and physical therapy techniques directed specifically towards the rehabilitation of the upper extremity;

Certified and licensed occupational and physical therapists;

Staff designated or qualified to be designated as certified hand therapist by the “Hand Therapy Certification Commission”;

Regular educational programs presented by the therapy staff;

A facility for the fabrication of custom individualized splints; and

The ability to care for the following types of clinical problems:

A CARF-accredited area dedicated to facilitating the transition of the injured worker back into the workforce;

Equipment to stimulate and practice the activities required at the majority of work sites;

Computerized analysis of multiple physical parameters required for performance in the workplace;

The ability to evaluate ergonomic factors in the scenario of the workers' stations; and

Social services to aid in the transition of the injured worker back into the workplace.

A dedicated adaptation hand clinic area for the evaluation and treatment of hand and upper extremity trauma patients on a nonemergent basis; and

A hand and upper extremity medical staff physician responsible for the overall clinical coordination and care delivery.

A facility to practice the microsurgical techniques needed in the acute treatment and reconstruction of upper extremity trauma victims;

Animal surgery available to simulate the human situation; and

Individualized instruction in microsurgery.

Have a facility for the dissection of human and animal specimens; and

Facilitate instruction in pertinent anatomy implicit in the treatment of hand and upper extremity trauma victims.

Provide educational support services including:

Provide psychosocial support, including a certified psychologist and a licensed social worker with special expertise in the evaluation and treatment of hand and upper extremity trauma victims; and

Provide an amputee-prosthetic clinic as a regional resource for amputee prosthetics using a team approach for management of post trauma patients with hand or upper extremity amputations, which team shall include one or more of each of the following:

Maintaining the hand physician representative on the following hospital committees to discuss quality management issues during monthly meetings:

Attendance by the hand and upper extremity trauma center representative responsible for quality management and quality improvement activities at:

Participation in State emergency medical services quality management activities;

Maintenance of a hand and upper extremity trauma registry on patients admitted to the hand and upper extremity trauma center;

Monthly review of hand and upper extremity trauma registry data and reports;

Maintenance of a patient care database on patients treated through the hand and upper extremity trauma rehabilitation unit and evaluation of the various outcomes, measures, and protocols;

Monthly review of morbidity and mortality data from the hand and upper extremity trauma center weekly patient sessions for trainees in which cases and complications can be discussed;

Making available to MIEMSS documentation of quality management including:

A monthly ethics in medicine forum to discuss ethical considerations that confront today's physician.

Coordinate ongoing research projects;

Meet monthly with hand and upper extremity trauma injury center staff to discuss the progress of research projects;

Assist in the preparation of projects for presentation and publication; and

Prepare documentation of ongoing research grants.

Residents;

Fellows; and

Attending physicians;

Medical staff internal continuing education shall consist of:

Operating room and inpatient nursing staff internal continuing education shall consist of:

Hand therapist internal continuing education shall consist of:

Review of the new attending and house staff manual;

Completion of an orientation/training session for new:

Review of trauma registry data including:

Educational activities;

Responsibilities; and

Grievances;