colorado trauma network spring 2019 conference pi/registry ... · performance improvement this may...
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Colorado Trauma Network
Spring 2019 Conference
PI/Registry Subcommittee
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TPM/ TNC PI
Subcommittee • Chair :Stephanie Vega
• Wendy Erickson
• Robbie Dumond
• Valerie Brockman
• Sherrie Peckham
• Missy Sorensen
• Christine Thorkildsen
• Adriana Heins
• Valorie Peaslee
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• Gwen Holland
• Heather Ditzler
• Jennifer Kraatz Landis
• Amber Lorman
• Meghan Cangley
• Steve Clayton
• Zoe Onyun
• Rochelle Flayter
• Karen Clark-Bond
• Laura Harwood
• Tiffany Moore
• Pam Vanderberg
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34 Total Responses!
Everything: 1
Registrars: 10
Trauma Nurse Coordinator/Clinician: 7
Trauma Program Manager: 4
Trauma Director: 1
Clinical Quality Specialist/PI Coordinator : 5
Outreach Education: 1
Thank you for participating!
Survey
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Hospital DC Date/Time
Q4) A patient arrives to your hospital at 2000 on
03.01.2019 assisted by family after he falls from a ladder
while cleaning gutters. He has an obvious deformity of the
wrist and a pelvis xray reveals a pelvic fracture.
The MD and trauma surgeon determine at 2130 that he
needs transfer to another trauma center. He departs with
EMS at 0100 03.02.2019 from your ED.
What do you report as the hospital discharge date and time?
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Answer Not Required field value as the ED Disposition is discharge.
CDPHE Data Dictionary
Level I-III
Page 57
Level IV-V
Page 14
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Sherrie Peckham
Trauma program manager Level I
Electric Scooters
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Scooter Codes – Survey Question
Q3) A patient is admitted to your hospital after striking a
parked car. He was riding an electric stand up motor
scooter that he rented using an app on his mobile device.
He was un-helmeted and travelling approximately 20mph.
What ICD 10 Cause E Code would you record in your
trauma registry?
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Scooter Codes – Which code?
A. V00.182A Pedestrian on other rolling-type pedestrian
conveyance colliding with stationary object, initial
encounter
B. V00.832A Motorized mobility scooter colliding with
stationary object, initial encounter
C. V00.898A Other accident on other pedestrian
conveyance, initial encounter
D. V00.142A Scooter (nonmotorized) colliding with
stationary object, initial encounter
Let’s take a look!
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Scooter Codes
• CTN – Winter Conference request
for unified code to support
research on the implementation of
the scooters in urban areas
• Electric powered
• Now regulated and required to
follow all traffic laws like bicycles
• Fort Collins is about to approve
implementation
• Registry staff discussion and
American Trauma Society
Webinar conclude:
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Scooter Codes – Which code?
A. V00.182A Pedestrian on other rolling-type pedestrian
conveyance colliding with stationary object, initial
encounter
B. V00.832A Motorized mobility scooter colliding with
stationary object, initial encounter
C. V00.898A Other accident on other pedestrian
conveyance, initial encounter
D. V00.142A Scooter (nonmotorized) colliding with
stationary object, initial encounter
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A. V00.182A Pedestrian on other rolling-
type pedestrian conveyance colliding with
stationary object, initial encounter
Quiz Answer
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Delay in Transfer
PI and Tracking Val Peaslee
Level III Trauma Program Manager
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Delay in Transfer
A. What does transfer delay mean?
• Facility defined
• Field must be answered yes or no
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Reason for Transfer Delay
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Delay in Transfer - PI
A. Review all transfers
B. Any delays should be investigated
C. Monitor delays from month to month
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Transfer delay mapping/tracking
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0
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1
2
2
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3
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0 0.5 1 1.5 2 2.5 3 3.5 4 4.5
EMS Issue
Receiving Facility Issue
Referring Facility Issue
Weather/Natural Factors
Other
Transfer Delay Mapping Example
Month 3 Month 2 Month 1
Hospital Events
Meghan Cangley & Melissa Truax
Trauma Quality Specialist
Unplanned Admission to ICU
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Survey Results:
Yes: 56%
No 38%
Unknown 6%
Correct Answer: Yes
Rationale: According to TQIP, it has to be determined
that the patient will require ICU care postop prior to
surgery
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Survey Results:
Yes 0%
No 97%
Unknown 3%
Correct Answer: Yes
Rationale: According to TQIP, “may require” does not exclude this complication. Must be determined that patient “will require” ICU care post-operatively.
Further Clarifications
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No time limit for unplanned admission to the ICU
Initial admission location does not matter
How do you PI Unplanned
Return to ICU? 27
QUARTERLY ACTIVITY REPORTS
LOOK FOR TRACKS AND TRENDS.
LIT SEARCH WAYS TO PREVENT THE RETURN TO ICUS.
Trends:
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Geriatric Femurs after OR
AMS after a TBI
CIWA
Preventing Returns to ICU
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Research
Alert
Communicate Trends
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Ventilator Codes and Vent Days
Meghan Cangley
Trauma Quality Specialist
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CDPHE:
Total Ventilator Days [ImageTrend Tag: TR26.58] [NTDS Tag: O_02]
Definition: The cumulative amount of time spent on the ventilator.
Values: Whole number between 0-400
Additional Information: Each partial or full day should be measured
as one calendar day.
Excludes mechanical ventilation time associated with OR procedures.
Non-invasive means of ventilatory support (CPAP or BiPAP) should not
be considered in the calculation of ventilator days. If ‘Not
Applicable’ is entered, the value will appear blank upon import to
the state.
NTDB:
The cumulative amount of time spent on the ventilator. Each partial
or full day should be measured as one calendar day.
Vent Days: State Aligns with
NTDB Definition
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Scenario:
Patient arrives to ED 1/2/2019 and is intubated for altered mental status and
placed on vent at 2300.
They are taken to OR at 2330 for a femur fixation and then go to ICU post-op
at 0100 on 1/3/2019.
Their mentation clears and they are extubated at 1600 on 1/3/2019.
Since they were on the vent in ED would this count as a partial day of
ventilation?
Vent Days TQIP Clarification
TQIP Answer:
Yes. Even though it was only for 30 minutes in the ED on that
calendar day, the patient was still on the ventilator for a partial
day, so it should be counted as one full day towards the cumulative
total. If they were extubated at 1600 the following day, then “2”
should be reported to TQIP for the Total Ventilator Days data
element, assuming that the patient was not on mechanical
ventilation at any other point during their initial stay.
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Continuous Mechanical Ventilation ICD 10 Code
Only required to report first occurrence to NTDB/TQIP/CDPHE
- 5A1935Z for less than 24 hrs
- 5A1945Z 24 - 96hrs
- 5A1955Z if > 96 hrs
IF first occurrence was less than 24hrs but then patient is re-
intubated and it is a longer timeframe, only the first occurrence
of mechanical ventilation is required.
Performance Improvement
This may meet NTDB/State definition for unplanned intubation
and should be reviewed.
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Performance Improvement Q&A
Valorie Brockman
Trauma Program Manager
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What PI data can you get from the state?
Examples of filter lists from different facilities.
Question
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Data Request Form
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Data Request Form
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Data
Request
Form
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Data
Request
Form
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Data
Request
Form
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When will the State be accepting the AIS 2015 codes?
NOW
Question
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How are systems tracking the documentations on
transfers and recommendations that a resource facility is
communicating. How are they tracking that instructions
recommended by the resource facility are being
followed?
Question
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Transferring Facility
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Trauma Transfers – PI Filters
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Trauma Transfers – Documents
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How are facilities incorporating the JCAHO
taxonomy of impact, type, domain, cause,
prevention and mitigation?
Question
Taxonomy
Have a reference sheet available for primary,
secondary and tertiary review to make
determinations on each case.
Make sure the registry PI screen matches the options
you have on your reference sheet so that it can be
added to the review in the registry.
If you keep minutes, separate from the registry,
include taxonomy on minutes.
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Example from Univ. of Colorado –
Stephanie Vega
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Front
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Back
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Taxonomy- PI in the Registry
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Performance Improvement
Review Tool
Jamie Teasley
Trauma Nurse Clinician
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• The chief cause of a trauma center’s verification failure is the lack of
adequate PIPS and event resolution.
• PIPS programs continuously evaluate trauma core measures through a
concurrent assessment of the process and outcome of patient care by
routine analysis achieved through Primary L1o, Secondary L2o and
Tertiary L3o levels of review.
• Once an event is identified, L1o review takes place concurrently, is
reported weekly in order to verify, validate and utilize a specific set
of core measure or “drill down” questions.
• If the provider or system events requires further investigation, then it
moves onto semi-monthly L2o with the Trauma Medical Director (TMD).
This includes a thorough review of the EMR, individuals involved, and a
timeline of events with the goal of prompt feedback and resolution.
• If resolution is not achieved then a L3o multidisciplinary peer review is
conducted to include, peer assessment of the efficiency, safety, and
efficacy of the trauma care with evidence based corrective actions.
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• We proposed that certain events could be closed at L1o
based upon impact/degree of harm or successful
corrective actions and event resolution.
• We projected that this lean and reliable L1o would
decrease the number of open events brought to L2o.
• We proposed that succinct and inclusive presentation of
each event would decrease the need for additional data
requested by the TMD at L2o and allow for prompt event
resolution.
• We desired to successfully implement a process to
stratify the degree of harm which would guide
consistent triage of events to L3o.
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• The result of defining drill down questions was a comprehensive list of core
measures available in a spreadsheet which includes: complications/audit
filters/clinical practice guidelines compliance which could be closed at L1o
or L2o, NTDB/institution specific definitions with stratification of minimal,
moderate, or severe degree of harm were included.
• Information was gathered concurrently from trauma service rounds, EMR,
EMS data, referring facilities, or provider discussions at morning handoff
report. Information is entered in the trauma registry PIPS module.
• This refined tool increased confidence and decreased the trauma staffs’
learning curve while streamlining analysis and resolution of events and
ensuring validity and inter-rater reliability.
• This drilldown tool continues to evolve as more Trauma PIPS event needs are
identified and level of harm defined.
• Clinical staff increased their review of more audit filters and events with
resolution at L1° review, resulting in fewer unnecessary events requiring L2°
review resulting in a leaner process.
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