[Federal Register: January 22, 2008 (Volume 73, Number 14)]
[Notices]
[Page 3726-3727]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr22ja08-68]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Agency for Healthcare Research and Quality, HHS.
ACTION: Notice.
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SUMMARY: This notice announces the intention of the Agency for
Healthcare Research and Quality (AHRQ) to request that the Office of
Management and Budget (OMB) approve the proposed information collection
project: ``Assessment of the Emergency Severity Index (ESI).'' In
accordance with the Paperwork Reduction Act of 1995, Public Law 104-13
(44 U.S.C. 3506(c)(2)(A)), AHRQ invites the public to comment on this
proposed information collection.
DATES: Comments on this notice must be received by March 24, 2008.
ADDRESSES: Written comments should be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by e-mail at
doris.lefkowitz@ahrq.hhs.gov.
Copies of the proposed collection plans, data collection
instruments, and specific details on the estimated burden can be
obtained from the AHRQ Reports Clearance Officer.
FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427-1477, or by e-mail at
doris.lefkowitz@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
Proposed Project
``Assessment of the Emergency Severity Index (ESI)''
AHRQ is proposing to examine uptake and use of an emergency room
triage tool, the Emergency Severity Index (ESI). The hospital emergency
department (ED) represents a critical point in care delivery for
patients across the United States. Over the past decade, however, the
dramatic influx of patients into EDs has seriously challenged the
ability of these departments to deliver timely, quality, and safe
emergency health care services. Moreover, with most emergency
departments operating at or over capacity it may prove difficult for
them to respond to the surge in emergency room demand created by
natural and man-made disasters. Development of increasingly refined and
validated triage methods is one potential key to addressing
overcrowding by speeding up the care delivery to the most acute ED
patients while helping hospitals assess, carefully allocate and plan
the amount of human and other resources needed to care for all
patients.
In response to a need to standardize the triage process and improve
the flow of patients, Richard C. Wuerz, M.D., (Department of Emergency
Medicine at the Brigham and Women's Hospital and the Harvard Medical
School) and David R. Eitel, M.D., (Department of Emergency Medicine,
The York Hospital WellSpan Health System) initiated development of the
Emergency Severity Index (ESI) in 1995. The ESI is unique in its focus
on appropriate resource allocation and its consideration of necessary
resource utilization in assigning acuity. To encourage adoption of the
ESI, AHRQ developed an implementation handbook (Emergency Severity
Index, Version 4) and companion DVDs. These materials are intended to
provide hospitals and triage nurses with background on why they might
want to implement the ESI as a triage tool, and offers recommendations
on the implementation process and staff training.
This project will assess the product's acceptance by emergency
departments and others involved in addressing medical surges to better
understand the usefulness of the ESI compared to other
[[Page 3727]]
similar tools. It will focus on the satisfaction with the product's
presentation, content, and clarity; extent to which the product has
improved emergency services and surge preparation; and the improvements
users would like to see in the next version of this product. This will
be accomplished through (1) developing and implementing an electronic
and paper-based survey targeting emergency department professionals
assessing the satisfaction with the ESI's content, clarity and actual
use of the system in everyday emergency departments, and (2) convening
focus groups of ED professionals to identify characteristics that might
predict uptake and use of this system in participating emergency
departments.
Method of Collection
Survey: A randomly selected sample of 600 ED professionals from the
database AHRQ maintains of individuals and organizations that requested
a copy of the ESI tools will be contacted to participate in the survey.
Where a phone number has been provided, we will do a reverse telephone
number search to identify the mailing address of the requestor and
conduct a mail survey with telephone follow-up. For those who have
provided an e-mail address, we will send a link to a web survey.
Telephone and e-mail prompts will be sent after two weeks to those who
have not yet completed the questionnaire, followed by two additional
remainders sent three weeks apart. The expected response rate of 80
percent will result in 480 respondents to the survey with approximately
half from ED physicians and half from ED nurses.
Focus Groups: Focus groups will be conducted to gauge ED managers'
and clinicians' awareness of the ESI tool as well as AHRQ's role in ED
surge planning and preparation. To the extent that we are able to
identify a subgroup of ED representatives who are aware of the ESI tool
but have chosen not to utilize it in their emergency departments, focus
groups may also be useful to gather information on why these
organizations opted not to employ the ESI. In order to facilitate
communication among focus group participants and ensure that responses
address the key issues identified in the focus group guide, we will
limit participation in each focus group meeting to between six and
eight individuals. A total of four focus group meetings will be held,
including two meetings each with ED medical directors, and ED triage
nurses.
Estimated Annual Respondent Burden
Exhibit 1.--Estimated Annualized Burden Hours
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Number of
Data collection effort Number of responses per Hours per Total burden
respondents respondent response hours
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ED professionals survey......................... 480 1 30/60 240
ED professionals focus groups................... 32 1 1.5 48
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Total....................................... 512 na na 288
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Exhibit 2.--Estimated Annualized Cost Burden
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Average
Data collection effort Number of Total burden hourly wage Total cost
respondents hours rate * burden
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ED professionals survey......................... 480 240 $43.93 $10,544
ED professionals focus groups................... 32 48 43.93 2,109
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Total....................................... 512 288 na 12,653
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* Based upon the mean of the average wages of ED physicians and nurses, National Compensation Survey:
Occupational wages in the United States 2006, ``U.S. Department of Labor, Bureau of Labor Statistics.''
This information collection will not impose a cost burden on
respondents beyond that associated with their time to provide the
required data. There will be no additional costs for capital equipment,
software, computer services, etc.
Estimated Annual Costs to the Federal Government
Developing and implementing the survey, $183,305.
Developing and conducting focus groups, $69,669.
Analyzing the data and report production, $26,172.
Associated personnel costs, $17,073.
The total cost to the government for this activity is estimated to
be $296,219.
Request for Comments
In accordance with the above-cited Paperwork Reduction Act
legislation, comments on AHRQ's information collection are requested
with regard to any of the following: (a) Whether the proposed
collection of information is necessary for the proper performance of
AHRQ health care research and health care information dissemination
functions, including whether the information will have practical
utility; (b) the accuracy of AHRQ's estimate of burden (including hours
and costs) of the proposed collection(s) of information; (c) ways to
enhance the quality, utility, and clarity of the information to be
collected; and (d) ways to minimize the burden of the collection of
information upon the respondents, including the use of automated
collection techniques or other forms of information technology.
Comments submitted in response to this notice will be summarized
and included in the Agency's subsequent request for OMB approval of the
proposed information collection. All comments will become a matter of
public record.
Dated: January 14, 2008.
Carolyn M. Clancy,
Director.
[FR Doc. 08-170 Filed 1-18-08; 8:45 am]
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