Data Quality: Case ascertainment & Accreditation The Trauma Audit & Research Network (TARN)

Case ascertainment % (quantity) Measure of Expected v Submitted number of cases per Hospital Expected no. of cases derived from 2015 & Q1 2016 HES/PEDW source data HES: Hospital Episode Statistics (UK Government database) PEDW: Patient Episode Database Wales Source data: ICD10 codes assigned by Trusts’ Clinical coding teams TARN inclusion criteria applied to source data: expected no. of cases derived>>>>

Inclusion Criteria 1) All Trauma patients who fulfill the following criteria:- 2) Admission > 3 days or Admission to an intensive care area or Transferred out for continuing care (>3 days total) or Transferred in for continuing care (>3 days total) or Died When deciding whether or not to include a patient in TARN. All 3 criteria must be met. Trauma patient LoS And Injuries 3) And whose injuries are TARN eligible

Inclusion Criteria: common inclusions/exclusions Include (in isolation) Exclude (in isolation) Brain injury or skull fracture Skin injuries Unstable facial fracture Stable facial fracture Spinal fracture &/or cord injury Spinal strains Any internal Thoracic injury Isolated Hip fractures 65+ (Neck of Femur fracture or single pubic rami) Any internal Abdominal injury Closed unilateral upper Limb fractures Femur fractures (except 65+ isolated hip #) Closed unilateral lower leg fractures Pelvic fractures (except 65+ isolated hip #)) Any injury to fingers &/or toes Open upper limb fracture Burns treated in burns unit Open lower leg fracture Crush to long bones Traumatic amputation to long bones Hanging, Drowning or Strangulation Blood loss >20% Common inclusions and exclusions – in isolation. Once one injury is included – all injuries should be included on the submission.

Case ascertainment % (quantity) Measure of Expected v Submitted number of cases per Hospital Expected no. of cases (denominator) compared to no. submitted cases per annum (numerator) Case ascertainment % calculated for each hospital & Trust Shown on Website, Clinical Reports & Dashboards Updated every 4 months Quarterly for Dashboards

Case ascertainment % (quantity) Measure of Expected v Submitted number of cases per Hospital Shown by default as 15% range, based on expected variation between source & TARN data Shown as exact figure, once denominator has been validated (more later) Case ascertainment used to validate published results

Case ascertainment RANGE calculation Expected submissions: DENOMINATOR 100 Submissions: NUMERATOR 70 Case ascertainment range 70-82%

Improving Case ascertainment HES v TARN comparison exercise produced each year Updated when latest HES data is received Comparison based on matching NHS numbers in each dataset 3 months’ data (July, October 2015 & Feb 2016) used as a representative sample

Case ascertainment validation exercise Green cases: In both TARN & HES datasets: complete Black cases: In HES dataset only: incomplete Hospitals to review only the missing ‘black’ cases

Improving case ascertainment in 2 ways Feedback list of ineligible cases to TARN Cases removed: Denominator reduced Identify missing groups of patients Include going forward: Numerator increased Case ascertainment then shown as exact (validated) figure at next update HES exercise under Audit tab on TARN website  

Results from previous years REDUCTING DENOMINATOR: Common reasons for removal of cases Rehabilitation only admissions Old injuries Incorrect ICD10 coding Non-traumatic injuries  INCREASING NUMERATOR: Commonly missed patient groups Non isolated 65+ Hip fractures Elderly SDH/SAH admitted to medical wards Spinal fractures LOS of exactly 3 day 

CURRENT ACCREDITATION FIELDS Data Accreditation % Measure of frequency of CORE data field completion CURRENT ACCREDITATION FIELDS Glasgow Coma Score or Intubation/ventilation (Recorded Pre hospital, ED or first GCS – All cases) Incident or 999 Date/time Arrival time Transfer reason, previous/next hospital, request date CT time Operation time, grade, speciality of surgeon, grade of anaesthetist ED doctors: time, grade & speciality Injury detail – proportion of NFS codes *Pre-existing conditions **Pupil reactivity for patients with AIS 3+ (Serious) head injuries (Recorded in any location – including 1st hospital) * Latest Probability of Survival (Ps)17 model ‘Other’ and ‘Not Known’ detrimental to Data Accreditation ** Future Probability of Survival model

Data Accreditation used to validate published results Shown in: Clinical report Dashboards Website

Questions?