Welcome

The Trauma Audit & Research Network (TARN)

Foundation course

TARN

The NHS in England has saved an additional 1,600 patients with severe injuries since the establishment of major trauma centres in 2012

20th August 2018NHS England

TARN

Today’s session

Background

Inclusion Criteria

Identifying Cases

Data Entry

System Features

Quality Assurance: Case ascertainment & Data Accreditation

Injury scoring & calculating the ISS

TARN

Background

Largest European Trauma registry: >800,0000 injured patients with >50,000 injured children

Review and monitor process of care & outcome

Report to Trusts & Commissioners

Inform changes in practice: Improve Trauma Care

100% membership in England, Wales, ROI and Northern Ireland

Member in Denmark

220 Hospitals submitting data

Clinically led (BOARD and Executive committees), Academic, Independent

TARN

The beginning

1988: Report by RCS: The Management of patients with Major Injuries“Serious deficiencies in the management of severely injured patients”

Enhancing pre-hospital care, ensuring appropriate medical intervention Rapid transfer to the best local facility Assessing the use of helicopters Adopting ATLS principles Integrating trauma services within and between hospitals Investing in rehabilitation services

System of Auditing & Research

TARN Established in 1990

Based Salford Royal Hospital

TARN

Major Trauma Network development

Public Accounts Committees March 2010Chief Executive of NHS on public record as ......

Committing to development of Major Trauma Networks across England by end of 2011/12

Mandating TARN membership

Most Major Trauma Networks “live” April 2012

TARN

TARN

What has changed

On scene patient triage: Positive

Direct to MTC (< 45 mins travel)

Indirect Transfer(>45 mins, time critical intervention)

MAJOR TRAUMA CENTREConsultant led trauma teamImmediate operating theatreAll specialties: neurosciencesImmediate CT scanInterventional radiologySpecialist critical care

Trauma UnitTrauma teamImmediate CT Resuscitate, Assess & ? Transfer

TARNTARN

Major Trauma Centre: Best Practice Tariff Year (19-20)

Additional payment made to Major Trauma Centres in England only

Based on Injury Severity• Level 1: Moderate Trauma (ISS>8): £1,500• Level 2: Major Trauma (ISS>15): £3,000

Conditional on ‘Best Practice’ targets being met & data correctly entered onto TARN database

NHS England have updated the BPT criteria for 2019-20

BPT worth 51 million per annum

Last year 5 million in missed payments

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Major Trauma Centre: Best Practice Tariff Year (19-20)

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Rehabilitation prescription 2019

Launched April 2019- mandatory from this point.

All patients admitted from April 2019 must have this section completed in order to be eligible for BPT.

Existing BPT rehabilitation questions will remain, and continue to determine BPT payment for all patients admitted before April 2019. Must be answered to ensure BPT payment for these patients.

Prescription matches TARN system exactly

Guidance document in Resources section of TARN website.

BPT flowchart document from NHS E & Professor Chris Moran available on website

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BPT Eligible

Rehabilitation needs assessed- no needs identified

Rehabilitation needs assessed- needs identified:

• rehabilitation prescription completed• Prescription contains core items• Prescription developed with patient/

family/ carer• Prescription discussed with patient

where possible• Prescription given to patient, GP & next

care provider• Rehabilitation needs checklist

completed

2019 Rehabilitation Prescription payment flow diagram available in 2019 BPT support document in resources section of website

TARN

• This includes patients transferred in to the MTC.

• This question appears in ED and CC if a GCS of less then 9 is recorded.

• If a patient arrives intubated and ventilated in the MTC no GCS should be recorded, this does not affect BPT eligibility.

• If a patient is admitted straight to a ward record the GCS on the ward in the extended dataset

• All non-intubated TTA patients must have a GCS recorded within 30 minutes

• It is expected that all level 2 patients will be TTA (NHS-E guidance Aug 19)

BPT 19-20 Consideration of Intubation

Patients with a GCS of <9 must have documented evidence of intubation being considered within 30 minutes of arrival at the MTC.

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Major Trauma Centre: Best Practice Tariff (19-20)

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BPT 19-20 Tranexamic Acid

Tranexamic acid is administered within one hour of arrival at scene (or arrival at the MTC for self-presentations) for patients with at least one injury associated with significant bleeding.

If time of Arrival at scene is missing, then time of incident or (if that is also missing) time of ambulance call will be used instead to ascertain compliance.

• Includes: All patients who receive a blood transfusion within 6 hours of injury or a procedure for haemorrhage control within 12 hours of injury, or die within 24hrs from extra-cranial injuries.

• Haemorrhage control procedure: Full list in guidance document, includes embolisation, laparotomy, BOAST4 ops, rib fixation

• Excludes: isolated hangings/ drownings

GUIDANCE: Please ensure that you record both the date and time that tranexamic acid was administered. Please also check whether blood products were given to the patient and record date, time and blood product type. If dates and times aren’t recorded, then this will affect tariff payment.

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BPT 19-20 Clinical Frailty Scale

All patients age 65 or older must have a Clinical Frailty Scale completed within 72 hours of admission by a geriatrician (defined as a Consultant, Non-Consultant Career Grade (NCCG) or Specialist Trainee ST3+).

• This is completed in the ‘At Discharge’ section of a TARN submission

• The Clinical Frailty Scale can be completed for all patients regardless of age, but this is only a BPT requirement for those 65 and older.

TARN

BPT 19-20 New report

Launched for patients admitted April 2019 onwardsNew fields highlighted

Existing 14-18 BPT report still exists: For older cases TARN

Web-based Trauma Data Collection

Electronic data collection & reporting system Secure on-line system through patient pathway Data Collection AND Reporting TARN

TARN Reports Clinical Reports: Uploaded March, August, November. Email notification to all users

Performance Comparisons: Updated March, August, November. Available to all.

Online Reports: Self produced reports

Ad Hoc analysis: Available any time

Dashboards: Published Quarterly for MTC and Trauma Units, half yearly for CMTCs

Separate Reporting & Refresher Training

session

TARN

Trauma DashboardsBenchmarking between comparable hospitals

Major Trauma Centre Dashboard Developed by MTC Clinical Reference Group

Children’s Major Trauma Centre DashboardDeveloped by TARNLet

Trauma Unit Dashboard Developed by Trauma Unit Working Party

TARN

• From April 2020 no Dashboard amendments will be accepted.

• Dashboards published from April 2020 onwards will be final, therefore the onus will be on the Hospitals to ensure their data is complete prior to dispatch to TARN.

• This decision is fully supported by the TARN Executive Committee and brings TARN into line with other National Audits who do not offer a validation period for reporting.

• If any Hospital wishes to discuss setting up an internal validation process to ensure their data is of the highest quality prior to dispatch, we are more than happy to help with this.

Dashboards April 2020

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Dashboard timescales: April 2020 Onwards

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The 2019 TARN databaseTARN

TARN figures: 2019: Gender breakdown

44% 56%TARN

TARN figures: 2019: Median Length of Stay

8 days TARN

TARN figures: 2019: Age breakdown

<16 16-35 35-65 65-80 >805% 14% 31% 22% 28%

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TARN figures: 2019: Mechanism of injury

Vehicle incident

19%

Falls <2m61%

Falls >2m10%

Penetrating injury

2%

Blows 6%

Other 2%

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TARN figures: 2019: Most severely injured body regions

Head 25%

Face 2%

Chest17%Abdomen

2%

Spine12% Limbs

32%

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TARN figures: 2019: ED Admissions

Accident & Emergency

10% not admitted to ED

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Contact us

Phone-line: 0161 206 4397 Email: support@tarn.ac.uktarn.supportstaff@nhs.net

Twitter account: @TARNaudit Website: www.tarn.ac.ukFacebook: www.facebook.com/TARNaudit

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