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Utilising a regional web-based trauma registry to support trauma quality improvement and injury prevention in the Midland region - a research collaboration.

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Presentation on theme: "Utilising a regional web-based trauma registry to support trauma quality improvement and injury prevention in the Midland region - a research collaboration."— Presentation transcript:

1 Utilising a regional web-based trauma registry to support trauma quality improvement and injury prevention in the Midland region - a research collaboration Bridget Kool, University of Auckland November 2014

2 Trauma care systems Organised and coordinated efforts in a defined geographic area to deliver the full spectrum of care to injured patients: time of injury rehabilitative care Key elements of the Acute phase of trauma care: Prehospital Care Triage Transport Trauma System Coordination Data Collection

3

4 Project Phases 1.A survey of people responsible for the collection of trauma registry data regarding their perceptions of the training and support they receive 2.A survey of clinicians involved in the management of trauma patients regarding the management of trauma patients in their institution and the region 3.A study exploring the feasibility of linking St John prehospital data with trauma registry and ACC data

5 Trauma Registry Data Collection

6 Trauma registries Essential component of any trauma system/service Source of information for injury epidemiology, performance improvement, efficacy of clinical management for trauma patients, evaluating prevention efforts, conducting outcomes research Types of data collected: demographic, injury circumstances, nature of injuries, physiological parameters, processes of care, outcomes Time stamped data Data collection forms an important part of trauma registries Poor data collection results in missing data, false positives, false negatives, inconsistent and incongruent coding, duplicate entries, redundant data and suppositious data

7 Midland Regional Trauma System: trauma registry Captures ~ 5000 people per year 85% single organ injuries Patients are selected prospectively in ED, according to the MRTS inclusion and exclusion criteria Information collected from prehospital and hospital stay Data: demographic, injury circumstances, nature of injuries, physiological parameters, processes of care, outcomes, quality filters

8 Project Overview Aims: To gain a better understanding of the data collection process for the MRTS Methods: Anonymous online survey (March 2014) Participants: Staff responsible for the collection of data used in the MRTS trauma registry Ethics approval: University of Auckland Human Participants Ethics Committee (Protocol number ), and the Waikato District Health Board (RD013071).

9 Results: Participants 5/7 took part - one from each of the 5 hospitals Mean length of time in the role 26 months (range 3-48 months) Spent on average 58% of their time completing TDFs (range 25-80%) Training and support: 5/5/had received training, 2/5 felt the training was inadequate 4/5 had received Abbreviated Injury Scale (AIS) training Most (3/5) felt that they received adequate support and guidance; 2/5 reported no regular reviews, updates or guidance sessions to ensure consistency and accuracy of data collection

10 Results: Completion of Trauma Data forms TDF for minor traumas take 5 to 25 minutes to complete, major trauma TDFs took 20 to 50 minutes 4/5 TDF was easy to work with 2/5 time allocated for data collection was adequate. Reasons for lack of adequate time: lack of leave cover patient notes being unavailable (e.g. mornings) difficulty juggling their roles

11 Results: Trauma Data forms - demographics Ethnicity data sources: patient admission sheets (‘front sheets’), ACC forms, electronic patient records, and from patients 2/5 had received ‘ethnicity data collection’ training Level of comfort collecting ethnicity data (1-very uncomfortable, 10-very comfortable): mean rating 7.6 (range 2- 10) If more than one ethnicity located: ‘the major one’ ‘the most obvious’ ‘Sometimes people circle NZ Maori and Tongan, so I revert to where they were born’ ‘the one the patient most identifies with’ ‘both’

12 Results: Trauma Data forms – clinical information ‘Major trauma’: 4/5 use “trauma call” and also the patients ISS ‘ISS’: 2/5 used ISS ≥15, 1/5 ISS >15 3/5 could calculate ISS (1 had an ISS calculator computer app) ‘ICU days’: inconsistencies when more than one period of stay in ICU (total days recorded, or recorded in ‘issues’ section) ‘iatrogenic pneumothorax’: 2/5 – ‘adverse effects’, 1/5 – ‘complications’, 1/5 – in both places, 1/5 – record one but location NS

13 Data collectors recommendations for improvements to data collection process

14 Key findings: Overall data collection is of a high standard Areas that could benefit from additional training and support have been identified Some form modifications required and clarification in the data dictionary Reassess role scope and funding Quality and completeness of data recorded in medical record and ongoing issue Findings consistent with international literature: Collecting and recording prehospital events (Jones, 1995) Under-reporting of complications (Zehtabchi, 2011) Variability in definitions between centres (Owen, 1999) Inconsistency or invalid records– 25% of NTDB records excluded (Hemmila, 2007)

15 Clinician survey

16 Project Overview Aims: To explore clinician’s perceptions of the quality of trauma care delivered in the five hospitals of the MRTS Methods: Anonymous online survey (Mid 2014) Clinicians invited by to take part Domains of enquiry included: what currently guides clinical practice, clinician’s perceptions of the quality of trauma care and presence or absence of inequities in trauma care in their region. Ethics approval: University of Auckland Human Participants Ethics Committee (Protocol number ), and the Waikato District Health Board (RD013071).

17 Results: trauma care management Overall clinicians felt their hospital and the region managed trauma well (mode 7; 1= very poor, 10=very good) The majority felt comfortable managing major trauma (mode 8; (1- not very comfortable, 10 very comfortable) Perceived barriers: lack of knowledge regarding diagnosis and management: Spinal trauma 29% (agreed or strongly agreed) Chest trauma 24% (agreed or strongly agreed) Abdominal trauma : 20% (agreed or strongly agreed) Head injuries 14% (agreed or strongly agreed) 93% used the internet to aid clinical decision making ; 96% of those used the site ‘UpToDate’ (evidence-based physician-authored clinical decision support resource)

18 Results: quality and equity of care Over half (56%) the clinicians ‘agreed/strongly agreed’ that there was consistency in the quality of trauma care delivered across their hospital Concern was expressed over: lack of consistency in trauma calls, reduced senior management out of hours, and variability within clinicians 93% of clinicians who responded felt that there was consistency in the quality of trauma care received by different ethnic groups across their hospital Organisation treats people unfairly based on: How well they speak English: 19% ‘somewhat often’ How well educated they are: 11% ‘somewhat often’

19 Record Linkage

20 Project Overview Aims: To establish the feasibility of linking data from prehospital emergency service providers to hospital trauma care providers and ACC at the individual level. Methods: St John records of acutely injured adults (≥ 15 year old) transferred to Waikato hospital during a 12 month period (Jan2012 to Feb 2013) were randomly selected. Patient status = 1 (immediate threat to life) or 2 (potential threat to life) 2.These records were probabilistically linked to the MRTS using the following fields: response date, patient name, patient DOB/age 3.Once the records were linked, the person’s ACC claim number and National Health Index (NHI) number were abstracted from the MRTS trauma registry 4.These records were then probabilistically linked to ACC claims data using the NHI and ACC numbers

21 Results Of the 200 patients identified by St John, 43 were registered with the MRTS Of these 41 matched with an ACC record (95% match) Of the 2 records that did not have a positive match – both had differing dates of injury to the MRTS and St John data Additional analyses will look at what factors made a positive match less or more likely

22 Conclusion These small projects are helping us to identify opportunities to improve the reliability of the data to inform quality improvement activities and monitor the effectiveness of injury prevention activities Other initiatives in the pipeline: 5 journal articles under development A study looking at the reliability of ethnicity data in the MRTS trauma registry A trial of an e-form for trauma registry data collection HRC grant application ‘Trauma Track’

23 Acknowledgements University of Auckland: Faculty Research Development Grant Coinvestigators: Grant Christey, Shanthi Ameratunga, Ross Lawrenson, and Nina Scott The survey participants MRTS staff MRTS Hub


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