Ambulatory Unit Induction Questionnaire 2020

2020 National Hospital and Medical Care Survey (NHAMCS)
Ambulatory Unit Induction questionnaire

Notice – CDC estimates the average public reporting burden for this collection of information as 15 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, MS D-74, Atlanta, GA 30333; ATTN: PRA (0920-0278).

 

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Form Approved: OMB No. 0920-0278; Expiration date: 06/30/2021

AMBULATORY UNIT (AU) INDUCTION: EMERGENCY DEPARTMENT (ED)
INTRO_INTERVIEW	If necessary, introduce yourself and explain the survey. Have a copy of the letter available as well. Explain that in order to develop a sampling plan, you would like to collect more specific information about this hospital's emergency department
ESA_NUM	ESA number
DEL_ESA	Does (ESA name) still exist and is it still operational? (Enter 97 to delete this ESA)
ESA_NAME	What is the name of this ESA?
ESATYPE	What type of ESA is (ESA name)? 1='General' 2='Adult' 3='Pediatric' 4='Urgent care/Fast track' 5='Psychiatric' 6='Other'
ESA_EVISITS	What is the expected number of visits from (Reporting period start date) to (Reporting period end date) for (ESA name)?
I_ESA	ESA name from previous year in panel
I_ESA_EVISITS	Estimated visits form previous year in panel
ESA_EVISITS_TOTAL	Total number of ED visits for all eligible ESAs
AU_ONSITE	Is this ESA on-site? 1=Yes 2=No
DONE_ED	Enter 1 to complete induction for this department WARNING: once you pass this screen, the ED portion of the induction interview will be closed, and you will not be allowed to re-enter to change any answers or add additional AUs. If you need to go back, use your up arrow to go back now, or press F10 to come back in later. DO NOT press 1 if you need to come back to this department section later.
AGREEEST	According to our information, there were (number) patient visits during the reporting period. Is this correct? 1=’Yes’ (Skip to NUMTRLEV) 2=’No’
ESTVISHR	How many visits did you have during the reporting period? (Instrument calculates new sampling pattern for patients’ visits)
NUMTRLEV	How many levels are in this ESA's triage system? 1=’Three’ 2=’Four’ 3=’Five’ 4=’Other – Specify’ (Go to NUMTRLEV_SP) 5=’None Do not conduct triage’
NUMTRLEV_SP	Specify other triage levels

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