[Federal Register Volume 73, Number 65 (Thursday, April 3, 2008)]
[Notices]
[Pages 18283-18284]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-6757]


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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.
    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 [email protected] (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 
[email protected].

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
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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.........................             405               1           20/60             135
ED professionals focus groups...................              32               1             1.5              48
                                                 ---------------------------------------------------------------
    Total.......................................             437              na              na             183
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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.........................             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
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\*\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