Md. Code Regs. 30.08.14.05

Current through Register Vol. 51, No. 12, June 14, 2024

Section 30.08.14.05 - Facility and Unit Capabilities

A. Hand and upper extremity trauma facilities shall be able to optimally and comprehensively care for every patient with an isolated upper extremity injury from the time the patient arrives at the hospital through acute treatment, rehabilitation, reconstruction, and re-entry into the work force.

B. Hand and upper extremity trauma area facilities shall have:

(1) A suite of rooms identified and specialized for examination and treatment of hand and upper extremity trauma emergencies in the hospital's emergency department with:

(a) A medical director or representative on the hospital's emergency services committee that shall oversee the management of the hand and upper extremity trauma center; and

(b) Appropriate nurse leaders who shall be responsible for all venues in which hand and upper extremity trauma care is rendered;

(2) Organized and specialized equipment and supplies to care for hand and upper extremity trauma including specialized prepackaged sterile surgical sets located in the hand trauma rooms to enable the performance of procedures including, but not limited to:

(a) Exploration and debridement of complex hand injuries;

(b) Bony debridement and shortening;

(c) Thermal injury care;

(d) Tendon repair;

(e) Full and partial thickness skin grafts;

(f) Composite tissue grafts; and

(g) Repair of simple and complex skin lacerations;

(3) Pneumatic tourniquets;

(4) High intensity light;

(5) Surgical loupes;

(6) Power equipment for skeletal fixation;

(7) Figure traps for fracture reduction;

(8) Casting material in a variety of sizes and compositions;

(9) Metallic malleable splints;

(10) Plastic or prefabricated splits;

(11) Specialized dressings for hand injuries including burns;

(12) Local anesthetics; and

(13) Doppler unit for vascular assessment.

C. The hospital shall have appropriate staffing and equipment readily available to offer the following services to patients in the hand and upper extremity trauma area:

(1) Standard stationary radiography;

(2) Portable C-Arm fluoroscopy;

(3) Diagnostic vascular imaging;

(4) Interventional vascular procedures;

(5) CT and MRI scans;

(6) MR angiography;

(7) Radionuclide scanning; and

(8) Ultrasonography.

D. The hospital shall have a direct communication link to the State communication network including:

(1) SYSCOM;

(2) Prehospital providers; and

(3) Referring hospitals.

E. The hospital shall have pharmacy support to provide all needed medications 24 hours a day.

F. The hand and upper extremity trauma center operating room shall have:

(1) Equipment for the treatment of all hand and upper extremity injuries reconstructive procedures;

(2) A specially trained and dedicated operating room team for hand surgery, musculoskeletal care, or both;

(3) Continuous availability of the operating suite with an in-house operating room scrub team 24 hours a day; and

(4) Specialized equipment readily available to enable:

(a) Microvascular tissue replantation;

(b) Microvascular free tissue transfer;

(c) Microsurgical nerve repair;

(d) Internal and external fixation of all bones of the upper extremity;

(e) Intraoperative vascular evaluation;

(f) Upper extremity endoscopy; and

(g) Upper extremity arthroscopy.

G. The hand and upper extremity trauma center inpatient unit shall have a nursing unit for the care of the patient with upper extremity injuries that provides nursing staff who are:

(1) Specially educated and demonstrate competencies in the postoperative evaluation of limb replantation and revascularization;

(2) Able to independently monitor the tissue perfusion of replanted limbs; and

(3) Specially educated in the care and postoperative monitoring of free tissue transfers.

H. The hand and upper extremity trauma center hand therapy unit shall have:

(1) A specialized area for inpatient and outpatient care utilizing individualized occupational and physical therapy techniques directed specifically towards the rehabilitation of the upper extremity;

(2) Certified and licensed occupational and physical therapists;

(3) Staff designated or qualified to be designated as certified hand therapist by the "Hand Therapy Certification Commission";

(4) Regular educational programs presented by the therapy staff;

(5) A facility for the fabrication of custom individualized splints; and

(6) The ability to care for the following types of clinical problems:

(a) Flexor tendon repair and reconstruction;

(b) Extensor tendon repair and reconstruction;

(c) Nerve repair or reconstruction;

(d) Tendon transfers;

(e) Thermal injuries;

(f) Repetitive stress and cumulative trauma disorders;

(g) Training in the use of prosthetic devices; and

(h) Upper extremity replantation.

I. The hand and upper extremity trauma center work rehabilitation services shall have:

(1) A CARF-accredited area dedicated to facilitating the transition of the injured worker back into the workforce;

(2) Equipment to stimulate and practice the activities required at the majority of work sites;

(3) Computerized analysis of multiple physical parameters required for performance in the workplace;

(4) The ability to evaluate ergonomic factors in the scenario of the workers' stations; and

(5) Social services to aid in the transition of the injured worker back into the workplace.

J. The hand and upper extremity trauma center outpatient clinical area shall have:

(1) A dedicated adaptation hand clinic area for the evaluation and treatment of hand and upper extremity trauma patients on a nonemergent basis; and

(2) A hand and upper extremity medical staff physician responsible for the overall clinical coordination and care delivery.

K. The hand and upper extremity trauma center microvascular laboratory shall have:

(1) A facility to practice the microsurgical techniques needed in the acute treatment and reconstruction of upper extremity trauma victims;

(2) Animal surgery available to simulate the human situation; and

(3) Individualized instruction in microsurgery.

L. The hand and upper extremity trauma center anatomy laboratory shall:

(1) Have a facility for the dissection of human and animal specimens; and

(2) Facilitate instruction in pertinent anatomy implicit in the treatment of hand and upper extremity trauma victims.

M. The hand and upper extremity trauma center information support services shall:

(1) Provide educational support services including:

(a) Preparation and dissemination of hand and upper extremity trauma educational information for:

(i) Patients;

(ii) Providers; and

(iii) The public;

(b) An Internet server for disseminating information regarding patient education and public safety;

(c) Audiovisual facilities to produce materials for presentations and patient education; and

(d) A robust conference schedule with rotating didactic lectureships covering the germinal information in the field of hand and upper extremity surgery;

(2) Provide psychosocial support, including a certified psychologist and a licensed social worker with special expertise in the evaluation and treatment of hand and upper extremity trauma victims; and

(3) Provide an amputee-prosthetic clinic as a regional resource for amputee prosthetics using a team approach for management of post trauma patients with hand or upper extremity amputations, which team shall include one or more of each of the following:

(a) Prosthetist;

(b) Social worker;

(c) Hand therapist;

(d) Hand resident;

(e) Hand fellow; and

(f) Attending hand surgeon.

Md. Code Regs. 30.08.14.05