The Case for Concurrency – GMC experience Monica Rozzell,RN,MS Trauma PI Manager Grant Medical...
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Transcript of The Case for Concurrency – GMC experience Monica Rozzell,RN,MS Trauma PI Manager Grant Medical...
The Case for Concurrency –GMC experience
Monica Rozzell,RN,MS
Trauma PI Manager
Grant Medical Center
In the Beginning
GMC trauma registry started 1987 1.0 FTE Duties included abstraction, reporting
• Approximate volume 800 - 1000/annually
• Retrospective entered on average 90 days after discharge
• Data supported verification efforts
• Hours worked 0400 – 1230
For the next 14 years.. We maintained the status quo
After 14 years it began to dawn on us that we needed a new approach
First Solution – add more people!
In 2001 we added .5 FTE registrar
As our patient volumes began to increase we added FTE’s but did not change our retrospective process
In 2003 we added 1.0 FTE and in 2004 we added an additional 0.7 FTE
And yet.. We were still always
behind
Despite everyone’s best efforts and commitment we were still about 60 days behind
Data was not valued but– viewed as a necessary thing for the state & ACS
2005 the Start of Concurrency
TPM had experience with concurrency at NWCH & determined we were going to go concurrent
Hired additionally 1.0 FTE Trauma Information Data Analyst who had started the NWCH concurrent process
Our question “Was it possible to take a registry as large (4000+/year) as ours concurrent”?
So how did we do it?
Committed to one process for data collection
Reworked our paper abstract
Improved our ICD9 coding techniques
Improved our AIS coding skills
Picked a start date and went!
And we have never looked back!
So what does it mean to be concurrent?
In Math Lines that contain the
same point are called concurrent. Concurrence is the concept of three or more lines intersecting in a single (common) point, having a single point of intersection.
What does being concurrent mean in the trauma data world?
We find, abstract, code and score all patients within 24 hours of presentation to our trauma center
We round on all admitted patients daily to find additional procedures
We complete all discharge information all patients within 48 hours of their departure from the trauma center
Our Daily Process
Find our peeps Set up for the day Utilize online resources—find, code and
score Go to the floor and find the chart –
progress notes Return and enter the data
Finding our Peeps
“The List”ED log bookOhiohealth
online resources
Morning report
Set up an abstraction gridDetermine who gets what!
Oct - Apr May - Sep
Currently
have
Open for
Currently have
Open for
SICU 4 2 SICU 4 2 to 3
Stepdown 4 2 to 3
Stepdown 4 4
Floor 10 5 Floor 10 6 to 8
9 to 10 12 to 15
Total Patients seen : 28
Abstractor: EB KAQ MP JW
SICU: 1 2 0 2
TICU: 1 0 0 1
FLOOR 4 4 0 3
T & R: 1 1 7 1
Total Patients Per Abstractor: 7 7 7 7
Extract data from on line resources
ORB Columbus fire EMSTAT Midas
Go to the floor/unit and read the chart
Return to the office and feed the beast
Speed vs Accuracy
Appearance vs Reality
Data Entry –aka Feeding the beast
Validating & Reporting – aka Taming the Beast
Weekly Validation
Daily Census
Monthly Activity Reports
Performance Improvement Reporting
Referring Hospital Lee Ann
Dietrich, RN Referring Hospital Coordinator
Grant Trauma serves central, southern and eastern Ohio hospitals. Trauma receives patients from over forty-five counties as well as, West Virginia and Kentucky. Approximately 35%-45% of admitted trauma volume are from referral centers.
OSUNatwd. Children’s
Doctors West
Mt. Carmel WestMt. Carmel East
RiversideDublin
Fairfield Medical
Berger Hospital
Hocking Valley
Adena Medical Center
Pike Community
Southern Ohio Medical Center
Adams County
Highland District Memorial
Greenfield Medical Center
HolzerMedicalCenter–Gallipolis
HolzerMedicalCenter:Jackson
O’BlenessMemorial
Dr’s HospitalNelsonville
Marietta Memorial
Selby General
GoodSamaritanGenesis
Barnesville
SoutheasternOhio Medical
Center
CoshoctonCounty
Memorial
Licking Memorial
KnoxCommunity
Grady Memorial
MorrowCounty
Samaritan
GalionCommunity
MedCentralShelby
MedCentalMansfield
BucyrusCommunity
WyandotMemorial
Marion General
MemorialHospitalof UnionCounty
FayetteMemorial
St. Anns
HardinMemorial
BlanchardValley
Lima Memorial
St. Rita’s Memorial
Mary Rutan
Mercy Memorial
Community Mercy HealthPartners Madison
County
Referring hospitals have a access to a specialized phone line that connects the referring physician directly with the Grant ED attending physician for faster transfer time. The trauma attending surgeons accept all trauma referrals (no diversion policy). The trauma referral phone line plus the authority for the ED attending to accept all trauma patients has decreased the time and effort to transfer an injured patient to Grant Medical Center.
Grant Medical Center Trauma ProgramPercentage of Referrals by Month
2009
256 260 328 363436 396 440 413 423 360 328 346
4349
176 166 136 124177 181135119102106 128139
1689
41%
36%36%
39%
43%41%
34%
41%
39%39%
36%
41%
38%40%
45%
39%
45%
43%
46%
36%
45%46%
43%41%
39%
44%
0
500
1000
1500
2000
2500
3000
3500
4000
4500
J an Feb Mar Apr May J un J ul Aug Sep Oct Nov Dec YTD
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Total Trauma Patients # from Referring Hospital All Referral % Admitted Referral %
Research
Houston We have a problem
Opportunities for improvement
• Intra rater reliability
• Paperless
• Cross training of all staff
• Maintaining concurrency
Thanks and if you have a question … Call
Monica Rozzell, RN, MS
GMC Trauma PI Manager