data entry system update - tarn. data... · nhs england have updated the bpt criteria for 2019- 20...

Data entry system update

The Trauma Audit & Research Network (TARN) TARN

Recent System ChangesAs agreed by TARN Audit Committee

TARN

Major Trauma Centre: Best Practice Tariff

NHS England have updated the BPT criteria for 2019-20

BPT is an additional payment made to Major Trauma Centres only

Based on Injury Severity• Level 1: Moderate Trauma (ISS>8): £1,500• Level 2: Major Trauma (ISS>15): £3,000

Conditional on ‘Best Practice’ targets being met & data correctly entered onto TARN database

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Recent system changes- From April 2019: Best Practice Tariff Criteria 2019-20Developed by NHS England

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Rehabilitation prescription 2019

Launched April 2019- mandatory from this point.

All patients admitted from April 2019 must have this section completed in order to be eligible for BPT.

Existing BPT rehabilitation questions will remain, and continue to determine BPT payment for all patients admitted before April 2019. Must be answered to ensure BPT payment for these patients.

Prescription matches TARN system exactly

Guidance document in Resources section of TARN website.

BPT flowchart document from NHS E & Professor Chris Moran available on website

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BPT Eligible

Rehabilitation needs assessed- no needs identified

Rehabilitation needs assessed- needs identified:

• rehabilitation prescription completed• Prescription contains core items• Prescription developed with patient/

family/ carer• Prescription discussed with patient

where possible• Prescription given to patient, GP & next

care provider• Rehabilitation needs checklist

completed

2019 Rehabilitation Prescription payment flow diagram available in 2019 BPT support document in resources section of website

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• This includes patients transferred in to the MTC

• This question appears in ED and CC if a GCS of less then 9 is recorded

• If a patient arrives intubated and ventilated in the MTC no GCS should be recorded, this does not affect BPT eligibility

• If a patient is admitted straight to a ward record the GCS on the ward in the extended dataset

• All non-intubated TTA patients must have a GCS recorded within 30 minutes

• It is expected that all level 2 patients will be TTA (NHS-E guidance Aug 19)

BPT 19-20 Consideration of Intubation

Patients must have a GCS recorded within 30 minutes of arrival at the MTC. Those with a GCS of <9 must have documented evidence of intubation being considered within 30 minutes of arrival.

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Recent system changes- From April 2019: Best Practice Tariff Criteria 2019-20Developed by NHS England

*

* Arrival of ambulance crew at scene

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BPT 19-20 Tranexamic Acid

Tranexamic acid is administered within one hour of arrival at scene (or arrival at the MTC for self-presentations) for patients with at least one injury associated with significant bleeding.

If time of Arrival at scene is missing, then time of incident or (if that is also missing) time of ambulance call will be used instead to ascertain compliance.

• Includes: All patients who receive a blood transfusion within 6 hours of injury or a procedure for haemorrhage control within 12 hours of injury, or die within 24hrs from extra-cranial injuries.

• Haemorrhage control procedure: Full list in guidance document, includes embolisation, laparotomy, BOAST4 ops, rib fixation

• Excludes: isolated hangings/ drownings

GUIDANCE: Please ensure that you record both the date and time that tranexamic acid was administered. Please also check whether blood products were given to the patient and record date, time and blood product type. If dates and times aren’t recorded, then this will affect tariff payment.

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BPT 19-20 Clinical Frailty Scale

All patients age 65 or older must have a Clinical Frailty Scale completed within 72 hours of admission by a geriatrician (defined as a Consultant, Non-Consultant Career Grade (NCCG) or Specialist Trainee ST3+).

• If the CFS is not recorded by a ST3+ Geriatrician, but the patient is seen by ST3+ Geriatrician within 72 hours, this can be interpreted as fulfilling the requirement because the Geriatrician is endorsing the CFS. In this case document the CFS as being recorded by the ST3+ Geriatrician. (The clinician must see the patient, reviewing the CFS on screen does not fulfil the requirement).

• This is completed in the ‘At Discharge’ section of a TARN submission

• The Clinical Frailty Scale can be completed for all patients regardless of age, but this is only a BPT requirement for those 65 and older.

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Recent system changes-CORE dataset: As agreed by TARN Audit Committee

• Non-Transfer Hospital Stay:Patients who are transferred to a hospital purely for imaging or for a review (usually Neurosurgical) and are not admitted to the second hospital should not be classed as transfers. TARN


• Estimated Injury Severity Score:

Not mandatory

If used will be calculated in Emergency Department (not by data coordinator)

• Admitting service: Paediatric Neurosurgery has been added

• Gender The word Gender has been changed to Sex and the help text updated to state that sex at birth should be documented in all cases. TARN

Recent system changes & guidance-CORE datasetAs agreed by TARN Audit Committee

Injury Intent Suspected domestic (intimate partner) violence added.

Additional Incident Information: Safeguarding for vulnerable adults added: involves reducing or preventing the risk of

significant harm from neglect or abuse, while also supporting people to maintain control of their own lives. This information is usually found in the nursing notes.

Animal bite has been added. Neglect added.

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Injury Mechanism guidance

• When completing the Incident section of a submission please ensure you are recording ‘Additional incident information’ where appropriate.

• This section allows you to record the presence of alcohol or substance intoxication, hypothermia, asphyxia type injury etc.

• It also allows you to record ‘Unknown Traumatic Mechanism’- this option should only be used when you do not know the specific mechanism of injury, but you do know that the patients injuries were caused by trauma of some kind.

• You will therefore never need to use this option if you have recorded anything besides ‘Other’ in the ‘Mechanism of injury’.

• If you are unsure when you should be using this option please get in touch with support.

Injury mechanism guidance sheet will be available under Resources very soon

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• Analgesia- Reason not AdministeredNot mandatory.

Record in Pre-hospital, ED and Critical Care sections.

• ED Investigations:

Not mandatory.

Help text provides details of the value limits for each field.

Blood gases are an important field for patients with a fracture of the rib/s and/ or sternum.

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• Doctors Training: We have added combinations of training courses:


• Resuscitation team presence in ED:The committee advised that Resuscitation is not a speciality in its own right, therefore we can’t add this as a speciality option. Users are advised to document the attendants original speciality (e.g. ED Nurse) if part of the Resuscitation team.

• Provisional Imaging reports:In line with NICE Quality standards please ensure that the date and time you record for any provisional report relates to the first written report. Dates and times of verbal reports should not be recorded.

“NICE Quality Statement 2People who have had urgent 3D imaging for major trauma have a provisional written radiology report within 60 minutes of the scan.”

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• Second Surgeon The Grade and Speciality of the second surgeon present in theatre is now a mandatory field. We have added an option for ‘Not Present’ which can be used when only one surgeon is present.

This request has come from NHS-England who are interested in knowing when both Consultant Orthopaedics and Consultant Plastic Surgeons are in theatre – particularly in relation to Open/BOAST4 fractures.

Ensure the highest grade from each speciality is documented.


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BOAST4 OPERATIONS:

We have simplified the options relating to BOAST4 operations. Previously many cases were recorded as

'other', which limits meaningful analysis.

SOFT TISSUE COVERAGE: • Direct closure• Split thickness skin graft• Local or perforator base skin/fascia

flap• Local muscle/musculocutaneous flap• Free tissue transfer• Other

STABILISATION:• Internal fixation: Nail• Internal fixation: Plate• Internal fixation: Other• External fixation: Application of

circular frame• External fixation: Application of

monolateral (non-circular) frame


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Anticoagulant reversal added to interventions, Pre Hospital, ED & CC

Pre-injury Anticoagulant added to At Discharge screen

The options for anticoagulants are the same as for antiplatelets. If you are unsure of the reason these products were administered please record them as anticoagulants.

Leucocyte Depleted Red Cells & Plasma added to blood products list.

London Air Ambulance carry this product, the equivalent of 1 unit of RBC & 1 unit of FFP in a single bag. Used by any London MTC. The volume of this product should be recorded as 2 units per bag.

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Complications: Addition of: Allergic reaction (which includes anaphylactic shock)

SIADH Syndrome of inappropriate antidiuretic hormone secretion

Pre-existing Medical conditions: Metastatic Cancers- Previously listed as 'Secondary Cancers'; now listed as 'Cancer,

metastatic'. Premature baby has been added. Advice from the TARNlet committee is that this

term should only be used up to 60 weeks, unless the child has an ongoing issue such as a cardiac defect.

60 weeks is derived from standard 40 week gestation period, plus 20 weeks. TARN

Recent system changes- From February 2019 As agreed by TARN Audit Committee

Chest Wall Trauma Screen report added:To accompany the Chest Wall Trauma specialist screen. This report pulls information both from the specialist screen & the CORE dataset and focuses on patients with 3+ rib fractures. It will be available for users to produce anytime – from the Audit tab (as with the

BOAST4 report TARN

Data Accreditation has been amended:

Time of Intubation: added due to inclusion in new NICE Quality standards.

People with major trauma who cannot maintain their airway and/or ventilation have drug-assisted rapid sequence induction (RSI) of anaesthesia and intubation within 45 minutes of the initial call to the emergency services (NICE Quality Statement)

Incident date/time is reviewed separately to 999 call date/time: Due to importance of ambulance call times in new NICE Quality standards regarding intubation.

Time of provisional and final CT report: added due to inclusion in new NICE Quality standards.(Written or verbal provisional report).

People who have had urgent 3D imaging for major trauma have a provisional written radiology report within 60 minutes of the scan (NICE Quality Statement)

Time of TXA: added as time administered determines effectiveness of this treatment

Name of Previous/next hospital patient is transferred to/from: removed.

These changes have been implemented on the Performance Comparisons section of the TARN website, in the Dashboards, Clinical reports and Data Quality report: July 2019 onwards.

Recent system changes- From July 2019 As agreed by TARN Audit Committee

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Planned System ChangesAs agreed by TARN Audit Committee

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Planned system changes-CORE dataset: As agreed by TARN Audit Committee

• Operative Procedures: Local & Epidural Anaesthetic should be recorded as analgesia, as an intervention in the location in which it is administered (Core: ED & CC, Extended: ED, Ward, CC):

• Interventions/Analgesia: Local Anaesthetic recorded as Local Anaesthetic Blockade Epidural recorded as Epidural block

• If the procedure is performed in theatre, users are advised to document this as an Intervention in the Operations section, which is accessible via the Extended dataset.

All previous recordings will be mapped accordingly.

All of the above guidance will be added to the system help text.

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• Admitting Service: ITUThis option will be removed, as patients admitted to ITU are done so under the a Speciality (Orthopaedic, Cardiothoracic etc), which ITU is not. All previous recordings will be mapped to the most Severe injury the patient has sustained or where this is not possible, the Ward Speciality they were admitted onto. TARN


• GCS Missing Assumed Normal This option will remain but should only be used for Children aged <16 where AVPU (A=Alert) has been documented. In these cases it will be considered as GCS 15 for purposes of Reporting and Data Accreditation.

If GCS is missing for any patient aged 16+, then GCS should be documented as No. Missing Assumed Normal should not be used in these cases.

All previous recordings aged 16+ will be considered to be GCS=Not documented.

• GCS Missing Assumed AbnormalThis option will be removed, as it is not used in any reporting or analysis. If GCS is not recorded then it should be documented as No in future.

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Dashboard Validation period ending The TARN Audit Committee has agreed that Dashboard Validation period will cease from April 2020 onwards.

Dashboards published from April 2020 onwards will be final, therefore the onus will be on the Hospitals to ensure their data is complete prior to dispatch to TARN.

This decision is fully supported by the TARN Executive Committee and brings TARN into line with other National Audits who do not offer a validation period for reporting.

If any Hospital wishes to discuss setting up an internal validation process to ensure their data is of the highest quality prior to dispatch, we are more than happy to help with this.


TARN

data entry system update - tarn. data... · nhs england have updated the bpt criteria for 2019- 20...

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