1. Data Entry: System structure The Trauma Audit & Research Network (TARN) Data Collection session

2. 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):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

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

4. 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

5. 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

6. 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

7. 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

8. The Submission Process New Submission:  Hospital: TARN Training Hospital  Surname: Your own  NHS Number: 9999999999  Date of Birth: Your own (minus 10 years)  Date of Incident: 10/10/2015  Date of Arrival: 10/10/2015  Time of Arrival: 10.30 CREATE NEW SUBMISSION

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

10. 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

11. Opening screen Surname & DOB will auto-populate using data entered into duplicate checking screen. Age will auto-calculate on saving. Pre-entered Will auto-calculate Help Text offers guidance for most fields. Click on field name to access E.g. Patient Postcode

12. Opening screen: Best Practice Tariff/BOAST4 To find GP practice code: 1 FIND GP CODE 2 ENTER FIRST PART OF POSTCODE: E.G. M44 3 HIGHLIGHT CORRECT PRACTICE 4 PRESS: USE THIS CODE

13. Specialist screens BOAST4 Rehabilitation prescription Chest Wall* *Launched April 2016

14. BOAST 4 Guidelines derived from BOA & BAPRAS Severe Open fractures of Tibia: Gustilo Anderson grade 3b or 3c Guideline requires: 1. Early identification of severe open fractures of the tibia 2. Joint care from orthopaedic & plastic surgeons 3. Surgical wound debridement & operative fracture stabilisation within 24 hours 4. Definitive soft-tissue cover within 72 hours of injury

15. Specialist screen – BOAST 4 Appears if “Yes” selected for “Does this patient have severe open tibial fracture?” Then Gustilo grade 3b or 3c selected

16. New Specialist screen – Chest Wall injury Appears if “Yes” selected for “Did the patient have a chest wall injury and/or a sternum fracture?”

17. Rehabilitation Prescription Appears if “Yes” selected for “Rehabilitation Prescription Details or “London Trauma System RP”

18. Incident Multiple responses: Use + button

19. Pre Hospital Pre Populate icon: Auto-populates date/time Major Trauma Triage Tool: Pt MTC criteria assessed at scene. Positive: MTC criteria pt. Negative: Non MTC criteria pt. Ambulance or Helicopter= Yes: PRF question appears Ensure call date/time are recorded.

20. Pre Hospital Attendants Multiple attendants: 1 ENTER DATA 2 SAVE 3 DATA SAVED IN CRUMB TRAIL 4 SCREEN REFRESHED 5 ENTER 2 ND ATTENDANT

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

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

23. *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 1 st hospital (Transfers in)  One of most important fields in EDCR: Part of the Data Accreditation %

24. **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

25. Pre Hospital Interventions

26. 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* * Newly added to CORE dataset

27.  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 Documentation of GCS & Intubation

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

29. ED Observations If patient arrives Intubated + Ventilated. 1 AIRWAY STATUS= INTUBATED 2 BREATHING STATUS= MECHANICALLY VENTILATED 3 GCS = NO 4 RESP RATE = NO

30. ED Interventions

31. ED Attendants “Is this the Trauma Team leader” Question appears only if “YES” to Trauma team has been selected. Multiple attendants: 1 ENTER DATA 2 SAVE 3 DATA SAVED IN CRUMB TRAIL 4 SCREEN REFRESHED 5 ENTER 2 ND ATTENDANT First and Most Senior Doctors from each specialism required

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

33. Operation 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

34. Critical Care Only complete if Pt goes to HDU/ICU (Level 1-4)

35. 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

36. 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.

37. 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”.

38. 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.

39. 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

40. 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.uktarn.supportstaff@nhs.netsupport@tarn.ac.uk Post Mortems shredded by TARN after coding

41. Extended Dataset 1.Complex cases a. Multiple ICU visits b. Transfers in: bypass ED 2. 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

42. Questions?