HAI Hospital Survey Tool
This survey is to provide the Florida Department of Health (FDOH) Healthcare-Associated Infections (HAI) Program with some basic information about Florida hospitals and their plans for electronic data reporting (EDR) to the National Healthcare Safety Network (NHSN). The information will be used to understand the facility’s current readiness and interest in HAI Electronic Data Reporting. The information will also provide the HAI Program with some background information that will be helpful when trying to assist your facility with any NHSN questions
General Information
1. Hospital name:
2. Address
3. County
4. Is your facility interested in assistance with electronic data reporting from the Florida HAI Program?
Yes
No
NOTE: if you have answered “No” to question four you do not need to answer any more questions.
5. Who would be the best person to contact if the FDOH has questions concerning the general use of NHSN (i.e. regular reporting, surveillance, etc.) at your facility?
6. Name
7. Phone Number
8. Email Address
9.Does your facility have multiple locations?
Yes
No
10. Which collaborative group are you participating in with the FDOH? (Please mark all that apply)
Catheter-associated Urinary Tract Infection (CAUTI)
Clostridium difficile Infection (CDI)
11. Is your facility considering reporting manually on any of the following in the NSHN system? (Please mark all that apply and what type data entry will be used.)
Bloodstream Infection Report (BSI)
Laboratory-identified Organism Report (LIO)
Surgical Site Infection Report (SSI)
Urinary Tract Infection Report (UTI)
Procedure Denominator Report
12. Is your facility considering reporting using CDA importing on any of the following in the NSHN system?
Bloodstream Infection Report (BSI)
Laboratory-identified Organism Report (LIO)
Surgical Site Infection Report (SSI)
Urinary Tract Infection Report (UTI)
Procedure Denominator Report
Facility Standards and Directions
13. Does your facility have an Electronic Health Record (EHR) system? If so, please indicate the Product name for your EHR system. (Example of a few EHR systems: Guardian System, Safety Surveillance, Theradoc):
No, our facility does not have an EHR
Yes
Yes, our facility’s EHR is called
14. Does facility’s EHR system have any of the following capabilities/modules? (Please mark all that apply)
Admissions-Discharges-Transfers (ADT)
Critical Care
Infection Control/Surveillance
Laboratory
Operating Room (OR)
Infection Control/Surveillance
15.Does the currently EHR system have HL7 interface capabilities?
Yes
No
Don't Know
16. Does your current Laboratory Information Management System (LIMS) system capable of Electronic Laboratory Reporting (ELR)?
Yes
No
Don't Know
17. Is your currently EHR system capable of producing the XML files needed for importing data to NHSN?
Yes
No
Don't Know
18. Is your facility planning to upgrade the ERH system with a system that will have the capability to create the XML files for importing into NHSN within the next 12 months?
Yes
No
Don't Know
Submit Data to NHSN
19. Does your facility currently submit any data to NHSN?
Yes
No
20. How do you currently submit data to NHSN? (Please mark all that apply)
Not currently submitting to NHSN
Import using a comma delimited file
Import using an XML file
Manually entered into NHSN system
21. Who is responsible in your facility for identifying cases that need to be reported to NHSN? (Please mark all that apply)
Infection prevention
Intensive care unit staff
Quality improvement
Other - Please indicate the group
22. Who is responsible in your facility for reporting cases to NHSN? (Please mark all that apply)
Infection prevention
Quality improvement
Other - Please indicate the group: