105 CMR 130.833
Quality Assurance
SEF specific quality assurance screens shall be developed. These screens, at a minimum,
shall include reviews of:
(1) patients who die in the SEF;
(2) if known to the SEF, patients admitted to a hospital within 72 hours of having been seen
at the SEF;
(3) all patients transferred from the SEF to an inpatient hospital, in which case said reviews
shall include the review of the management of the patient, whether transport was by
ambulance, and whether transport was done at the appropriate level of care;
(4) walk-in patients who are transferred; and
(5) all patients arriving by ambulance.
(B) Any appropriate Continuous Quality Improvement (CQI) processes evaluated at the main
campus of the hospital shall also be evaluated at the SEF.