Kentucky’s Trauma System: A Work in Progress

Julia F. Costich, JD, PhD & Svetla S. Slavova, PhDKentucky Injury Prevention & Research Center

Depts. of Health Services Management & BiostatisticsUniv. of Kentucky College of Public Health

Topics Covered• Trauma system participating facilities• Trauma registry characterization• Trauma registry data• Trauma system strategic planning• Trauma system evaluation structure

Participating facilities/ACS Verified

• Level I: Univ. of Kentucky & Univ. of Louisville• Level I Pediatrics: Kosair Children’s Hospital & Ky Children’s

Hospital• Level II: None

o Pikeville & Owensboro in process• Level III: Ephraim McDowell, Taylor Regional Medical Center,

Frankfort Regional Medical Center o Hazard Appalachian Regional Hospital in process

Participating facilities/State-verified

• Fort Logan Hospital: Level IV • James B. Haggin Memorial Hospital: Level IV• Livingston County Hospital: Level IV • Marcum and Wallace Hospital: Level IV

Level IV status under development• Crittenden County Hospital • Harrison Memorial Hospital• Medical Center at Franklin• Medical Center at Scottsville• Methodist Union Hospital• Parkway Regional Medical Center• Russell County Hospital• St. Joseph Berea• Trigg County Hospital• Possibly 7 more

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Crittenden Co.

Eph. McDowell

U of L

Trigg Co.

St. Joseph Berea

Livingston Co.l

Fort Logan

UK

Spring View Pikeville Med. Ctr.

Owensboro Med Ctr

Harrison Memorial

UK Children's.

Taylor Regional.

Kosair Children's l

Frankfort Regional.

Marcum & WallaceJames B. Haggin.

®v KY Trauma Centers

All Trauma Facilities in Current Reports

Trauma Registry vs. Hospital Discharge Data

• Trauma Registryo 902 KAR 28:040: regulatory authorization and structureo Cases that meet ACSCOT case definitiono Verified or applicant facilitieso Extensive clinical informationo ED and inpatient information in same dataset

• Hospital Discharge and Outpatient/ED Datao 900 KAR 7:030: regulatory authorization and structureo All non-federal facilitieso Limited clinical informationo Injury analysis includes all injury-related ICD codes, not just ACSCOTo Inpatient and ED information in different datasets

Table 1: Reporting Site Totals, 2012

Univ. of Louisville Hospital 2964 30%Univ. of Kentucky Hospital 2875 29%Kosair Children's Hospital 864 9%Pikeville Medical Center 650 6%Owensboro Medical Center 633 6%Kentucky Children's Hospital 442 4%Frankfort Regional Medical Center 312 3%Eph. McDowell Regional Med Ctr 299 3%Taylor Regional Medical Center 228 2%Haggin Memorial Hospital 147 1%Eph. McDowell Ft. Logan 142 1%Harrison Memorial Hospital 139 1%All others 349 3%Total 10044 (ED: 2006)

Table 2: Primary Body Part Injured

Brain 2285 24%Lower extremity 2001 21%Torso 1836 19%Upper extremity 1386 15%Other head/face/neck 874 9%Vertebral column 753 8%Spinal cord 106 1%System-wide/late effects 17 0%Other & unspecified 213 2%

Primary Body Part Injured

Brain24%

Vertebral column1%

Lower extremity21%

Torso19%

Other & unspecified2%

Other head/face/neck8%

System-wide/late effects15%

Spinal cord0.2%

Upper extremity9%

Table 3: Major Findings by Location & CauseOther Fire- Cut/

Location MVC transp arm Falls Fire Pierce Struck Other TotalStreet & highway 39% 3084 452 85 71 10 25 41 30 3798Home 38% 21 111 256 2184 273 266 232 362 3705Farm 2% 13 40 1 55 4 7 17 53 190Industrial site 3% 11 15 3 127 19 19 46 67 307Recreational site 6% 34 269 3 167 4 4 56 25 562Public building 4% 1 24 21 226 5 24 45 27 373Residential institution 2% 0 0 0 155 3 7 24 17 206Other 1% 3 15 3 48 2 4 16 22 113Unspec/missing 5% 25 69 46 170 23 44 81 76 534Total 3192 995 418 3203 343 400 558 679 9788

Major Findings by Location

Street & highway39%

Public building4%

Home38%

Farm2%

Industrial site3%

Recreational site6%

Residential institution

2%

Other1%

Unspecified/missing

5%

Table 4: Pre-Hospital Information

Zip code of the injury is not available for about 30% of the trauma registry records

Table 5: Inpatient & ED Discharge

Destinations

ED Discharge DestinationsSame hospital 231 11.7%

Another hospital 950 48.2%

Home 626 31.7%

Other institution 31 1.6%

Died 135 6.8%

Inpatient Discharge Destinations

Home 5606 69.7%

LTC/ICF/Rehab 1517 18.9%

Home health/hospice 550 6.8%

Died 311 3.9%

Other hospital 54 0.7%

Table 6: Primary Method of PaymentAuto insurance 1972 19.6%Commercial insurance 1874 18.7%"Self-pay" 1873 18.6%Medicare 1768 17.6%Medicaid 1304 13.0%Workers compensation 269 2.7%Other 123 1.2%Missing 861 8.6%

Table 7: Age-Related Information Primary Intentional

Age group Number % Cause % %Missing 19 0.2% <1yr 170 1.7% Falls 41.8% 25.9%1-4yr 418 4.2% Falls 39.7% 5.5%5-14yr 912 9.1% Falls 35.4% 1.2%15-24 1453 14.5% MVC 46.5% 13.9%25-34 1324 13.2% MVC 44.0% 17.5%35-44 1217 12.1% MVC 38.9% 14.3%45-54 1311 13.1% MVC 36.2% 10.6%55-64 1101 11.0% Falls 39.2% 6.2%65-74 844 8.4% Falls 50.2% 3.3%75-84 785 7.8% Falls 68.8% 2.3%85+ 490 4.9% Falls 81.2% 0.4%Total 10044

Other Data

Drug or Alcohol InvolvementN= %

Alcohol 776 7.7%Rx drug 777 7.7%

Illegal drug 264 2.6%

1817 18.1%

Patient Sex N= %Female 3834 38.2%Male 6209 61.8%Total 10043

Race & Ethnicity N= %White 9009 89.7%African-American 767 7.6%Other/missing 268 0.8%Hispanic/Latino 191 1.9%

Length of Stay N= %1-7 days 6714 66.8%8-30 days 98 1.0%> 30 days 1262 12.6%Missing 1970 19.6%

Mission

Right Patient, Right Care, Right Time

Trauma Advisory Council RetreatVision

Provide a comprehensive, coordinated accessible trauma care system, striving for optimal prevention,

management and mitigation of injury in the Commonwealth of Kentucky.

Values

• Inclusivity (starting with EMS, first responders through all levels of care)

• Accessibility• Cost-efficiency• Evidence-based care• High quality• Timeliness

• Performance improvement• Collaboration• Consistency

(standardization)• Professionalism• Reliability• Equitability• Appropriate funding

Strengths of current system

• Leadership• Trauma Advisory Council• Existing trauma centers and

future potential• Statute and regulations• Funding from outside

sources• State Trauma Registry• Air ambulance availability• Modular educational

programs

• Telemedicine and tele-health availability

• CDM (registry data management vendor)

• RTTDC (rural training)• Statewide registrar meeting• Inclusiveness• KHA support• State Public Health support

Weaknesses of current system• Funding• Public perception• Perception of injury• Perception of trauma centers• Geographic distribution • Law without funding• Inadequate regional support

& coordination• MD buy-in• EMS systems & turnover in

some areas• EMS reluctant to transport to

trauma center

• Shortage of burn beds and burn training

• Rural EMS agencies poorly funded

• Database doesn’t capture non-verified centers/lack of statewide participation

• TAC has no executive power• Education deficit (clinical

trauma knowledge)• Challenging geography• Lack of specialists in rural

facilities

Strategic Initiatives

1. Achieve state general funding using TAC, trauma centers, EMS, KHA and the legislation.

2. Educate legislators, public and providers about the value and relevance of the trauma system.

3. Enhance EMS engagement in the system, and enhance EMS relevance as defined by role, purpose and identity.

4. Support hospital initiatives to achieve trauma reimbursement.

5. Use state trauma data to provide a dashboard for legislature and public, enhanced by personal stories.

What would a well-developed trauma system look like?

(based on Amer. Coll. of Surgeons guidelines)

Key Elements:System AssessmentPolicy DevelopmentSystem Assurance

System AssessmentCategory Standard

Injury Epidemiology Thorough description of injury epidemiology

Trauma Management Information System

Established trauma MIS

Resource Assessment Assessment completed and updated

Emergency Preparedness Assessment

Assessment completed including coordination

Cost/Benefit and Societal Investment

Assesses and monitors values to constituents

Policy DevelopmentCategory Standard Category StandardStatutory Authority/Administrative Rules

Statutory Authority & Administrative rules

System Performance Data

Data used to evaluate performance and develop policy

System Leadership Process used to establish, maintain, improve system

Performance Reports and Reviews

System leaders review system performance reports

Statewide Trauma System, Plan

Comprehensive written system plan

Inform/Educate Partnerships

Lead agency informs and educates State, fosters collaboration

Financial & Infrastructure related resources

Sufficient resources exist, financial and infrastructure

Public Health Emergency Preparedness Links

Trauma, public health and emergency preparedness are linked

System AssuranceCategory Standard Category Standard

Trauma MIS & Outcomes

Trauma MIS used to assess & assure system performance

Integration of Trauma Plan

Trauma plan integrated with mass casualty plan

EMS System Support

System supported by EMS, trauma, EMS, public health integrated

Outreach and Prevention

Trauma system demonstrates prevention & outreach activities

Role for all Acute Care Facilities

All acute care facilities integrated into network that meets standards; optimal care for all injured patients

Continuous Trauma Care Improvement

Each hospital must improve care as measured by outcomes

Analytic Monitoring Tools

Agency uses tools to monitor performance

Rehabilitation Availability

Adequate rehab facilities integrated into system

Contact InformationKentucky Injury Prevention & Research Center

333 Waller Ave.Lexington, KY 40504

859-257-4954www.mc.uky.edu/kiprc