Items tagged with ENGLISH

Background: Trauma registries (TRs) play an integral role in the assessment of trauma care quality. TRs are still uncommon in developing countries owing to awareness and cost. We present a case study of development and pilot implementation of “Karachi Trauma Registry” (KITR), using existing medical records at a tertiary-care hospital of Karachi, Pakistan to present results of initial data and describe its process of implementation.

Methods: KITR is a locally developed, customized, electronic trauma registry based on open source software designed by local software developers in Karachi. Data for KITR was collected from November 2010 to January 2011. All patients presenting to the Emergency Department (ED) of the Aga Khan University Hospital (AKUH) with a diagnosis of injury as defined in ICD-9 CM were included. There was no direct contact with patients or health care providers for data collection. Basic demographics, injury details, event detail, injury severity and outcome were recorded. Data was entered in the KITR and reports were generated.

Results: Complete data of 542 patients were entered and analyzed. The mean age of patients was 27 years, and 72.5% were males. About 87% of patients had sustained blunt injury. Falls and motor vehicle crashes were the most common mechanisms of injury. Head and face, followed by the extremities, were the most frequently injured anatomical regions. The mean Injury Severity Score (ISS) was 4.99 and there were 8 deaths. The most common missing variables in the medical records were ethnicity, ED notification prior to transfer, and pre-hospital IV fluids. Average time to review each chart was 14.5 minutes and entry into the electronic registry required 15 minutes.

Conclusion: Using existing medical records, we were able to enter data on most variables including mechanism of injuries, burden of severe injuries and quality indicators such as length of stay in ED, injury to arrival delay, as well as generate injury severity and survival probability but missed information such as ethnicity, ED notification. To make the data collection process more effective, we propose provider based data collection or making a standardized data collection tool a part of medical records.

Introduction

• Trauma service department growth leads to additional personnel which over time necessitates a review of workflows to evaluate redundancies
• Abstraction requirements may vary between centers affecting productivity
• Adopting concurrent abstraction includes challenging the status quo
• Concurrent registry abstraction leads to concurrent performance improvement

Objectives

• Understand the various strategies that promote concurrent registry abstraction
• Recognize the challenges associated with concurrent abstraction
• Identify strategies to reduce redundancies in workflow processes which promotes concurrent abstraction
• How a level 2 trauma center can implement the strategies to become concurrent

Use of A-WPTAS and GCS for patients with MTBI
The A-WPTAS combined with a standardized GCS assessment is an objective measure of post traumatic amnesia (PTA).

Only for patients with current GCS of 13-15 (<24hrs post injury) with impact to the head resulting in confusion, disorientation, anterograde or retrograde amnesia, or brief LOC. Administer both tests at hourly intervals to gauge patient’s capacity for full orientation and ability to retain new information. Also, note the following: poor motivation, depression, pre-morbid intellectual handicap or possible medication, drug or alcohol effects. NB: This is a screening device, so exercise clinical judgement. In cases where doubt exists, more thorough assessment may be necessary.

Admission and Discharge Criteria:

• A patient is considered to be out of PTA when they score 18/18.
• Both the GCS and A-WPTAS should be used in conjunction with clinical judgement.
• Patients scoring 18/18 can be considered for discharge.
• For patients who do not obtain 18/18 re-assess after a further hour.
• Patients with persistent score <18/18 at 4 hours post time of injury should be considered for admission.
• Clinical judgement and consideration of pre-existing conditions should be used where the memory component of A-WPTAS is abnormal but the GCS is normal (15/15).
• Referral to GP on discharge if abnormal PTA was present, provide patient advice sheet.

n/a

n/a

n/a

n/a

A. Trauma Population
The patients that will be reviewed for performance improvement and patient safety (PIPS) and included in the hospital Trauma Registry are consistent with the Los Angeles County Trauma System patient inclusion criteria (Appendix 1), and the National Trauma Data Standard (NTDS). Cedars-Sinai Medical Center (CSMC) submits trauma data to the LA County Trauma and Emergency Medical Information System (TEMIS), California EMS Information System (CEMSIS), American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) and the ACS National Trauma Data Bank (NTDB). Data elements included in the CSMC hospital Trauma Registry include those required for each of these 4 entities.B. Standards of Quality Care
Evaluation and monitoring of trauma care delivery at CSMC is based on national, regional and local standards of trauma care.

C. Credentialing Standards for Practitioners – Initial and Ongoing
All surgical staff will be credentialed per CSMC Medical Staff Bylaws and the Department of Surgery Policy & Procedure before being scheduled for trauma call. The Trauma Medical Director (TMD) will complete an initial and annual review of credentials for the trauma call panel. The TMD has the authority to set the qualifications for the trauma service members including initial and ongoing review. The form “Annual Trauma Panel Credentialing-Ongoing Professional Practice Evaluation (OPPE)” will be used for supporting the process (Appendix 2). This form and supporting documents will be kept on file in the office of the Trauma Program Manager (TPM). The trauma physician liaisons from Neurosurgery, Orthopedic Surgery, and Emergency Medicine will also undergo annual review for participation on the trauma call panel.

D. Operational Support
The TMD and the TPM are empowered by the Board of Directors and the Medical Staff to maintain all aspects of Level I trauma hospital requirements, including all PIPS requirements. This is evidenced by the “Resolution” from both the Board and the Medical Executive Committee that is updated every 3 years. The TMD and TPM are responsible for the oversight of the Trauma PI (systems) and QI (peer review) processes. The Trauma Performance Improvement Coordinator works closely with the TMD, TPM, and all departments to maintain the Trauma PIPS Program. The Trauma Registrars support the PIPS process with a concurrent data process. The concurrent data process is dependent on adequate staffing. In the event of an inability to maintain par trauma registry staffing levels, data backlog will occur. All efforts, (administratively), will be implemented to sustain a concurrent data process to meet all Level I trauma hospital data and PIPS requirements.