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

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: Names, Hospital Numbers, Full Postcodes not seen by TARN Location based system, following patient pathway: From scene to Discharge Choice of datasets: Core or Extended

Submission Contains all the data relating to a Patient’s incident: Location Outcome Injuries

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 Example: Hospital: St Elsewhere3 Admission Dates: 01/05/15-02/05/15 Status: All

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 User: Create New Submission: Example: Hospital Holbya NHS Number: 9999999999 Date of Arrival: 10/01/2015 Time of Arrival: 10.00 Check for duplication Unique Submission ID generated Choose Dataset: Core or Extended Enter & Save data Validate data Dispatch

Standard Screens Core dataset Extended dataset

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

Requested: Pre Hospital, ED and Critical Care Generic Questions Requested: Pre Hospital, ED and Critical Care Dates Times Observations (Patient’s observed status on arrival in location)

Requested: Pre Hospital, ED and Critical Care Generic Questions Requested: Pre Hospital, ED and Critical Care Interventions (non surgical procedures given to patient in that location) Attendants (Doctors who treated patient in that location)

Core Dataset: Observations & Interventions 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 Interventions: Airway support Breathing support Blood products in 24hrs Tranexamic Acid Chest drain Spinal protection Fluid Extubation Spinal Protection Removal Embolisation

*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 %

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

**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

Specialist screens BOAST4 Rehabilitation prescriptions

Severe Open fractures of Tibia BOAST 4 Guideline derived from BOA & BAPRAS Severe Open fractures of Tibia TARN specialist screen used to collect data 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

Severe Open Tibial fracture: Gustilo Anderson grade IIIB or IIIC Gustilo Anderson Open fracture Classification Severe Open Tibial fracture: Gustilo Anderson grade IIIB or IIIC

Specialist screen – BOAST 4 BOAST4 screen appears if User answers “Yes” to question on the Opening section: “Does this patient have severe open lower limb fractures”?

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

Rehabilitation Prescription

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

Validating Click here to Dispatch to TARN VALIDATE Missing Mandatory (red) & Preferred fields (green) Mandatory fields must be corrected Click here to Dispatch to TARN

View Diary* Rejected submissions: Reason for rejection noted by TARN in Diary Returned submissions: Additional information requested by TARN in Diary Re-dispatched submissions: User should respond to TARN request in Diary & then Re-dispatch the submission

Awaiting Post Mortem** Where selected: User 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