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

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.

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

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

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

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.

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

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

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

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

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! cases per full-time registrar

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.

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.

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.

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

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

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.

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

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

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.