Illinois Administrative Code
Title 77 - PUBLIC HEALTH
Part 640 - REGIONALIZED PERINATAL HEALTH CARE CODE
Section 640.41 - Level I - Standards for Perinatal Care
Universal Citation: 77 IL Admin Code ยง 640.41
Current through Register Vol. 48, No. 12, March 22, 2024
To be designated as Level I, a hospital shall apply to the Department as described in Section 640.60; shall comply with all the conditions described in Subpart O of the Hospital Licensing Requirements that are applicable to the level of care necessary for the patients served; and shall comply with the following provisions:
a) Level I - General Provisions
1) The Maternity and Neonatal Service Plan
shall include:
A) A letter of agreement
between the hospital and its APC establishing criteria for maternal and
neonatal consultation; criteria for maternal and neonatal transports; standards
of care of mothers and neonates; and support services to be provided. (Section
640.70
establishes the minimum components for the letter of agreement.);
B) Continuing education of staff in perinatal
care; and
C) Participation in the
CQI program implemented by the APC.
2) The critical considerations in the care of
patients anticipating delivery in these hospitals are as follows:
A) The earliest possible detection of the
high-risk pregnancy (risk assessment); consultation with a maternal-fetal
medicine subspecialist or neonatologist as specified in the letter of
agreement; and transfer to the appropriate level of care; and
B) The availability of trained personnel and
facilities to provide competent emergency obstetric and newborn care. Included
in the functions of this hospital are the stabilization of patients with
unexpected problems, initiation of neonatal and maternal transports, patient
and community education, and data collection and evaluation.
3) The Level I hospital shall
provide continuing education for medical, nursing, respiratory therapy, and
other staff providing general perinatal services, with evidence of a yearly
competence assessment appropriate to the patient population served.
4) The Level I hospital shall maintain a
system of recording patient admissions, discharges, birth weight, outcome,
complications, and transports to meet the requirement to support network CQI
activities described in the hospital's letter of agreement with the APC. The
hospital shall comply with the reporting requirements of the State Perinatal
Reporting System.
b) Level I - Standards for Maternal Care
1) The
maternal patient with an uncomplicated current pregnancy and no previous
history that suggests potential difficulties is considered appropriate for
Level I hospitals; however, the hospital's letter of agreement shall establish
the specific conditions for the Level I hospital.
2) Other than those maternal patients
identified in subsection (b)(1), pregnancies of fewer than 36 weeks gestation
constitute potentially high-risk conditions for which the attending health care
provider shall consult with a board-certified obstetrician or maternal-fetal
medicine subspecialist to determine whether a transport or transfer to a higher
level of care is needed. The letter of agreement shall specify policies for
consultation and the hospital's obstetric policies and procedures for each of,
but not limited to, the pregnancy conditions listed in Section 640.Appendix H.
Exhibit A.
3) Hospitals shall have
the capability for continuous electronic maternal-fetal monitoring for patients
identified at risk, with staff available 24 hours a day, including physician
and nursing, who are knowledgeable of electronic fetal monitoring use and
interpretation. Physicians and nurses shall complete a competence assessment in
electronic maternal-fetal monitoring every two years.
4) Hospitals shall provide caesarean section
decision-to-incision capabilities within 30 minutes.
c) Level I - Standards for Neonatal Care
1) Neonatal patients greater than 36 weeks
gestation or greater than 2500 grams without risk factors and infants with
physiologic jaundice are generally considered appropriate for Level I
hospitals; however, the hospital's letter of agreement shall establish the
specific conditions for Level I hospitals.
2) For all neonatal patients other than those
identified in subsection (c)(1), consultation with a neonatologist is required
to determine whether a transport to a higher level of care is needed.
Consultation shall be specified in the letter of agreement and outlined in the
hospital's pediatric policies and procedures for conditions including, but not
limited to:
A) Small-for-gestational age (less
than 10th percentile)
B) Documented sepsis
C) Seizures
D) Congenital heart disease
E) Multiple congenital anomalies
F) Apnea
G) Respiratory distress
H Neonatal asphyxia
I) Handicapping conditions or developmental
disabilities that threaten life or subsequent development
J) Severe anemia
K) Hyperbilirubinemia, not due to physiologic
cause
L) Polycythemia
d) Level I - Resource Requirements
The following support services shall be available:
1) Blood bank technicians shall be on call
and available within 30 minutes for performance of routine blood banking
procedures.
2) General anesthesia
services shall be on call and available within 30 minutes to initiate caesarean
sections.
3) Radiology services
shall be available within 30 minutes.
4) Clinical laboratory services shall include
microtechnique for hematocrit, blood gases, and routine urinalysis within 15
minutes; glucose, blood urea nitrogen (BUN), creatinine, complete blood count
(CBC), routine blood chemistries, type, cross, Coombs' test and bacterial smear
within one hour; and capability for bacterial culture and sensitivity and viral
culture.
5) A physician for the
program shall be designated to assume primary responsibility for initiating,
supervising and reviewing the plan for management of distressed infants.
Policies and procedures shall assign responsibility for identification and
resuscitation of distressed neonates to individuals who have completed a
nationally recognized neonatal resuscitation program and are both specifically
trained and immediately available in the hospital at all times, such as another
physician, a nurse with training and experience in neonatal resuscitation, or a
respiratory care practitioner.
e) Application for Designation, Redesignation or Change in Network
1) To be designated or
to retain designation, a hospital shall submit the required application
documents to the Department. For information needed to complete any of the
processes, see Section
640.50
(Designation and Redesignation of Non-Birthing Center, Level I, Level II, Level
II with Extended Neonatal Capabilities, Level III Perinatal Hospitals, and
Administrative Perinatal Centers) and Section
640.60
(Application for Hospital Designation and Redesignation as Non-Birthing Center,
Level I, Level II, Level II with Extended Neonatal Capabilities, Level III
Perinatal Hospital, and Administrative Perinatal Center, and Assurances
Required of Applicants).
2) The
following information shall be submitted to the Department to facilitate the
review of the hospital's application for designation or redesignation:
A) Appendix A (fully completed);
B) Resource Checklist (fully
completed);
C) A proposed letter of
agreement between the hospital and the APC (unsigned);
D) The curriculum vitae for all directors of
patient care, i.e., obstetrics, neonatal, ancillary medical and
nursing.
3) When the
information described in subsection (e)(2) is submitted, the Department will
review the material for compliance with this Part. This documentation will be
the basis for a recommendation for approval or disapproval of the applicant
hospital's application for designation.
4) The medical co-directors of the APC (or
their designees), the medical directors of obstetrics and maternal and newborn
care, and a representative of hospital administration from the applicant
hospital shall be present during the PAC's review of the application for
designation.
5) The Department will
make the final decision and inform the hospital of the official determination
regarding designation. The Department's decision will be based upon the
recommendation of the PAC and the hospital's compliance with this Part, and may
be appealed in accordance with Section
640.45.
The Department will consider the following criteria to determine if a hospital
is in compliance with this Part:
A) Maternity
and Neonatal Service Plan (Subpart O of the Hospital Licensing
Requirements);
B) Proposed letter
of agreement between the applicant hospital and its APC in accordance with
Section 640.70;
C) Appropriate
outcome information contained in Appendix A and the Resource Checklist
(Appendices L, M, N and O);
D)
Other documentation that substantiates a hospital's compliance with particular
provisions or standards of perinatal care; and
E) Recommendation of Department program
staff.
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