What is the name of your hospital/ED?
* must provide value
What is the mailing address of your hospital/ED?
* must provide value
In 2021, was your ED open 24 hours/day, 7 days/week?
(A1a)
* must provide value
Yes
No
In 2021, was your ED open 365 days per year?
(A1b)
* must provide value
Yes
No
If NOT open 24/7 all year in 2021, please explain:
Please indicate the total number of patient visits at your ED and the 12-month reporting period to which they apply.
Number of ED visits:
(A2)
* must provide value
12-month reporting period (from MM/YY to MM/YY)
* must provide value
MM/YY to MM/YY
Please indicate the approximate number of ED visits by children (e.g., age < 18).
Number of Child ED visits (e.g., age < 18).
(A3)
* must provide value
If your ED uses another age to distinguish between children and adults (e.g., age < 21 years), and it's difficult to obtain data for age < 18, please respond above according to your ED's cut-off.
Specify age cut-off if not < 18 years:
(A3a)
* must provide value
For EDs that regularly treat adults: Does your ED have a dedicated area for children only (e.g., dedicated beds)?
(A4)
* must provide value
Yes
No
Not applicable (e.g., children's hospital)
A pediatric area is any separate physical area where children are seen or sent (e.g., a designated pediatric area of the waiting room, pediatric treatment room/beds). If an area is meant for children but sometimes used for adults in case of overflow, this still counts as a pediatric area.
Do you have an identified coordinator(s) for pediatric emergency care in your ED?
(A5)
* must provide value
Yes
No
An identified coordinator for pediatric emergency care, or pediatric emergency care coordinator (PECC), is someone who manages pediatric care in the ED and who helps educate other ED staff on pediatric emergency care. PECC roles can vary, and some EDs refer to these individuals with different titles (e.g., Pediatric Champion).
How many identified coordinators does your ED have?
(A5a)
* must provide value
1
2
> 3
Please specify the type of coordinator(s): (check all that apply)
(A5b)
* must provide value
Physician coordinator(s)
Nurse coordinator(s)
Other (e.g. PA, administrator)
If "other" pediatric coordinator, please specify:
* must provide value
How many total hours (weekly) do/does your identified coordinator(s) devote to the role?
(A5c)
* must provide value
< 5 hours
5 - 9.99 hours
10 - 19.99 hours
20 - 39.99 hours
> 40 hours
Does your ED utilize telehealth services to evaluate patients in your ED ?
(A6)
* must provide value
Yes
No
Does your ED utilize telehealth for: (check all that apply)
(A6a)
* must provide value
Pediatrics
Stroke/Neuro
Psychiatry
Trauma
Dermatology
Radiology
Transfer coordination
Disaster preparedness
COVID-19
Other
If "other", please specify:
(A6a)
* must provide value
Does your ED receive telehealth services from another facility in your health system or from an outside organization ?
(A6b)
* must provide value
Yes
No
Do clinicians within your ED evaluate patients within your ED using telehealth (e.g., using telehealth as electronic PPE)?
(A6c)
* must provide value
Yes
No
Does your ED utilize telehealth services to evaluate your own patients who are remote (e.g., in their homes or at a skilled nursing facility)?
(A7)
* must provide value
Yes
No
Does your total visit volume reported in A2) include these virtual ED visits?
(A7a)
* must provide value
Yes
No
Were these visits typically done with video?
(A7b)
* must provide value
Yes, 2-way video connection
Yes, 1-way video connection
No, phone connection only
Does your hospital/ED provide telehealth services out for the evaluation of patients in other EDs ?
(A8)
* must provide value
Yes
No
Not sure
On a typical day at 6 pm : Are there any ED patients being cared for primarily in the hallway?
(A9a)
* must provide value
Yes
No
On a typical day at 6 pm : Are there patients that "board" in the ED for >2hrs until an inpatient bed becomes available?
(A9b)
* must provide value
Yes
No
Approximate percent of patients that arrived to the ED by ambulance.
(A10)
* must provide value
% BY AMBULANCE
Approximate percent of ED patients that were uninsured or 'self-pay'
(A11a)
* must provide value
% UNINSURED
Approximate percent of ED patients participating in Medicaid.
(A11b)
* must provide value
% MEDICAID
Approximate percent of all ED visits that led to admission, including ICU and OBS admissions
(ED-based OBS unit + OBS status).
(A12)
% ADMIT
Does your ED have accreditation as a geriatric emergency department?
(A13)
* must provide value
Yes
No
Approximate number of ED patients over age 65.
(A14)
* must provide value
# OVER 65
Approximate number of critical care transfers to other facilities (i.e., transfers requiring a level of care beyond ALS - Advanced Life Support)
(A15)
* must provide value
# PATIENTS/YR
For 2021, please indicate the average total number of clinicians , after accounting for departures and new hires.
Totals are expressed as full-time employees (FTE) - e.g., 2 half-time = 1 FTE.
(B1)
Number of FTE ED attending physicians:
(B1a)
* must provide value
Number of FTE ED nurses:
(B1b)
* must provide value
Number of FTE ED physician assistants:
(B1c)
* must provide value
Number of FTE ED nurse practitioners:
(B1d)
* must provide value
Percent of attending emergency physicians board-certified or board-eligible (BC/BE) by ABEM, AOBEM or ABP/Peds EM:
(B2)
* must provide value
% BC/BE
Is at least one Certified Emergency Nurse (CEN) on duty in the ED 24 hours/day, 7 days/week?
(B3)
* must provide value
Yes
No
Don't know
Is at least one attending physician (not resident) on duty in the ED 24 hours/day, 7 days/week?
(exclude on-call physicians) .
(B4)
* must provide value
Yes
No
If NO, when a physician is not on duty in the ED , is any physician available to the ED by two-way voice communication 24 hours/day, 7 days/week:
(B4a)
From within your hospital?
(B4ai)
* must provide value
Yes
No
From outside of your hospital?
(B4aii)
* must provide value
Yes
No
Are there neurology consultants available in-person to the ED?
(C1)
* must provide value
Yes
No
On average, how long does the consultant take to arrive?
(C1a)
* must provide value
0-29 min
30-59 min
> 60 min
Is the consultant available 24 hours/day, 7 days/week?
(C1b)
* must provide value
Yes
No
e. Time elapsed between request for patient transfer and departure from ED to an intensive care unit (e.g. on a mechanical ventilator)
(C2e)
* must provide value
< 30 min
30-59 min
> 60 min
NA
f. Time elapsed between request for patient transfer and departure from ED to the operating room (e.g. for emergent condition)
(C2f)
* must provide value
< 30 min
30-59 min
> 60 min
NA
Is alteplase (i.e., tissue plasminogen activator, tPA) available in your ED for eligible patients?
(C3)
* must provide value
Yes
No
Not sure
If YES, in 2021, select approximately how many stroke patients were treated with alteplase in your ED.
(C3a)
* must provide value
0
1-3
4+
Not sure
Does your ED have a written protocol for the management of acute stroke patients?
(C4)
* must provide value
Yes
No
Not sure
Approximately how many potential stroke patients were cared for in your ED in 2021?
(C5)
* must provide value
0
1-60
61-120
>120
Not sure
If a stroke patient requires transfer, to what hospital are patients most often sent? Please specify:
(C6)
* must provide value
Is endovascular therapy (i.e., mechanical thrombectomy) available in your hospital for eligible acute stroke patients with large vessel occlusion?
(C7)
* must provide value
Yes
No
Which of the following type of patients does your hospital typically admit? Check all that apply :
(C8)
* must provide value
TIA patients
Stroke patients not treated with alteplase
Stroke patients treated with alteplase
Stroke patients that require thrombectomy
Stroke patients that have an intracranial hemorrhage
None of these
Position (e.g., ED Director)