Transcript A Trauma Physician`s point of View

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
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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
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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
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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)
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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
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How do you know if you are a “good” trauma
center?
American College of Surgeons (ACS)
verification.
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PI is the #1 reason centers are unable to get
verification or designation
Developing trends to identify system and
provider issues.
Performance Improvement
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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)
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Trauma registry works closely with both the
trauma medical director and program manger
to PI identify cases.
PI outcome reports
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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)
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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)
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Data collection can either be concurrent or
retrospective
Retrospective
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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)
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“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!
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500-700 cases per full-time registrar
Clinical Protocols
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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
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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.
Trauma Services
Title: PATIENT MANAGEMENT GUIDELINE WITH C-COLLAR
IN PLACE
Policy Statement:
C-Spine Radiographic Evaluation Guideline
Procedure:
Alert, cooperative, GCS>13, and without evidence of:

Impairment by drugs or alcohol

Neurological deficit

Distracting pain or injury
Yes
No
Midline
tenderness or
pain with limited
range of motion
Cleared
No
C-spine CT or 3-view C-spine
Positive/
Suspicious
Yes
Negative
3-view C-spine
X-ray or CT
Positive/
Suspicious
C-spine CT (if
not already
complete)
Negative
Negative
Positive
Consider
Neuro/Ortho
consult;
Consider MRI*
C-spine
remains
immobilized
Consider
Neuro/Ortho
consult; Consider
MRI*
C-spine remains
immobilized
Significant
neck
pain?
Yes
C-spine remains immobilized until:
 Alert, cooperative, GCS>13
 Without evidence of:

Impairment by drugs or

alcohol

Distracting pain or injury

Neurological deficit
No
Cleared
*Urgent need in cases of cord
lesion or neurological deficit.
PATIENT MANAGEMENT GUIDELINE WITH C-COLLAR IN PLACE
Trauma Services Manual
Page 1 of 2
Policy #
Intubate
*Providers may consider the use of
other medications as deemed
appropriate.
If After 3 Failed Intubation Attempts Call
Anesthesia/Consider Surgical Airway
Data Elements
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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.
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Our trauma flow sheet was designed to reflect
what data elements are needed for the registry.
Registry Data
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Audit filters
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ACS has common filters that help identify issues
or potential issues
Types of indicators
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Process- Length of stay
Performance- Provider compliance with protocols
Clinical- Protocol development and evaluation
Resource use- Air ambulance use
System- EMS, transfers
TRAUMA REGISTRY WORKSHEET
TR#
MR#
ROOM
PT#
ARRIVE DATE
TIME
UNKNOWN,
DEMOGRAPHICS
PREHOSPITAL
LAST
REFERRING AGENCY
FIRST
MI ____
SSN
SEX
DOB
M
RACE
AGE
F
W
A
B
H
I
O
RESIDENCE COUNTY
EMS AGENCY (to st. als)
CONDITION
A
STATE
ZIP
P
mv
npa
ccp npa LF AA
ASL other
ARRIVE SCENE
DEPART SCENE
ARRIVE HOSP
GCS
RR
eye
BP
verbal
T=tubed
motor
TP=tubed paralytics
TREATMENT
CPR
INJURY
other
U
DISPATCH TIME
OCCUPATION
(WORK RELATED)
DATE
ccp
acems
V
HR
CITY
acems
mast
total
L=legitimate
S=sedation
chest tube
Needle thoracostomy
TIME
CITY
ZIP
COUNTY
AIRWAY
none/normal
ECODE
O2
bvm
PET nasal ett
crico
trach
oral ett
oral airway
DESCRIPTION
IV FLUIDS
MECHANISM
blunt
penetrating
ND
burn
0-500
500-2000
saline lock
>2000
unk amount
SITE E849
RESTRAINT
2-pt
Carseat
3-pt
helmet
belted/NOS
airbag airbag/belted
helmet/protective gear
unk
DRUGS GIVEN
NONE
REFERRING HOSPITAL
TRANSFERRING AGENCY
ativan demerol etomidate
morphine succ vecuronium
Y
fentanyl
valium versed
phenergan
None
N
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
Pos
Neg
N/d
VS
GCS
HR
RR
eye
verbal
T=tubed
AIRWAY
ICU?
TP=tubed paralytics
none/normal
O2
PET
BP
motor
bvm
nasal ett
L=legitimate
crico
oral ett
ARTERIO/ANGIO
total
CPR
Y / N
S=sedation
PERITONEAL LAVAGE
Y / N
trach
DRUGS GIVEN
oral airway
morphine
succ
ativan demerol etomidate fentanyl phenergan
vecuronium
valium versed
NONE
OR?
Rev 01/06:mf
Page 1
ED ADMISSION
DIRECT ADMIT
Y
ED ASSESS 1
N
HR
DC DATE
DC TIME
ARRIVED FROM
home
TRANSPORT
amb
COMPLAINT
fall
horse
gsw
mvc
V
TRAUMA LEVEL
assault
bike
AIRWAY
burn
snow inj
cut
self-inflicted
other
TP=tubed paralytics
O2
TREATMENT
TIME ACTIVATED
ETOH
ETA
bvm
PET
L=legitimate
oral ett
oral airway
amph
benzo
barb
pcp
not done
HCT
coc
marijuana
tricyclics
Arrived
Called
Arrived
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
PERIT LAV
pos
neg
n/d
CTA
pos
neg
n/d
AORTOGRAM
pos
neg
n/d
ARTERI/ANGI
pos
neg
n/d
ED ASSESS 2
BB TIME:
mobility
2-dep:partial help
DC DATE
verbal
3-indep w/device
4-indep
TIME
DISPOSITION
home
DC SERVICE
trauma
DEATH LOCATION
ADMITTING SVC
rehab-ST ALS
Transfer
jail
ED
rehab-OTHER
nrsg home
ortho
neuro
Floor
ON VENT
ICU
date
time
MD
HOSPITAL OUTCOME
1-dep
n/d
BASE DEFICIT
Called
self care
unk
>.000
PEDS MD
FIM SCORE
S=sedation
trach
TRAUMA MD
TRAUMA BAND#
Expired
ED DISPOSITION
other
other
OR
Trauma
ICU
Neuro
OR
Expired
OR DISPOSITION
ICU
Ortho
Floor
DOA
Floor
ADMITTING MD
Non-surg
other
Telemetry
Transfer out
DA
Death
ATTENDING MD
OFF VENT
VENT DAYS
CONSULT
DATE
TIME
ADMIT ICU DATE
TIME
CONSULT
DATE
TIME
DC ICU DATE
TIME
CONSULT
DATE
TIME
CONSULT
DATE
TIME
CONSULT
DATE
TIME
CONSULT
DATE
TIME
ICU DAYS
ORGAN DONATION
AUTOPSY
COLLAR:
Y
YES
N
Y
N
UNK
UNK
NONE
UNK
N/A
FINANCIAL
DATE ON: _____________
TIME: ______________
FINANCIAL ACCT #
DATE OFF: ____________
TIME: ______________
ACCT SYSTEM NAME
ORDERED BY (MD):
__________________________
y/n
temp mont y / n
units/blood (1st 24 hrs)
none
.000/none
warm
total
crico
nasal ett
ed cpr
DRUGS SCREEN
1
motor
none/normal
poly
2
TEMP
verbal
U
3
BP
eye
T=tubed
other
other transport
P
none
other
pov
ATV
machinery
A
refer
FW
other animal
mcc
pedestrian
CONDITION
scene
heli
RR
GCS
PRIMARY/SEC PAYOR
WORK COMP INJURY
YES
NO
Page 2
Data Validity
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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.
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Institution specific
Reports Writing
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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
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Well written reports aid…
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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
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Focused Audits
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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

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DVT
Infections
Dashboard
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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.