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Trauma Data Use:A Trauma Physician’s
Point of View
Frederick A. Foss, Jr. M.D. F.A.C.S
Trauma Medical Director
Saint Alphonsus Regional Medical Center
Objectives
Understand the relationship of the registry data and how it can impact patient care
Understand the use of data in the performance improvement process
Understand the registrars role in the trauma system.
Trauma Registry Role in the Trauma System
Fundamental component of the trauma system.
Collection of data to assess performance improvement
Data repository for clinical and system research
Supports trauma centers verification process
Trauma Registry Role in the Trauma System
Can be used to contribute to trauma service financial evaluation and utilization review
Identifies target areas for injury prevention and education.
Tool to evaluate Clinical care
Performance Improvement (PI)
Systematic evaluation of the care of each patient
Performance Improvement vs. Quality Assurance
Cornerstone of any trauma program Trauma Care is process and system driven
Performance Improvement
How do you know if you are a “good” trauma center?
American College of Surgeons (ACS) verification. PI is the #1 reason centers are unable to get
verification or designation Developing trends to identify system and
provider issues.
Performance Improvement
Based strictly on data, PI is a very data driven process
ACS requires that a trauma center shows that the registry contributes to the PI process
PI program would not exists without the Trauma Registry
Registry Role in Trauma Performance Improvement (PI)
Trauma registry works closely with both the trauma medical director and program manger to PI identify cases.
PI outcome reports Trends patient outcomes Allows service to benchmark with national
standards Able to evaluate the effectiveness of the clinical
protocols
Registry Role in Trauma Performance Improvement (PI)
Calculates volume/trend and injury information
Calculates occurrences, trends, and reports for comprehensive system analysis
Trauma scoring-collection of activation data leads to accurate scoring
ISS and TRISS calculation
Registry role in Trauma Performance Improvement (PI)
Data collection can either be concurrent or retrospective
Retrospective Limited amount of trauma data No ability to effect patient care management Registry not used to it’s full potential Does not require many resources to run
retrospective data
Registry role in Trauma Performance Improvement (PI)
“Front end data” Collected and abstracted daily on paper Provides immediate access to data Issues can be resolved while the patient is
still in the hospital. Requires resources!
500-700 cases per full-time registrar
Clinical Protocols
Clinical protocols are a by product of productive performance improvement process.
Decrease variation, decrease errors, increase positive patient outcomes.
Evidence-based medicine has become the standard of care.
Clinical protocols ensure that all the care that is given is contemporary and consistent.
Clinical Protocols
Concise and constant data allows for the implementation of clinical protocols based on the needs of the trauma system.
Data collection needs to be accurate and absolute.
The data analysis that occurs leads directly to changes in patient care.
PATIENT MANAGEMENT GUIDELINE WITH C-COLLAR IN PLACE Trauma Services Manual
Page 1 of 2 Policy #
Trauma Services
Title: PATI ENT MANAGEMENT GUI DELINE WITH C-COLLAR
I N PLACE
Policy Statement: C-Spine Radiographic Evaluation Guideline
Procedure:
*Urgent need in cases of cord lesion or neurological deficit.
Consider Neuro/Ortho
consult; Consider MRI*
C-spine remains
immobilized
Negative
Negative
No
Significant neck pain?
Cleared
C-spine CT or 3-view C-spine
C-spine remains immobilized until: Alert, cooperative, GCS>13 Without evidence of:
Impairment by drugs or alcohol Distracting pain or injury Neurological deficit
Positive/ Suspicious
Cleared
No
3-view C-spine X-ray or CT
Yes
No
C-spine CT (if not already complete)
Intubate
If After 3 Failed Intubation Attempts Call Anesthesia/Consider Surgical Airway
*Providers may consider the use of other medications as deemed appropriate.
Alert, cooperative, GCS>13, and without evidence of: Impairment by drugs or alcohol Neurological deficit Distracting pain or injury
Midline tenderness or
pain with limited range of motion
Yes
Consider Neuro/Ortho
consult; Consider MRI*
C-spine remains immobilized
Positive/ Suspicious
Negative
Positive
Yes
Data Elements
Data abstracted needs to reflect what will be reported on a later date.
Can change depending on the need or the area of focus.
Need to ensure that the nursing documentation clearly reflects what data is needed. Our trauma flow sheet was designed to reflect
what data elements are needed for the registry.
Registry Data
Audit filters ACS has common filters that help identify issues
or potential issues Types of indicators
Process- Length of stay Performance- Provider compliance with protocols Clinical- Protocol development and evaluation Resource use- Air ambulance use System- EMS, transfers
TR# TRAUMA REGISTRY WORKSHEET
MR# ROOM
PT# ARRIVE DATE TIME
UNKNOWN,
DEMOGRAPHICS PREHOSPITAL
LAST REFERRING AGENCY acems ccp mv npa other
FIRST MI ____ EMS AGENCY (to st. als) acems ccp npa LF AA ASL other
SSN DOB AGE CONDITION A V P U
SEX M F DISPATCH TIME ARRIVE SCENE
RACE W A B H I O DEPART SCENE ARRIVE HOSP
RESIDENCE COUNTY HR RR BP
CITY STATE ZIP GCS eye verbal motor total
OCCUPATION (WORK RELATED)
T=tubed TP=tubed paralytics L=legitimate S=sedation
TREATMENT CPR mast chest tube
INJURY Needle thoracostomy
DATE TIME
CITY COUNTY ZIP AIRWAY none/normal bvm crico trach
ECODE O2 PET nasal ett oral ett oral airway
DESCRIPTION
IV FLUIDS ND 0-500 500-2000 >2000
MECHANISM blunt penetrating burn saline lock unk amount
SITE E849
RESTRAINT 2-pt 3-pt belted/NOS airbag airbag/belted DRUGS GIVEN ativan demerol etomidate fentanyl phenergan
Carseat helmet helmet/protective gear unk NONE morphine succ vecuronium valium versed None
REFERRING HOSPITAL Y N
TRANSFERRING AGENCY HEAD CT Pos Neg N/d
ARRIVAL DATE TIME ABD CT Pos Neg N/d
DISCHARGE DATE TIME CHEST CT Pos Neg N/d
HOSPITAL ABD ULTRASD Pos Neg N/d
DOCTOR AORTOGRAM Pos Neg N/d
VS HR RR BP ARTERIO/ANGIO Pos Neg N/d
GCS eye verbal motor total CPR Y / N
T=tubed TP=tubed paralytics L=legitimate S=sedation PERITONEAL LAVAGE Y / N
AIRWAY none/normal bvm crico trach DRUGS GIVEN ativan demerol etomidate fentanyl phenergan
O2 PET nasal ett oral ett oral airway morphine succ vecuronium valium versed NONE
ICU? OR?
Rev 01/06:mf Page 1
ED ADMISSION ED ASSESS 1
DIRECT ADMIT Y N HR RR BP TEMP warm y / n
DC DATE DC TIME GCS eye verbal motor total temp mont y / n
ARRIVED FROM home scene refer other T=tubed TP=tubed paralytics L=legitimate S=sedation
TRANSPORT amb heli FW pov other AIRWAY none/normal bvm crico trach
COMPLAINT horse other animal assault bike burn cut O2 PET nasal ett oral ett oral airway
fall gsw mcc mvc ATV snow inj self-inflicted TREATMENT ed cpr units/blood (1st 24 hrs)
pedestrian machinery other transport other DRUGS SCREEN none amph barb coc marijuana
CONDITION A V P U poly benzo pcp tricyclics unk n/d
TRAUMA LEVEL none 3 2 1 ETOH .000/none not done >.000
TIME ACTIVATED ETA HCT BASE DEFICIT
TRAUMA MD Called Arrived
PEDS MD Called Arrived ED ASSESS 2 date time
NEURO MD Called Arrived HEAD CT pos neg n/d
ORTHO MD Called Arrived ABD CT pos neg n/d
ED MD Called Arrived CHEST CT pos neg n/d
ANES MD Called Arrived ABD ULTRA - ED pos neg n/d
TRAUMA BAND# BB TIME: MD
PERIT LAV pos neg n/d
HOSPITAL OUTCOME CTA pos neg n/d
FIM SCORE self care mobility verbal AORTOGRAM pos neg n/d
1-dep 2-dep:partial help 3-indep w/device 4-indep ARTERI/ANGI pos neg n/d
DC DATE TIME ADMITTING SVC Trauma Neuro Ortho Non-surg other
DISPOSITION home rehab-ST ALS rehab-OTHER Expired ED DISPOSITION ICU OR Floor Telemetry
Transfer jail nrsg home other Expired DOA Transfer out DA
DC SERVICE trauma ortho neuro other OR DISPOSITION ICU Floor Death
DEATH LOCATION ED Floor ICU OR ADMITTING MD ATTENDING MD
ON VENT OFF VENT
VENT DAYS CONSULT DATE TIME
ADMIT ICU DATE TIME CONSULT DATE TIME
DC ICU DATE TIME CONSULT DATE TIME
ICU DAYS CONSULT DATE TIME
ORGAN DONATION Y N UNK CONSULT DATE TIME
AUTOPSY Y N UNK CONSULT DATE TIME
COLLAR: YES NONE UNK N/A
FINANCIAL
DATE ON: _____________ TIME: ______________ FINANCIAL ACCT #
DATE OFF: ____________ TIME: ______________ ACCT SYSTEM NAME
ORDERED BY (MD): __________________________ PRIMARY/SEC PAYOR
WORK COMP INJURY YES NO
Page 2
Data Validity
Very important that the data that is used is accurate.
Reported on a local and national level Guides patient care. ACS requires that some sort of data validity
occurs. Institution specific
Reports Writing
Need to have intimate knowledge of your data so you can understand the limitations.
Opinions can be changed by how the data is presented. Remember data is a very powerful tool.
Sometime what the data does NOT contain is valuable information in itself.
Report Writing
Well written reports aid… In getting more resources for the trauma service Guiding outreach efforts Guiding prevention efforts The development of the strategic plan In assessing provider competency Show the effectiveness of clinical protocols
Report Writing
Focused Audits- Specifically look at a data element I.e. Backboard use, surgeon arrival to the trauma bay, OR
times ACS filters
Mortality and Morbidity review Provider issues Complications
DVT Infections
Dashboard
Important measurement of the quality of your program
Advanced report writing and calculations Benchmark with national data (NTDB) Able to show the progress and trends of your
program against previous years.