[Federal Register: April 3, 2008 (Volume 73, Number 65)]
[Notices]
[Page 18283-18284]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr03ap08-64]
=======================================================================
-----------------------------------------------------------------------
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.
-----------------------------------------------------------------------
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.
This proposed information collection was previously published in
the Federal Register on January 22nd, 2008 and allowed 60 days for
public comment. No comments were received. The purpose of this notice
is to allow an additional 30 days for public comment.
DATES: Comments on this notice must be received by May 5, 2008.
ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk
Officer by fax at (202) 395-6974 (attention: AHRQ's desk officer) or by
e-mail at OIRA_submission@omb.eop.gov (attention: AHRQ's desk
officer). 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 healthcare 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, MD, (Department of Emergency
Medicine at the Brigham and Women's Hospital and the Harvard Medical
School) and David R. Eitel, MD, (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 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
[[Page 18284]]
system in participating emergency departments.
Method of Collection
Survey: An equal-probability sample of 507 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
requester 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 reminders sent three weeks apart. The expected response rate
of 80 percent will result in 405 respondents to the survey with
approximately 70% ED nurses, 20% ED medical and health services
managers, and 10% ED physicians.
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, ED triage
nurses, and ED medical and health services managers.
Estimated Annual Respondent Burden
Exhibit 1.--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
Number of
Data collection effort Number of responses per Hours per Total burden
respondents respondent response hours
----------------------------------------------------------------------------------------------------------------
ED professionals survey......................... 405 1 20/60 135
ED professionals focus groups................... 32 1 1.5 48
---------------------------------------------------------------
Total....................................... 437 na na 183
----------------------------------------------------------------------------------------------------------------
Exhibit 2.--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
Average
Data collection effort Number of Total burden hourly wage Total cost
respondents hours rate* burden
----------------------------------------------------------------------------------------------------------------
ED professionals survey......................... 405 135 $33.70 $4,549.50
ED professionals focus groups................... 32 48 36.62 1,757.76
---------------------------------------------------------------
Total....................................... 437 183 na 6,307.26
----------------------------------------------------------------------------------------------------------------
\*\Total cost burden for the survey is based upon the weighted average of 13 physicians at $58.76/hr, 95 nurses
at $29.10/hr, and 27 medical and health services managers at $37.82/hr. Total cost burden for the focus groups
is based on the weighted average of 6 ED physicians at $58.76/hr, 21 nurses at $29.10/hr, and 21 medical and
health services managers at $37.82/hr. 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: March 25, 2008.
Carolyn M. Clancy,
Director.
[FR Doc. E8-6757 Filed 4-2-08; 8:45 am]
BILLING CODE 4160-90-M