HCA Midwest Health
July 14, 2011

The Time Critical Diagnosis, or TCD system, is a comprehensive, coordinated statewide and regional network that delivers emergency medical care under one system rather than through three separate systems. The goal is to create consistent, state-wide rules and regulations to help EMS, EMTs and hospital personnel. This will ensure patients are being transported to and treated by the most appropriate facility for their needs when suffering from acute trauma, stroke or ST-segment elevation myocardial infarction (STEMI). All of these conditions require quick assessment, diagnosis, timely treatment, and definitive care to improve patient outcomes and minimize risk for preventable complications and sometimes even death.

The Comprehensive Emergency Medical Services Systems act was passed in 2008 and final revisions were completed in 2009. Beginning in 2009, the Missouri Department of Health and Senior Services coordinated a series of quarterly meetings around the state encouraging healthcare professionals to have input on the legislation and to be a part of the conversation regarding the most efficient way to take care of the patients we serve. A final approval of the rules and regulations is expected in 2011, and implementation state-wide will soon follow.

Time Critical Diagnosis System Detailed
The TCD system represents the continuum of services beginning with public education about prevention, recognition of signs and symptoms, and the importance of immediately seeking care. It then circles through the series of system components to emphasize evidence-based and best practices for incident recognition, first aid, 911 access, response coordination, pre-hospital response, transport, emergency department care, acute medical care and rehabilitation. Finally, it incorporates quality improvement processes throughout the system.

The TCD system also allows resource sharing and coordination at different levels to decrease duplication and costs for services similar for each condition. For example: 911 and emergency medical dispatch and pre-hospital response and transport center designation processes for hospitals that meet regulatory criteria.

The experiences and results from numerous other states demonstrate the potential benefits from a systemized approach to emergency medical care for trauma, stroke and STEMI. The TCD system in Missouri, however, further advances the concept by creating an umbrella system for the time critical care of conditions—stroke, STEMI, trauma and other potential conditions which warrant time critical care. While other states have organized responses to each of these conditions, no other state has approached them on such an integrated level as represented by the Missouri TCD system. However, it is widely accepted that this system, or one highly similar, will be adapted by other states, including Illinois, in the future.

Understanding that health care delivery is an ever-changing system, the Missouri Department of Health and Human Services envisions that the transport/triage protocol for trauma will be regularly updated either through recommendations from the State advisory Committee for EMS/ Trauma Subcommittee, or another ad-hoc content expert advisory body for trauma as well as for STEMI and stroke, who are not a part of the current department. These bodies would review our regional processes, the results of quality improvement activities and any new national evidence. They would then make recommendations to the department for updates to the triage and transport protocol.

For more information on the Missouri TCD legislation and system, visit http://health.mo.gov, a comprehensive breakdown of the regulations, along with Frequently asked Questions is available for review, along with the ability to submit questions and suggestions to the state regarding the system. Time Critical Diagnosis at HCA Midwest Health System