Registry Basics

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

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Abstract Trauma and other disease registries have been used to improve patient care and outcomes at the system level. Paradoxically, registries have had little role in informing the care of any individual patient while that care is being determined and delivered. The lack of timeliness of useful data is a major barrier to the value of registries in improving individual patient care real-time. What do trauma and emergency care providers require from their trauma registries to inform real-time patient tailored improvements in trauma care? Research is urgently needed to improve the usefulness of disease registries, and to develop innovative processes and applications using patient data to inform patient care real-time, thereby improving patient outcomes.

Each year approximately 5 million people die from injury globally, accounting for 9% of all deaths. Injury causes more deaths than human immunodeficiency virus (HIV), malaria and tuberculosis combined. Road injury alone ranks fifth among the leading causes of death. In Australia, where injury is one of nine National Health Priority Areas, it is the leading cause of death before the age of 45, with more than 10 000 deaths per year. Disproportionately affecting young adults, injury is the major cause of longterm disability and lost productivity.

A primary purpose of aggregating trauma related data across the nation and within a state is to provide data for research purposes and to have evidence to direct and improve treatment which can maximize positive outcome for the trauma population. Good data provides evidence for benchmarking and process improvement activities as well as a base from which to develop standards of care. In order to preserve data integrity, each data element must be collected, as closely as possible, by the same definition and according to the same guidelines by each facility that contributes to a state or national database.

The integrity and value of data entered into a trauma registry database will be directly affected by the training and expertise of the Trauma Registrar who abstracts, enters, and manages the data. The American Trauma Society provides a combined Basic and Advanced Course that should be considered the minimum necessary trauma registry training. Knowledge of medical terminology and human anatomy are also important especially in light of the scheduled implementation of ICD-10-CM in 2013. The focus of this manual is to provide clarity of definition and process guidance as the NTDB®, National Trauma Databank, national elements are entered into facility trauma registries for uploading into the state and national databases. Once the data has been entered in a facility trauma registry, the data will then be uploaded directly or be mapped to the corresponding fields at the state and national level; therefore, monitoring data mapping and understanding software functionality will be a necessary task for the trauma registrar in every trauma department.

The Kentucky Trauma Registry (KTR) was established by state law (KRS 211.490 et seq.; 902 KAR 28:040) to be the statewide repository for trauma data. It is housed administratively in the Kentucky Department for Public Health and managed by the Kentucky Injury Prevention and Research Center (KIPRC), a unit of the University of Kentucky’s College of Public Health. All trauma centers designated by the Commissioner of Public Health in the Kentucky Trauma Care System maintain trauma registries that are compatible with the National Trauma Data Bank (NTDB) standards established in the National Trauma Data Standard Data Dictionary. The trauma centers upload their trauma data electronically at least quarterly to the KTR. Clinical Data Management, Inc. (CDM) is the vendor that manages the downloading and compilation of data from participating trauma centers, including unverified facilities that report to the registry, and supplies the data to the Kentucky Injury Prevention and Research Center.

With support from the National Highway Traffic Safety Administration through the Kentucky Transportation Cabinet, KIPRC analyzes the statewide trauma registry data and provides a detailed profile of the traumatic injuries treated in the state’s trauma facilities.

Objectives

• List the components essential to a trauma registry
• Identify the trauma registry population
• Describe various standard coding systems and scoring methodologies as it applies to the trauma population

Background: In majority of the low- and middle-income countries (LMICs), the societal cost of injuries are alarming. The severity and magnitude of the road traffic injuries (RTI) in India are not estimated accurately due to the lack of availability of data. The data are limited on the aspects such as demographics, cause, severity of injury, processes of care, and the final outcome of injuries. This study aimed to determine the feasibility of setting up a sustainable trauma registry in Odisha, India, and to determine the demographics, mechanism, severity, and outcomes of injury reported to the facilities/hospital.

Materials and Methods: A prospective observational study was conducted at Srirama Chandra Bhanja Medical College and Hospital (SCB-MCH), Cuttack, India. Injured patients who reported/admitted to the emergency department were observed, and data were collected by using a minimum data set (MDS) developed by the World Health Organization (WHO). Data were collected for a period of one month in June 2015. Observations were collected on 20 variables. The completeness of data collection ranged from 60% (19 variables) to 70% (23 variables) out of total 33 variables.

Results: This study uses 145 cases of injury reported in SCB-MCH. Out of the total reported population at the trauma registry, about 21% were females. Nearly 45% of the injury occurred on road/street. RTI accounted for 36.6% of injury. Out of the total admitted cases, 2.8% died in the emergency department, 11% were discharged to home, and 7.6% left against medical advice. Majority of the respondents have reported single injuries (77%). Head injuries were more common and severe among majority of the reported cases (44.1%), followed by neck injury (28.3%) and chest (15.9%).

Conclusions: This study indicates the challenges in obtaining complete data on injury. Data were missing in terms of admission, discharge, and Glasgow Comma Scale (GCS) among the studied population. This study suggests that individual GCS scoring should be done instead of total GCS scoring in each trauma patient. By collection and storage of adequate data, better policy decisions can be implemented, which will minimize and prevent trauma cases and maximize the utilization of the available resources.