Assessment of the Emergency Severity Index (ESI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #2 ED Professionals Focus Groups	Form and Instruction	New	Available
Form Form #1 ED professionals survey	Form and Instruction	New	Available
Attachment P - Focus Group Letter.doc	Supplementary Document	Uploaded 2008-07-09	Available
Attachment B - ED Professionals Survey - Rev.doc	Supplementary Document	Uploaded 2008-07-09	Available
Supporting Statement Part B_ESI Final.doc	Supporting Statement B	Uploaded 2008-07-09	Available
Attachment A -- AHRQ Legislation.pdf	Supplementary Document	Uploaded 2008-04-04	Available
Attachment D -- 30 Day Notice.pdf	Supplementary Document	Uploaded 2008-04-04	Available
Attachment E - Outside Consultants.doc	Supplementary Document	Uploaded 2008-04-04	Available
Attachment H - Written Informed Consent for Focus Groups.doc	Supplementary Document	Uploaded 2008-04-04	Available
Attachment O- Flyer for Focus Group Recruitment.doc	Supplementary Document	Uploaded 2008-04-04	Available
Attachment F - Cover Letter for Email and Mail Survey.doc	Supplementary Document	Uploaded 2008-04-03	Available
Attachment N- Three Week Phone.doc	Supplementary Document	Uploaded 2008-04-03	Available
Attachment M- Three Week Email.doc	Supplementary Document	Uploaded 2008-04-03	Available
Attachment L- Three Week Postcard.doc	Supplementary Document	Uploaded 2008-04-03	Available
Attachment K- One Week Phone.doc	Supplementary Document	Uploaded 2008-04-03	Available
Attachment J- One Week Email.doc	Supplementary Document	Uploaded 2008-04-03	Available
Attachment I- One Week Postcard.doc	Supplementary Document	Uploaded 2008-04-03	Available
Attachment G - Cover Letter for Telephone Survey.doc	Supplementary Document	Uploaded 2008-04-03	Available
Supporting Statement Part A_ESI Final.doc	Supporting Statement A	Uploaded 2008-07-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
184580	ED Professionals Focus Groups	Form and Instruction	New
184579	ED professionals survey	Form and Instruction	New

ICR Details

OMB Control No: 0935-0139	ICR Reference No: 200804-0935-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Assessment of the Emergency Severity Index (ESI)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/15/2008
	Date Received in OIRA: 04/23/2008
Terms of Clearance: Approved with change.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2009	12 Months From Approved
Responses	437	0	0
Time Burden (Hours)	183	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: 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.

---

Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 3726	01/22/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 18283	04/03/2008
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
ED professionals survey	Form #1	ED professionals survey
ED Professionals Focus Groups	Form #2	Focus Group Protocal

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	437	0	0	437	0	0
Annual Time Burden (Hours)	183	0	0	183	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection.

---

Annual Cost to Federal Government: $296,219

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/23/2008

---