Classification of emergency general medicine services

(a) Level IV. A Level IV facility shall provide emergency medical services with at least a licensed independent practitioner, registered nurse, licensed practical nurse, or intermediate or paramedic level emergency medical technician on site twenty-four (24) hours a day. A hospital shall be classified at Level IV for emergency general medicine services if it meets the following requirements: (1) Clinical services and resources. No diagnostic, surgical, or medical specialty services are required. (2) Personnel. A physician, licensed independent practitioner, registered nurse, licensed practical nurse, or intermediate or paramedic level emergency medical technician shall be on site twenty- four (24) hours a day. In the absence of a physician, licensed independent practitioner, registered nurse, or paramedic level emergency medical technician, at least one of the practitioners on duty shall have received training in advanced life support techniques and be deemed competent to initiate treatment of the emergency patient. (A) If the facility is licensed as a General-Medical Surgical Hospital it shall also meet the personnel and staffing requirements at OAC 310:667-29-1 and any other applicable parts of this Chapter. (B) If the facility provides emergency medical services and is licensed as a Specialized Hospital: Psychiatric, it shall also OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 223 September 13, 2019 meet the personnel and staffing requirements at OAC 310:667-33-2 and any other applicable parts of this Chapter. (C) If the facility provides emergency medical services and is licensed as a Specialized Hospital: Rehabilitation, it shall also meet the personnel and staffing requirements at OAC 310:667-35-3 and any other applicable parts of this Chapter. (D) If the facility provides emergency medical services and is licensed as a Critical Access Hospital, it shall also meet the personnel and staffing requirements at OAC 310:667-39-14 and any other applicable parts of this Chapter. (3) Supplies and equipment. The hospital shall have equipment for use in the resuscitation of patients of all ages on site, functional, and immediately available, including at least the items specified in OAC 310:667-59-9(a)(3) (4) Policies on transfers. The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility. (b) Level III. A Level III facility shall provide emergency medical services with an organized emergency department. A physician and nursing staff with special capability in emergency care shall be on site twenty-four (24) hours a day. General surgery and anesthesiology services shall be available either on duty or on call. A hospital shall be classified at Level III for emergency general medicine services if it meets the following requirements: (1) Clinical services and resources. (A) Emergency services. A physician deemed competent in the care of the critically injured and credentialed by the hospital to provide emergency medical services and nursing personnel with special capability in emergency care shall be on site twenty-four (24) hours a day. (i) For a hospital licensed as a general medical surgical hospital or specialty hospital, emergency services shall also comply with the requirements of OAC 310:667-29-1 through OAC 310:667-29-2. (ii) For a hospital licensed as a critical access hospital, emergency services shall also comply with OAC 310:667-39-14. (B) General surgery. A board certified, board eligible, or residency trained general surgeon shall be on call twenty-four (24) hours a day and promptly available in the emergency department. For a hospital licensed as a general medical surgical hospital, surgical services shall also comply with the requirements of OAC 310:667-25-1 through OAC 310:667-25-2. (C) Anesthesia. Anesthesia services shall be on call twenty-four (24) hours a day, promptly available, and administered as required in OAC 310:667-25-2. (D) Internal medicine. A physician board certified, board eligible, or residency trained in internal medicine shall be on call twenty-four (24) hours a day and promptly available in the emergency department. (E) Other specialties. The hospital shall also have services from the following specialties on call and promptly available: OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 224 September 13, 2019 (i) Family/general medicine; (ii) Pathology; and (iii) Radiology. (F) Operating suite. An operating suite with thermal control equipment for patients and infusion of blood and fluids shall be available twenty-four (24) hours a day. (G) Post-anesthesia recovery unit. The hospital shall have a post-anesthesia recovery room or intensive care unit in compliance with OAC 310:667-15-7 with nursing personnel and anesthesia services remaining in the unit until the patient is discharged from post-anesthesia care. The post-anesthesia recovery unit shall be equipped as required by OAC 310:667-59-9(b)(3)(B). (H) Intensive care unit. The hospital shall have an intensive care unit in compliance with OAC 310:667-15-7 with a registered nurse on duty in the intensive care unit whenever the unit has a patient(s). A registered nurse shall be on call and immediately available when no patients are in the unit. The hospital shall define and document in writing the minimum staffing requirements for the intensive care unit and shall monitor compliance with these requirements through the quality improvement program. The intensive care unit shall be equipped as required by OAC 310:667- 59-9(b)(3)(C). (I) Diagnostic imaging. The hospital shall have diagnostic x-ray services available twenty-four (24) hours a day. A radiology technologist shall be on duty or on call and immediately available twenty-four (24) hours a day. (i) For a hospital licensed as a general medical surgical hospital or specialty hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. (ii) For a hospital licensed as critical access hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 39 of this Chapter. (J) Clinical laboratory service. The hospital shall have clinical laboratory services available twenty-four (24) hours a day. All or part of these services may be provided by arrangements with certified reference laboratories provided these services are available on an emergency basis twenty-four (24) hours a day. At least the following shall be available: (i) Comprehensive immunohematology services including blood typing and compatibility testing. A supply of blood and blood products shall be on hand and adequate to meet expected patient needs. All blood and blood products shall be properly stored. The hospital shall have access to services provided by a community central blood bank; (ii) Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing; (iii) Coagulation studies; (iv) Blood gas/pH analysis; (v) Comprehensive microbiology services or appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures; and OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 225 September 13, 2019 (vi) Drug and alcohol screening. (vii) For a hospital licensed as a general medical surgical hospital or specialty hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. (viii) For a hospital licensed as a critical access hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 39 of this Chapter. (K) Social services. Social services shall be available and provided as required in Subchapter 31 of this Chapter. (2) Personnel: Emergency services director. The medical staff shall designate a physician credentialed to provide emergency medial care as emergency services director. The emergency services director may serve as the trauma service director. (3) Supplies and equipment: Emergency department. The emergency department shall have equipment for use in the resuscitation of patients of all ages on site, functional, and available in the emergency department, including at least the items specified in OAC 310:667-59-9(b)(3)(A). (4) Policies on transfers. The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility. (5) Organ Procurement. The hospital, in association with an organ procurement organization certified by the CMS, shall develop policies and procedures to identify and refer potential organ donors. (c) Level II. A facility providing emergency medical services with an organized emergency department. A physician and nursing staff with special capability in emergency care shall be on site twenty-four (24) hours a day. General surgery and anesthesiology services shall be available on site or on call twenty-four (24) hours a day. Services from an extensive group of clinical specialties including infectious disease, internal medicine, nephrology, and orthopedics shall be promptly available on call. A hospital shall be classified at Level II for emergency general medicine services if it meets the following requirements: (1) Clinical services and resources. (A) Emergency services. A physician deemed competent in the care of the emergent patient and credentialed by the hospital to provide emergency medical services and nursing personnel with special capability in emergency care shall be on site twenty-four (24) hours a day. For a hospital licensed as a general medical surgical hospital or specialty hospital, emergency services shall also comply with the requirements of OAC 310:667-29-1 through OAC 310:667-29-2. (B) General surgery. A board certified, board eligible, or residency trained general surgeon shall be on call twenty-four (24) hours a day and promptly available in the emergency department. For a hospital licensed as a general medical surgical hospital, surgical services shall also comply with the requirements of OAC 310:667-25-1 through OAC 310:667-25-2. (C) Anesthesia. Anesthesia services shall be on call twenty-four OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 226 September 13, 2019 (24) hours a day, promptly available, and administered as required in OAC 310:667-25-2. (D) Internal medicine. A physician board certified, board eligible, or residency trained in internal medicine shall be on call twenty-four (24) hours a day and promptly available in the emergency department. (E) Other specialties. The hospital shall also have services from the following specialties on call and promptly available: (i) Cardiology; (ii) Family/general medicine; (iii) Infectious disease. (iv) Neurology; (v) Obstetrics/gynecology; (vi) Ophthalmology; (vii) Orthopedics; (viii) Otolaryngology; (ix) Pathology; (x) Pediatrics; (xi) Psychiatry; (xii) Pulmonary medicine; (xiii) Radiology; and (xiv) Urology. (F) Operating suite. An operating suite with adequate staff and equipment shall be immediately available twenty-four (24) hours a day. The hospital shall define and document in writing the minimum staffing requirements for the operating suite. The operating room shall be equipped as required by OAC 310:667-59- 9(c)(3)(B). An on call schedule for emergency replacement staff shall be maintained. (G) Post-anesthesia recovery unit. The hospital shall have a post-anesthesia recovery room or intensive care unit in compliance with OAC 310:667-15-7 with nursing personnel and anesthesia services remaining in the unit until the patient is discharged from post-anesthesia care. The post-anesthesia recovery unit shall be equipped as required by OAC 310:667-59-9(c)(3)(C). (H) Intensive care unit. The hospital shall have an intensive care unit in compliance with OAC 310:667-15-7 with a registered nurse on duty in the intensive care unit whenever the unit has a patient(s). A registered nurse shall be on call and immediately available when no patients are in the unit. The hospital shall define and document in writing the minimum staffing requirements for the intensive care unit and shall monitor compliance with these requirements through the quality improvement program. The intensive care unit shall be equipped as required by OAC 310:667- 59-9(c)(3)(D). (I) Diagnostic Imaging. The hospital shall have diagnostic x-ray services available twenty-four (24) hours a day. A radiologic technologist and computerized tomography technologist shall be on duty or on call and immediately available twenty-four (24) hours a day. A single technologist designated as qualified in both diagnostic x-ray and computerized tomography procedures by the radiologist may be used to meet this requirement if an on call schedule of additional diagnostic imaging personnel is maintained. OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 227 September 13, 2019 The diagnostic imaging service shall provide at least the following services: (i) Angiography; (ii) Ultrasonography; (iii) Computed tomography; (iv) Magnetic resonance imaging; (v) Neuroradiology; and (vi) Nuclear medicine imaging. (vii) For a hospital licensed as a general medical surgical hospital or specialty hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. (J) Clinical laboratory service. The hospital shall have clinical laboratory services available twenty-four (24) hours a day. All or part of these services may be provided by arrangements with certified reference laboratories provided these services are available on an emergency basis twenty-four (24) hours a day. At least the following shall be available: (i) Comprehensive immunohematology services including blood typing and compatibility testing. A supply of blood and blood products shall be on hand and adequate to meet expected patient needs. All blood and blood products shall be properly stored. The hospital shall have access to services provided by a community central blood bank; (ii) Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing; (iii) Coagulation studies; (iv) Blood gas/pH analysis; and (v) Comprehensive microbiology services or appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures; and (vi) Drug and alcohol screening. (vii) For a hospital licensed as general medical surgical hospital or specialty hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. (K) Respiratory therapy. Routine respiratory therapy procedures and mechanical ventilators shall be available twenty-four (24) hours a day. Respiratory therapy services shall comply with OAC 310:667-23-6. (L) Social services. Social services shall be available and provided as required in Subchapter 31 of this Chapter. (2) Personnel: Emergency services director. The medical staff shall designate a physician credentialed to provide emergency medical care as emergency services director. (3) Supplies and equipment: Emergency department. The emergency department shall have equipment for use in the resuscitation of patients of all ages on site, functional, and available in the emergency department, including at least the items specified in OAC 310:667-59-9(c)(3)(A). (4) Policies on transfers. The hospital shall have written policies defining the medical conditions and circumstances for those OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 228 September 13, 2019 emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility. (5) Organ Procurement. The hospital, in association with an organ procurement organization certified by CMS, shall develop policies and procedures to identify and refer potential organ donors. (d) Level I. A Level I facility shall provide emergency medical services with an organized emergency department. A physician and nursing staff with special capability in emergency care shall be on site twenty- four (24) hours a day. General surgery and anesthesiology services shall be available on site or on call twenty-four (24) hours a day. Additional clinical services and specialties such as nuclear diagnostic imaging, dermatology, endocrinology, and hematology/oncology specialists shall also be promptly available. A hospital shall be classified at Level I for emergency general medicine services if it meets the following requirements: (1) Clinical services and resources. (A) Emergency services. A physician deemed competent in the care of the emergent patient and credentialed by the hospital to provide emergency medical services and nursing personnel with special capability in emergency care shall be on site twenty-four (24) hours a day. For a hospital licensed as a general medical surgical hospital or specialty hospital, emergency services shall also comply with the requirements of OAC 310:667-29-1 through OAC 310:667-29-2. (B) General surgery. A board certified, board eligible, or residency trained general surgeon shall be on call twenty-four (24) hours a day and promptly available in the emergency department. For a hospital licensed as a general medical surgical hospital, surgical services shall also comply with the requirements of OAC 310:667-25-1 through OAC 310:667-25-2. (C) Anesthesia. Anesthesia services shall be on call twenty-four (24) hours a day, promptly available, and administered as required in OAC 310:667-25-2. (D) Internal medicine. A physician board certified, board eligible, or residency trained in internal medicine shall be on call twenty-four (24) hours a day and promptly available in the emergency department. (E) Other specialties. The hospital shall also have services from the following specialties on call and promptly available: (i) Cardiology; (ii) Critical care medicine; (iii) Dermatology; (iv) Emergency medicine; (v) Endocrinology; (vi) Family/general medicine; (vii) Gastroenterology; (viii) Hematology/oncology; (ix) Infectious disease; (x) Nephrology; (xi) Neurology; (xii) Obstetrics/gynecology; (xiii) Ophthalmology; OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 229 September 13, 2019 (xiv) Orthopedics; (xv) Otolaryngology; (xvi) Pathology; (xvii) Pediatrics; (xviii) Psychiatry; (xix) Pulmonary medicine (xx) Radiology; (xxi) Rheumatology; and (xxii) Urology. (F) Operating suite. An operating suite with adequate staff and equipment shall be immediately available twenty-four (24) hours a day. The hospital shall define and document in writing the minimum staffing requirements for the operating suite. The operating room shall be equipped as required by OAC 310:667-59-9(d)(3)(B). An on call schedule for emergency replacement staff shall be maintained. (G) Post-anesthesia recovery unit. The hospital shall have a post-anesthesia recovery room or intensive care unit in compliance with OAC 310:667-15-7 with nursing personnel and anesthesia services remaining in the unit until the patient is discharged from post-anesthesia care. The post-anesthesia recovery unit shall be equipped as required by OAC 310:667-59-9(d)(3)(C). (H) Intensive care unit. The hospital shall have an intensive care unit in compliance with OAC 310:667-15-7 with a registered nurse on duty in the intensive care unit whenever the unit has a patient(s). A registered nurse shall be on call and immediately available when no patients are in the unit. The hospital shall define and document in writing the minimum staffing requirements for the intensive care unit and shall monitor compliance with these requirements through the quality improvement program. The intensive care unit shall be equipped as required by OAC 310:667- 59-9(d)(3)(D). A physician with privileges in critical care shall be on duty in the unit or immediately available in the hospital twenty-four (24) hours a day. (I) Diagnostic Imaging. The hospital shall have diagnostic x-ray services available twenty-four (24) hours a day. A radiologic technologist and computerized tomography technologist shall be on duty or on call and immediately available twenty-four (24) hours a day. A single technologist designated as qualified in both diagnostic x-ray and computerized tomography procedures by the radiologist may be used to meet this requirement if an on call schedule of additional diagnostic imaging personnel is maintained. The diagnostic imaging service shall provide at least the following services: (i) Angiography; (ii) Ultrasonography; (iii) Computed tomography; (iv) Magnetic resonance imaging; (v) Neuroradiology; and (vi) Nuclear medicine imaging. (vii) For a hospital licensed as a general medical surgical hospital or specialty hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. OAC 310:667 OKLAHOMA STATE DEPARTMENT OF HEALTH 230 September 13, 2019 (J) Clinical laboratory service. The hospital shall have clinical laboratory services available twenty-four (24) hours a day. All or part of these services may be provided by arrangements with certified reference laboratories provided these services are available on an emergency basis twenty-four (24) hours a day. At least the following shall be available: (i) Comprehensive immunohematology services including blood typing and compatibility testing. A supply of blood and blood products shall be on hand and adequate to meet expected patient needs. All blood and blood products shall be properly stored. The hospital shall have access to services provided by a community central blood bank; (ii) Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing; (iii) Coagulation studies; (iv) Blood gas/pH analysis; (v) Comprehensive microbiology services or appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures; and (vi) Drug and alcohol screening. (vii) For a hospital licensed as a general medical surgical hospital or specialty hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 23 of this Chapter. (K) Respiratory therapy. Routine respiratory therapy procedures and mechanical ventilators shall be available twenty-four (24) hours a day. Respiratory therapy services shall comply with OAC 310:667-23-6. (L) Acute hemodialysis. The hospital shall have the capability to provide acute hemodialysis services twenty-four (24) hours a day. All staff providing hemodialysis patient care shall have documented hemodialysis training and experience. (M) Social services. Social services shall be available and provided as required in Subchapter 31 of this Chapter. (2) Personnel: Emergency services director. The medical staff shall designate a physician credentialed to provide emergency medical care as emergency services director. (3) Supplies and equipment: Emergency department. The emergency department shall have equipment for use in the resuscitation of patients of all ages on site, functional, and available in the emergency department, including at least the items specified in OAC 310:667-59-9(d)(3)(A). (4) Policies on transfers. The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility. (5) Organ Procurement. The hospital, in association with an organ procurement organization certified by CMS, shall develop policies and procedures to identify and refer potential organ donors. OAC OKLAHOMA STATE DEPARTMENT OF APPENDIX A. VENTILATION REQUIREMENTS FOR AREAS AFFECTING PATIENT CARE IN HOSPITALS AND OUTPATIENT FACILITIES [REVOKED] [Source: Added at 12 Ok Reg 1555, eff 4-12-95 (emergency) ; Added at 12 Ok Reg 2429, eff 6-26-95; Revoked and reenacted at 20 Ok Reg 1664, eff 6-12-03; Revoked at 36 Ok Reg 1730, eff 9-13-19] OAC OKLAHOMA STATE DEPARTMENT OF APPENDIX B. STATION OUTLETS FOR OXYGEN, VACUUM (SUCTION), AND MEDICAL AIR SYSTEMS IN HOSPITALS1 [REVOKED] [Source: Added at 12 Ok Reg 1555, eff 4-12-95 (emergency) ; Added at 12 Ok Reg 2429, eff 6-26-95; Revoked and reenacted at 20 Ok Reg 1664, eff 6-12-03; Revoked at 36 Ok Reg 1730, eff 9-13-19] OAC OKLAHOMA STATE DEPARTMENT OF APPENDIX C. SOUND TRANSMISSION LIMITATIONS IN GENERAL HOSPITALS [REVOKED] [Source: Added at 12 Ok Reg 1555, eff 4-12-95 (emergency) ; Added at 12 Ok Reg 2429, eff 6-26-95; Revoked and reenacted at 20 Ok Reg 1664, eff 6-12-03; Revoked at 36 Ok Reg 1730, eff 9-13-19] OAC OKLAHOMA STATE DEPARTMENT OF APPENDIX D. FILTER EFFICIENCIES FOR CENTRAL VENTILATION AND AIR CONDITIONING SYSTEMS IN GENERAL HOSPITALS [REVOKED] [Source: Added at 12 Ok Reg 1555, eff 4-12-95 (emergency) ; Added at 12 Ok Reg 2429, eff 6-26-95; Revoked and reenacted at 20 Ok Reg 1664, eff 6-12-03; Revoked and reenacted at 21 Ok Reg 2785, eff 7-12-04; Revoked at 36 Ok Reg 1730, eff 9-13-19] OAC OKLAHOMA STATE DEPARTMENT OF APPENDIX E. HOT WATER USE - GENERAL HOSPITAL [REVOKED] [Source: Added at 12 Ok Reg 1555, eff 4-12-95 (emergency) ; Added at 12 Ok Reg 2429, eff 6-26-95; Revoked and reenacted at 20 Ok Reg 1664, eff 6-12-03; Revoked at 36 Ok Reg 1730, eff 9-13-19]