Welcome The Trauma Audit & Research Network (TARN) Data Collection session

Today Background Inclusion criteria Identifying cases Quality Assurance: Data Accreditation and Completeness Data Entry Injury scoring & calculating the ISS (Injury Severity Score) Ps14 (Probability of Survival) & Hospital Survival rate (Ws)

TARN Largest European Trauma registry Over 500,0000 injured patients with more than 46,000 injured children Review and monitor processes of care & outcomes Report to trusts & commissioners Inform changes in practice: Improve Trauma Care

TARN Team Administrator/PA: Gemma Reed Coding team: Laura Blakeley Naomi Brook Paul Gembarski Phil Hammond (Supervisor) Corinne Tilley Victoria Zagrodnik Training & Audit Manager: Laura White Financial Accountant: Jean Hodkinson Projects Manager: Victoria Phillipson Registry Manager: Tom Jenks Systems Analysts: Marisol Fragoso Sophie Jones Tom Lawrence Mike Young Medical Statistician: Omar Bouamra Executive Director: Maralyn Woodford Operations Director & Deputy to the Executive Director: Antoinette Edwards

TARN Academic: University’s of Manchester, Sheffield and Leicester Non Profit making 100% membership in England and Wales Members in Southern Ireland, Denmark and Switzerland Clinically led BOARD and Executive Committees Research and Audit Committees

TARN Research Committee Director: Professor Fiona Lecky, Clinical Professor & Honorary Consultant in Emergency Medicine (EM) at ScHARR and Salford Royal NHS Foundation Trust 11 members including: Executive Director, Medical Statistician, Registry Manager, Data Analysts, Clinical Research Advisor, Research Fellows, Pre-hospital research advisor. Meet Monthly to review: Ongoing Research projects New Research proposals Meetings & teleconferences with researchers

Have you got a Research idea? Complete Request form or email Support@tarn.ac.uk

TARN Audit Committee Director: Dr Dhushy Kumar, Consultant in Critical Care, Pre-hospital Care and Anaesthesia at University Hospital Coventry. 15 members - National representation: Clinicians, TNCs, Data Coordinators, Rehabilitation, TARN Executive Director, TARN Registry & Training Managers Meet 6 times per year to discuss audit changes Have you got an audit request? Email Support@tarn.ac.uk

The beginning 1988: Report by RCS: The Management of patients with Major Injuries “Serious deficiencies in the management of severely injured patients” Enhancing pre-hospital care, ensuring appropriate medical intervention Rapid transfer to the best local facility Assessing the use of helicopters Adopting ATLS principles Integrating trauma services within and between hospitals Investing in rehabilitation services System of Auditing & Research TARN Established in 1989: Based Salford Royal Hospital

Major Trauma reports 2000: Joint report by RCS and BOA: Better Care for the Severely Injured “Standards & outcome measures developed, against which institutions can audit the outcome of treatment” 2007: NECPOD: Trauma: Who cares? “Given the importance of evaluation of processes and outcomes in the trauma patient, all units providing treatment for severely injured patients should contribute to the Trauma Audit & Research Network”

Major Trauma Network development Public Accounts Committees March 2010 Chief Executive of NHS on public record as ...... Committing to development of Major Trauma Networks across England by end of 2011/12 Mandating TARN membership Most Major Trauma Networks “live” April 2012

17 Major Trauma Network and Major Trauma Centres (MTCs) Greater Manchester Network Salford Royal Hospital Wythenshawe Hospital Manchester Royal Infirmary Royal Manchester Children’s Hospital Merseyside & Cheshire Network University Hospital of Aintree Walton Centre for Neurology Royal Liverpool University Hospital Alder Hey Children’s Hospital South Cumbria & Lancashire Network Royal Preston Hospital Northern James Cook University Hospital Royal Victoria Infirmary, Newcastle North East Yorkshire & Humber Leeds General Hospital Sheffield Teaching Hospital NHS Trust Sheffield Children’s Hospital Hull Royal Infirmary S. Cumbria & Lancashire Yorkshire & the Humber Greater Manchester East Midlands Network Nottingham University Hospital Merseyside & Cheshire East Midlands East of England Network Addenbrooke’s Hospital West Midlands Network North West Midlands Network Royal Stoke University Hospital Centre of England Network University Hospital of Coventry & Warwickshire Birmingham and the Black Country Network Queen Elizabeth Hospital, Birmingham Birmingham Children’s Hospital N.W. Midlands Centre of England East of England Birmingham & Black Country NE London Network Royal London Hospital NW London Network St. Mary’s Hospital SE London Network Kings College Hospital SW London Network St. George’s Hospital Thames Valley London Severn Sussex Peninsula Wessex Severn Network Southmead Hospital Bristol Royal Children’s Hospital Peninsula Network Derriford Hospital Thames Valley Network John Radcliffe Hospital Wessex Network Southampton General Hospital Sussex Network Royal Sussex County Hospital

On scene patient triage: Positive What has changed On scene patient triage: Positive Direct to MTC (< 45 mins travel) TARN Indirect Transfer (>45 mins, time critical intervention) MAJOR TRAUMA CENTRE Consultant led trauma team Immediate operating theatre All specialties: neurosciences Immediate CT scan Interventional radiology Specialist critical care Trauma Unit Trauma team Immediate CT Resuscitate, Assess & ? Transfer

Major Trauma Centre: Best Practice Tariff Year 3 (14-15) Additional payment made to Major Trauma Centres only Based on Injury Severity Moderate Trauma (ISS>8): £1,500 Major Trauma (ISS>15): £3,000 Payment conditional on Best Practice criteria being met

Major Trauma Centre: Best Practice Tariff Year 3 (14-15) Level 1 (Moderate Trauma): Injury Severity Score >8 TARN data is completed and dispatched within 25 days of discharge/death. Rehabilitation prescription completed for each patient & recorded on TARN. Tranexamic acid (TXA) administered within 3 hours of injury for any patient receiving blood: Exclusions: Isolated Serious (Severity 3+) Head injuries Non-emergency transfers: Patient must be admitted to MTC within 2 calendar days of referral from Trauma Unit

Major Trauma Centre: Best Practice Tariff Year 3 (14-15) Level 2: (Major Trauma) Injury Severity Score >15 Level 1 criteria and following additional criteria met: Direct admissions or emergency (<12 hour) transfers: Patient must be seen by Consultant within 5 minutes of arrival Direct admissions: Head CT performed within 1 hour of arrival for patients with SeeAIS1+ Head injury & GCS <13 in ED (or intubated pre-hospital) Exclusions: patients requiring emergency surgery or interventional radiology within 1 hour of admission Additional BPT fields added to TARN database

Web-based Trauma Data Collection Electronic data collection & reporting system Secure on-line system through patient pathway Data Collection AND Reporting

Separate Reporting Training session TARN Reports Clinical Reports: Published March, July, November. Email notification to all users Performance Comparisons: Updated March, July, November. Available to all. Online Reports: Self produced reports Ad Hoc analysis: Available any time Separate Reporting Training session

Questions?