Time Critical Diagnosis System

Overview

Missouri’s Goal: To improve health outcomes by establishing a Time Critical Diagnosis (TCD) system for Missourians who suffer acute trauma, stroke, or ST-segment elevation myocardial infarction (STEMI). 

Missouri has recently enacted new legislation (HB1790) that creates the Time Critical Diagnosis (TCD) System through which emergency medical care is provided for patients who experience trauma, stroke, or STEMI, a potentially fatal form of heart attack. All of these conditions require quick assessment, diagnosis and treatment by a facility that can provide timely, definitive care to minimize risk for preventable complications and death. 

The TCD system is a comprehensive, coordinated statewide and regional network that delivers emergency medical care under one banner rather than through three separate systems. 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 continuum model is shown below:

The TCD system allows resource sharing and coordination at many different levels to decrease duplication and costs for services similar for each condition (e.g., 911 and emergency medical dispatch, pre-hospital response and transport, center designation process for hospitals that meet regulatory criteria); while supporting the unique and distinct care required by each condition (e.g., assessment, diagnosis and treatment by those hospitals that meet specific care and capacity requirements for specialty center designation).

The experiences and results from numerous other states demonstrate both the feasibility of and actual and 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 for which future advances will warrant time critical care.  While other states have organized responses to each of these conditions, independently, no state has approached them on such an integrated systems level as represented by the Missouri TCD system.

At this time the Department of Health and Senior Services (DHSS), is working to enhance the trauma arm and establish the stroke and STEMI arms of the TCD system.