Trauma Registry: The Nuts Trauma Registry: The Nuts & Bolts of Data Collection& Bolts of Data Collection

Karla Bryan, RN, BSNKarla Bryan, RN, BSN

Trauma CoordinatorTrauma Coordinator

EIRMCEIRMC

Trauma Resuscitation Trauma Resuscitation OverviewOverview

• Report received from EMS; trauma page Report received from EMS; trauma page goes outgoes out

• Pt. arrives in EDPt. arrives in ED

• Met by resuscitation team: at least 2 MDs, Met by resuscitation team: at least 2 MDs, 2 RNs, Lab, X-ray, Respiratory Therapist, 2 RNs, Lab, X-ray, Respiratory Therapist, Pharmacist, Scribe, House Supervisor, Pharmacist, Scribe, House Supervisor, Social Services, Security, CT Tech, EMSSocial Services, Security, CT Tech, EMS

• Assessment, stabilization, procedures, tests Assessment, stabilization, procedures, tests (plain films/CT, angio, FAST)(plain films/CT, angio, FAST)

What precludes thorough data What precludes thorough data collection?collection? The Trauma Bay EnvironmentThe Trauma Bay Environment • Recorder: Primary RN or dedicated recorderRecorder: Primary RN or dedicated recorder

• The number of trauma team members in the roomThe number of trauma team members in the room

• Intense team activity: assessment, stabilization, Intense team activity: assessment, stabilization, diagnostics diagnostics

• Charting after the factCharting after the fact

Recording Extremes:Recording Extremes:• Difficult: Pt. arrives from MVC, ejected, Difficult: Pt. arrives from MVC, ejected,

comatose, obvious open femur fx, open comatose, obvious open femur fx, open tib/fib fx, distended abdomen, tib/fib fx, distended abdomen, respiratory distressrespiratory distress

• Easy: Pt. arrives after being bucked off Easy: Pt. arrives after being bucked off horse, c/o sore back, obvious forearm fx, horse, c/o sore back, obvious forearm fx, no neuro deficits, VSS, alert/oriented.no neuro deficits, VSS, alert/oriented.

Getting the Necessary Getting the Necessary InformationInformation

• Know what you needKnow what you need ITR, ACS, NTDB ITR, ACS, NTDB

• Look in depth at ED chart for needed data elementsLook in depth at ED chart for needed data elements

• Take information to your directorTake information to your director

• Meet with ED Director/Manager: be prepared to Meet with ED Director/Manager: be prepared to show ITR requirements, what is lacking on chart (if show ITR requirements, what is lacking on chart (if cues aren’t there, info won’t be collected)cues aren’t there, info won’t be collected)

• Work with core group of ED RNs to revise chart to Work with core group of ED RNs to revise chart to get required data elementsget required data elements

ED staff meetings:ED staff meetings:

• Describe the purpose of the registryDescribe the purpose of the registry

• Describe the needed data elementsDescribe the needed data elements

• Ask staff for ideas of how best to Ask staff for ideas of how best to collect needed data elements (buy-collect needed data elements (buy-in)in)

• Describe how data can/will be used— Describe how data can/will be used— can benefit them for presentations can benefit them for presentations they do in the community/hospitalthey do in the community/hospital

ED staff meetings: ED staff meetings: continuedcontinued

• Describe necessity of accurate data Describe necessity of accurate data collection for PI purposescollection for PI purposes

Examples: Examples:

Physician timeliness— ACS Physician timeliness— ACS requirementrequirement

. (Our solution- team members . (Our solution- team members

names on glass trauma doors)names on glass trauma doors)

3%

97%

Not DocumentedDocumented

Per review of nursing documentation only.

TS Timeliness L1/L2TS Timeliness L1/L2 11stst-2-2ndnd Q 2006 Q 2006 (n =93)(n =93)

97%

3%>15 MinsWithin 15 Mins

Per review of nursing documentation only. 3 cases > 15 mins.

TS Timeliness L1/L2TS Timeliness L1/L2 11stst-2-2ndnd Q 2006 Q 2006 (n = 90)(n = 90)

PI examples for ED staff meeting PI examples for ED staff meeting cont.cont.

Triss: Need ISS, RTS (systolic BP, Triss: Need ISS, RTS (systolic BP, RR, RR, GCS), Age, GCS), Age, Blunt/PenetratingBlunt/Penetrating

Appropriateness of Activation: Appropriateness of Activation: without without documentation of documentation of mechanism, mechanism, injuries, unable to injuries, unable to determinedetermine

Appropriateness of Activations Appropriateness of Activations

ALLALL

11stst-2-2ndnd Q 2006 Q 20062% 20%

78%

Appropriate Over ActivatedUnder Activated Not Activated

(n=465)

ACS EXPECTED RATEACS EXPECTED RATE

Under triage Under triage 5-10%5-10% Over triage Over triage 30-50%30-50%

Appropriateness of Appropriateness of

Activations Activations L1L1

11stst-2-2ndnd Q 2006 Q 20069%

91%

Appropriate Over ActivatedUnder Activated Not Activated

(n=23)

Appropriateness of Activations Appropriateness of Activations

L2L2

11stst-2-2ndnd Q 2006 Q 20063%

97%

Appropriate Over ActivatedUnder Activated Not Activated

(n=75)

Appropriateness of Activations Appropriateness of Activations

L3L3

11stst-2-2ndnd Q 2006 Q 2006

25%

73%2%

Appropriate Over ActivatedUnder Activated Not Activated

(n=367)

Data abstraction/entryData abstraction/entry

• Don’t guess-if the information isn’t documented, Don’t guess-if the information isn’t documented, mark as unknownmark as unknown

• Check your abstraction form for missing data Check your abstraction form for missing data elements and do your data entry before you elements and do your data entry before you return the chart to medical recordsreturn the chart to medical records

• Remember—garbage in, garbage out. Check your Remember—garbage in, garbage out. Check your data against other reports data against other reports

• Continue to update nurses on what’s missing Continue to update nurses on what’s missing from documentationfrom documentation

• Use your data: Report to ED, QI Dept, Physicians, Use your data: Report to ED, QI Dept, Physicians, Administration, OthersAdministration, Others