Data Entry: System structure The Trauma Audit & Research Network (TARN) Log into: https://www.tarn.ac.uk

Electronic Data Collecting & Reporting system (EDCR) overview Process of care & outcome data relating to eligible Trauma patients Secure on-line system (www.tarn.ac.uk): Username & password required Patient confidentiality paramount: Location based system, following patient pathway: From scene to Discharge Choice of datasets: Core or Extended: NOCA advise CORE dataset

Contains all the data relating to a Patient’s incident: Submission Contains all the data relating to a Patient’s incident: Patient details* Incident Location Outcome Injuries * More later

Submission Summary screen Screen showing current STATUS of all your Hospitals’ submissions You can access any submission by clicking on number adjacent to Status You can see all submissions created by any User linked to your Hospital

Only Approved cases are used in Reports Submission Status CREATED DISPATCHED APPROVED REJECTED RETURNED REDISPATCHED DISPATCHED & FLAGGED AWAITING POST MORTEM Incomplete submission, data being entered Complete submission, TARN to check Checked & coded by TARN (part of Hospital dataset) Does not fulfil inclusion criteria Additional information requested by TARN Additional information supplied by User Flagged awaiting matching Transfer or PM PM to be sent to TARN at later date (reminder email sent regularly) Only Approved cases are used in Reports

Searching for submissions Use any fields on SEARCH screen. FIND Results appear at bottom of screen Access relevant submission by clicking on (12 digit) Submission ID Click REPORT to convert to Excel St Elsewhere Admission Dates: 01/08/2015-02/08/2015 Status: Created

Transfer notification system TRANSFER NOTIFICATION: Submission Summary screen Shows Missing transfers into/from your Hospital Hover over Hospital name to show corresponding site coordinator details

The Submission Process: Example New Submission: Hospital: TARN Training Hospital Surname: X NHS Number: 8888888888 Date of Birth: Your own (minus 10 years) Date of Incident: 10/10/2016 Date of Arrival: 10/10/2016 Time of Arrival: 10.30 CREATE NEW SUBMISSION

The Submission Process Duplication check Unique Submission ID generated Choose Dataset: Core or Extended Enter & Save data Validate data Dispatch electronically to TARN

Standard Screens Core dataset Extended dataset

Contains: ALL Fields used in routine analysis and reporting Core Dataset For standard cases Most fields Mandatory Contains: ALL Fields used in routine analysis and reporting Generic screens: Pre Hospital, ED, Critical Care Selected Observations & Interventions

Opening screen Irish Hospitals should enter data in the Opening section as follows: ED number and Hospital Patient Number: Blank NHS Number: 8888888888 Full Date of Birth: No Short date of Birth: Yes * Age: To remain Patient postcode: ZZ99 3WZ * Agreed by NOCA Spring 2017 that Short DOB can now be entered. Will auto-calculate

Opening screen: Best Practice Tariff & Rehabilitation

Incident

Pre Hospital

Pre Hospital Attendants

Pre Hospital Observations GCS (Glasgow Coma Score) can be entered using individual components (E,V,M) or as Total score.

Observations: 1st taken Core Dataset: Generic Observations Pre-hospital, ED and Critical Care locations Observations: 1st taken Respiratory rate Oxygen saturation Blood pressure Capillary refill Pulse rate Glasgow Coma Score* Pupil reactivity** Pupil size Airway status Breathing status

*GCS: Glasgow Coma Score: GCS Measure of a patient’s level of consciousness, taken by assessing: Eye, Verbal and Motor responses. Ranges from 15 (normal functioning) to 3 (no responses). Reduced GCS is an indication of a possible brain injury. Used in the Probability of Survival model Record: Pre Hospital, ED & at 1st hospital (Transfers in) One of most important fields in EDCR: Part of the Data Accreditation %

**Pupil Reactivity Record: Pre Hospital, ED & Critical Care Particularly important: When GCS is <15 or Head injury Included in future Probability of Survival model One of most important fields in EDCR: Part of the Data Accreditation % Note: PEARL (Pupils Equal & Reacting to light) Record as BRISK Non Reacting pupils: Record as Absent

Pre Hospital Interventions

* ED and Critical Care only Core Dataset: Generic Interventions Pre-hospital, ED and Critical Care locations Airway support Breathing support Thoracostomy* Blood products in 24hrs Chest drain Spinal protection Fluid Tranexamic Acid Extubation Spinal Protection Removal Embolisation Analgesia * ED and Critical Care only

Documentation of GCS & Intubation Rapid Sequence Intubation (RSI) sometimes performed Pre Hospital RSI: sedation & paralysis of a pt prior to Intubation GCS3 often documented in ED: THIS SHOULD NOT BE RECORDED Users should record in ED: Airway Status: Intubated Breathing Status: Ventilated GCS: No Resp Rate: No

ED Trauma Team activation: If Yes, you will be prompted to answer who lead the Trauma team (More later on).

ED Observations If patient arrives Intubated + Ventilated. AIRWAY STATUS= INTUBATED BREATHING STATUS= MECHANICALLY VENTILATED GCS = NO RESP RATE = NO

ED Interventions

ED Attendants “Is this the Trauma Team leader” Question appears only if “YES” to Trauma team has been selected. Multiple attendants: ENTER DATA SAVE DATA SAVED IN CRUMB TRAIL SCREEN REFRESHED ENTER 2ND ATTENDANT

Imaging ‘Provisional report date/time’: when initial report was written (any grade). ‘Review date/time’: when reviewed by Consulant Radiologist. 1st CT only

Operative session 1 Choose: BODY AREA: BOAST4 (SOFT TISSUE COVER) OPERATION 1: SKIN GRAFT – UNSPECIFIED Choose BODY AREA: BOAST 4 (SURGICAL STABILISATION) OPERATION 2: PRIMARY CLOSED REDUCTION & INTERNAL FIXATION

Operative session 2 Choose: BODY AREA: THORACIC OPERATION: RIB FRACTURE FIXATION

Critical Care Only complete if Pt goes to Level 2-4 wards (HDU, ICU/CCU)

Ward Observations, Interventions and Attendants not required on WARD To enter multiple Ward stays: Enter first stay Save and Next Click on WARD in menu bar Add new section Enter second stay

At Discharge Complications: Acute kidney injury (AKI) = Renal failure. It is not an injury (as name suggests) but a complication. Pneumonia= is entered as Bronchopneumonia PMC: Document all conditions (even in remission) DON’T ENTER LOS This will auto-calculate on SAVE and includes any readmission days. Will auto-calculate

At Discharge Readmission: Complete if patient is readmitted within 30 days relating to initial incident. Never complete 2 submissions for one patient’s incident.

Specialist screens BOAST4 Chest Wall* *Launched April 2016

Opening screen: Other audits

Severe Open fractures of Tibia: Gustilo Anderson grade 3b or 3c BOAST 4 Guidelines derived from BOA & BAPRAS Severe Open fractures of Tibia: Gustilo Anderson grade 3b or 3c Guideline requires: Early identification of severe open fractures of the tibia Joint care from orthopaedic & plastic surgeons Surgical wound debridement & operative fracture stabilisation within 24 hours Definitive soft-tissue cover within 72 hours of injury

BOAST4 “Did the fracture have surgical stabilisation” & “Was definitive soft tissue cover of injury achieved” Only answer YES if procedures performed at your Hospital.

TARN Update: Chest Wall Trauma Specialist screen One recent advancement in Trauma Care: Rib fracture plating Not standard, nor widely practiced CWTS screen developed to improve further care Data on all patients collected - both operative & non-operative Bespoke fields included on screen Most information in CORE dataset Complete CWTS screen for any patient with rib(s) &/or sternum fracture

Chest Wall Trauma Specialist screen Screen appears if “Yes” selected on Opening screen for the question “Did the patient have a chest wall injury – fractures of the rib(s) and/or sternum?”

Chest Wall injury Screen only appears if patient has Rib or Sternum fracture /s. Only 4 initial questions. Help text guidance is available on each field.

Core Dataset: Outcome Measures screen Note: This screen auto-populates post Injury Coding by TARN Users do not enter data into this screen

Validating and Dispatching Once data entry is complete: 1. Click: Validate and Dispatch 2. List of Validation errors appear: Red errors: missing Mandatory fields or timeline errors. Must be rectified prior to Dispatch. Green errors: missing preferred fields. Submission can be Dispatched using “Click here to Dispatch this submission to TARN with warnings”.

Chest Wall confirmation screen Asking users to confirm that no data is available for certain key data points associated with Chest wall trauma e.g. Thoracostomy. Simply tick to confirm if each data point is unavailable then click: Confirm & Dispatch. If data point has been missed, click: Back and enter missing data. Then re-validate submission.

View Diary* Rejected submissions: Reason noted in Diary Returned submissions: Reason noted in Diary Re-dispatched submissions: Users should respond to TARN request in Diary & then Re-dispatch the submission

Awaiting Post Mortem** Users should send Post Mortem to TARN when available Particularly important: Deaths in ED When sending PMs: Annonymise Include 12 digit submission ID Email to: tarn.supportstaff@nhs.net or support@tarn.ac.uk Post Mortems shredded by TARN after coding

Extended Dataset Complex cases Multiple ICU visits Transfers in: bypass ED Or ADDITIONAL data points e.g. Haematology, Blood Gases, Pelvic binder All Observations, Interventions & Investigations shown Core fields remain Mandatory Extended dataset only fields: Not routinely analysed

Questions?