Trauma Registry Mazen S. Zenati, M.D. MPH, PH.D. University of Pittsburgh Department of Surgery and...
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Transcript of Trauma Registry Mazen S. Zenati, M.D. MPH, PH.D. University of Pittsburgh Department of Surgery and...
Trauma Registry
Mazen S. Zenati, M.D. MPH, PH.D.
University of Pittsburgh
Department of Surgery and Epidemiology
What Is a Trauma Registry? A computerized data base
that consist of extensive demographic, injury information, and trauma outcome
Includes all trauma patient data from scene to hospital discharge
Many uses, many users
Trauma Registry
A trauma registry is a system of timely data collection that aids in the evaluation of trauma care for a set of injured patients who meet specific criteria for inclusion. In addition to hospital-based trauma data, it also includes patient information from other health care providers including pre-hospital care and rehabilitation if utilized.
Provides a mechanism for overall patient care and system evaluation.
Trauma Registry Relay on Commercial Software:
Collector®, TraumaBase®, Trauma 1®, NTRACS®.
Used by most trauma centers in U.S. Designed by Tri-Analytics, based on:
The ABBREVIATED INJURY SCALE (AIS) which is an anatomical scoring system in which injury are ranked on a scale of 1 to 6, with a being minor, 5 severe, and 6 an un-survivable
The INTERNATIONAL CLASSIFICATION of DISEASES (ICD-9) which is used to provide a standard classification of diseases for the purpose of health records and to classify diseases and to track mortality rates based on death certificates and other vital health records.
What Does a Trauma Registry Do?
Provides for the:
Collection
Storage
Reporting
of trauma patient data
Trauma Registry Functions
Trauma case identification, abstraction Trauma quality improvement Data sets for research and outcome studies Reporting: Standard reports, quarterly reports
to State registry Trauma report for projecting and strategic
planning: Billing, transfer center, ad hoc reports
State trauma designation
Trauma Case Abstraction: Collector
Trauma patient information from: Power chart notes and other
electronic data sources Emergency Department (ED),
Operating Room (OR) radiology reports and discharge summary
Entered directly into Collector data base
Data Collection Certain parts are concurrent and many retrospective
in nature Concurrent for front ended data and retrospective
for back ended data Identifying patients based on trauma lists, ICD-9 of
admission and diagnosis and used to obtain concurrent data
Medical records are the main source for retrospective data collection
Data collected on concurrent bases can be used in identifying patients for quality assurance projects and clinical trial.
Record Manager to add, edit, view and search
Data that need to be entered
Looking for individual record
Trauma Registry Functions: Quality Improvement
Quality improvement looks at: Patients Providers Processes Outcomes
Collector Registry Software• Free to all hospitals
•Built-In Logic Checks• Logger Submission Tool
• Error Reports
Training•Data Entry & Submission
• Report Writing• Registry Users Manual
• AIS Injury Scoring Course
Technical Assistance• On-site consultation
• Toll-free support
Trauma RegistryQuality Improvement
Internal Analysis• Record linking
• Comparative Reports• Data quality indicators
Trauma Registrars Networks
Trauma Registry Data Validation during
Designation Reviews
A Model for Trauma Registry Quality Improvement
OutcomesTAC
Trauma Registry :Quality Improvement Individual and aggregate cases Many trauma quality indicators reviewed by
an interdisciplinary committee Indicators (audit filters) divided into
categories by patient age, area of care, complications
Trauma Quality Audit Filters-- Pre-hospital: No Emergency Medical Services (EMS) run report
in chart Scene time > 20 minutes Cricothyroidotomy in field
Trauma Registry :Quality Improvement
Trauma Audit Filters-- Emergency Department: Difficult intubation No CAT scan within 2 hours if head injury ED stay > 2 hours with BP <90, admit to OR Admitted, readmitted within 72 hours Trauma Team not activated Delay in attending/service response Length of ED stay > 6 hours ISS > 14 (medium to serious injury) admitted to non-
surgical service
Trauma Registry :Quality Improvement
Trauma Audit filters-- Complications: Decubitus ulcer Deep vein thrombosis Pulmonary Embolus
Trauma Audit Filters—Process: Laparotomy needed, not done within 4 hr Non-surgical treatment of: Gunshot wound to abdomen Adult femoral shaft fracture Open long bone fractures, no operative treatment within 8
hours Epidural and subdural hematoma, first craniotomy > 4 hours
after arrival Trauma audit filters—Deaths:
All trauma deaths Unexpected deaths (ISS < 15) Unexpected survivors (ISS > 50)
Trauma Registry: Quality Improvement
Trauma audit filters– Pediatric: Transfers to Children’s Hospital for continued
care—review length of stay, outcomes (excludes rehab transfers)
Diagnostic peritoneal lavage in child < 12 years of age
Negative laparotomy; or gastrostomy, jejunostomy tube placement in patients < 15 years of age
ALL pediatric deaths
Trauma Registry: Reporting Standard reports: Run a SQL query against the
main data base Convert result to Excel spreadsheet, MS word document Standard reports:
Abstract list, status report Activity reports Transfusion Practice Committee report Annual trauma summary Regional Quality Assurance summary State Trauma Registry Quarterly report Requires complex manipulation of data in certain occasions
Trauma Registry: Reporting
Standard reports—Collector: Billing reports—Uses ISS for state trauma fund
reimbursement Transfer Center reports—ISS info to referring
facilities Ad hoc reports:
As requested, Trauma Registry info to support quality improvement and research programs
Data released under HIPPA and IRB (Institutional Review Board) guidelines
Query the registry and producing reports
Running a report
Trauma RegistryWho Do We Include? State criteria: All patients with a discharge trauma diagnosis code
ICD-9 800-904, 910-959 Drowning, asphyxiation (hanging), electrocution Activated the Trauma Resuscitation Team response Deaths: on arrival, in hospital Transfers: In or out, via EMS or ambulance All pediatric trauma patients, age 0 to 14 All adult patients with length of stay > 48 hours Foreign body diagnosis that causes injury (GSW) ALL admits, even if < 48 hours
Trauma Registry:What We Collect Demographics: Name, hospital number, address, age Date of birth, race, sex Social Security number Incident info: Injury date/time Primary, secondary E-codes (etiology, external cause of event) Setting (street vs home) Injury location (address) E-codes: External cause, circumstances of injury Very detailed—Falls: From stairs, or steps, ladders, scaffolding, out of building, other
structure, into hole or other opening,
Trauma Registry:What We Collect One level, same level, other, unspecified……. Incident info, E-Codes very important for: Research: What really causes injury? Injury prevention: Intentional vs non-intentional
trauma and interventions Incident info: (Yes, No, Unknown) Occupant: Driver, passenger, unknown Seat belt: Type (lap, shoulder) Air Bag Protective Device: (helmet, other) Work Related
Trauma Registry:What We Collect
Incident info: Injury note: Hand written explanation of any unusual factors relating to
traumatic event Abuse, pregnant, missed diagnosis Seen within 72 hours Other Hospital: Other facility transfer: Yes, No Transfer from: Other facility: admit date/time, patient number, alcohol level, toxicology
screen Pre-hospital/field: Transport mode: Air, ground, multiple methods Times: Dispatch, scene arrival/departure, ED arrival Pre-hospital/field: Field vital signs: pulse, respiratory rate, blood pressure
Trauma Registry:What We Collect
Glasgow Coma Score: neuro status Procedures: CPR, flutter valve, intubation, MAST pants Emergency Department: Admit date/time, disposition Trauma Team Activation Admit vital signs: pulse, respirations, blood pressure, Glasgow
coma score Procedures: multiple! Inpatient: Inpatient admit date/time, service, unit, provider, disposition Discharge: transfer, rehab, psych Patient Outcome: Glasgow coma score, functional level Diagnosis, procedures summary Death: Organ/tissue donor status Brain Death criteria
Trauma Registry:Where Does the Data Go?
Quarterly submission to State Trauma Registry—300 to 400 data elements per patient
Trauma Registry:How Is The Data Used? Injury surveillance, analysis, prevention programs Monitor, evaluate major trauma patient outcomes Compliance with state standards Resource planning, system design and
management Research and education State-wide and regional quality assurance, system
evaluation
Trauma Registry:Impact On Trauma Care
Identifies injury cause: What is really hurting people? Provides “counts:” Spike in injury type Intentional vs. unintentional: GSW: suicide, homicide,
or “accidental” Identifies cases for research, quality assurance Data drives legislation: Motorcycle helmet, seatbelt
laws Design, evaluate injury prevention programs Evidence based trauma care practice Injury severity scores/financial issues
—State trauma fund
Trauma Registry:Impact On Trauma Care Concurrent review of complications:
preventable/non-preventable Case distribution: Facial fractures Facility improvements: More operating rooms, ED
CAT scanner Blood usage Answers the questions: Who is getting hurt and how? What really works for treatment, prevention? How much does it all cost? How, where can we improve?
Trauma Registry:Summary
Lots of data Lots of users Lots of uses Lots of work Increasingly important for evaluating care,
systems, and prevention Very useful tool for trauma research Still under-utilized and need to be more
readily accessible for research