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.