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

2. Electronic Data Collecting & Reporting system (EDCR) overview
Process of care & outcome data relating to eligible Trauma patients
Secure on-line system (
Username & password required
Patient confidentiality paramount:
Location based system, following patient pathway: From scene to Discharge
Choice of datasets: Core or Extended: NOCA advise CORE dataset

3. Contains all the data relating to a Patient’s incident:
Submission
Contains all the data relating to a Patient’s incident:
Patient details*
Incident
Location
Outcome
Injuries
* More later

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. 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 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
St Elsewhere
Admission Dates: 01/08/ /08/2015
Status: Created

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: Example
New Submission:
Hospital: TARN Training Hospital
Surname: X
NHS Number:
Date of Birth: Your own (minus 10 years)
Date of Incident: 10/10/2016
Date of Arrival: 10/10/2016
Time of Arrival:
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. Standard Screens
Core dataset
Extended dataset

11. Contains: ALL Fields used in routine analysis and reporting
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

12. Opening screen
Irish Hospitals should enter data in the Opening section as follows:
ED number and Hospital Patient Number: Blank
NHS Number:
Full Date of Birth: No
Short date of Birth: Yes *
Age: To remain
Patient postcode: ZZ99 3WZ
* Agreed by NOCA Spring 2017 that Short DOB can now be entered.
Will auto-calculate

13. Opening screen: Best Practice Tariff & Rehabilitation

14. Incident

15. Pre Hospital

16. Pre Hospital Attendants

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

18. Observations: 1st taken
Core Dataset: Generic Observations 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

19. *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 %

20. **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

21. Pre Hospital Interventions

22. * ED and Critical Care only
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
* ED and Critical Care only

23. 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

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

25. ED Observations If patient arrives Intubated + Ventilated.
AIRWAY STATUS= INTUBATED
BREATHING STATUS= MECHANICALLY VENTILATED
GCS = NO
RESP RATE = NO

26. ED Interventions

27. ED Attendants
“Is this the Trauma Team leader” Question appears only if “YES” to Trauma team has been selected.
Multiple attendants:
ENTER DATA
SAVE
DATA SAVED IN CRUMB TRAIL
SCREEN REFRESHED
ENTER 2ND ATTENDANT

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

29. Operative session 1 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

30. Operative session 2 Choose: BODY AREA: THORACIC
OPERATION: RIB FRACTURE FIXATION

31. Critical Care
Only complete if Pt goes to Level wards (HDU, ICU/CCU)

32. 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

33. 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.
Will auto-calculate

34. At Discharge
Readmission: Complete if patient is readmitted within 30 days relating to initial incident.
Never complete 2 submissions for one patient’s incident.

35. Specialist screens BOAST4 Chest Wall*
*Launched April 2016

36. Opening screen: Other audits

37. Severe Open fractures of Tibia: Gustilo Anderson grade 3b or 3c
BOAST 4
Guidelines derived from BOA & BAPRAS
Severe Open fractures of Tibia: Gustilo Anderson grade 3b or 3c
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

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

39. TARN Update: Chest Wall Trauma Specialist screen
One recent advancement in Trauma Care: Rib fracture plating
Not standard, nor widely practiced
CWTS screen developed to improve further care
Data on all patients collected - both operative & non-operative
Bespoke fields included on screen
Most information in CORE dataset
Complete CWTS screen for any patient with rib(s) &/or sternum fracture

40. Chest Wall Trauma Specialist screen
Screen appears if “Yes” selected on Opening screen for the question
“Did the patient have a chest wall injury – fractures of the rib(s) and/or sternum?”

41. Chest Wall injury
Screen only appears if patient has Rib or Sternum fracture /s.
Only 4 initial questions.
Help text guidance is available on each field.

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

43. 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”.

44. 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.

45. 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

46. 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
to: or
Post Mortems shredded by TARN after coding

47. 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

48. Questions?