Trauma Data Use: A Trauma Physician’s Point of View

1. 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

2. 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.

3. 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

4. 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

5. 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

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. 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.

15. 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.

16. 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

19. 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

20. 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.

21. 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

22. 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

23. 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.