Transcript The Queensland Trauma Registry HIMAA National Conference 2010 Health Information: The Golden Thread in Health Reform Wednesday 27 October 2010 Harbourside Events Centre, Sydney Jasmin.

The Queensland Trauma Registry
HIMAA National Conference 2010
Health Information: The Golden Thread in Health Reform
Wednesday 27 October 2010
Harbourside Events Centre, Sydney
Jasmin Carroll and Chantal Spanagel
Health Information Managers
Queensland Trauma Registry
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
The Queensland Trauma Registry
Funding Partners
The Queensland Trauma Registry (QTR) is a programme of the
Centre of National Research on Disability and Rehabilitation (CONROD)
and based at CONROD within the UQ School of Medicine at Herston
The QTR is supported by funding from
the Motor Accident Insurance Commission, Queensland Health,
CONROD and The University of Queensland
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
The QTR Core Team
Chantal Spanagel, Jacelle Lang, Natalie Dallow, Jasmin Carroll,
Kathy Harvey, Associate Professor Cliff Pollard (Director RBWH Trauma Service)
• Director and Manager: clinical expertise / QTR operations
• Data experts: data collection / quality / feedback
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training hospital staff in injury coding (AIS) / manuals / workshops
ensuring data quality – database / site audits / cleaning / verification
ensuring data set relevance – clinicians / Australia / worldwide
maintaining the database across Queensland
facilitating the timely collection of QTR data statewide
statistical analysis and reporting of the data – QA / research / annual
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Background to the QTR Data Collection
1998 to 2010
The QTR has collected and reported injury data since 1998 when it was
piloted at PAH and RBWH
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
The QTR Statewide Team
Across 20 Participating Queensland Health Hospitals
On-site Nurses and HIMs at 20 hospitals are accredited in Abbreviated
Injury Scale (AIS) injury coding and employed by the QTR to:
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identify trauma cases
abstract relevant trauma data from medical records
enter the data to the QTR database
provide local feedback and trauma education, and
establish a Trauma Review Committee and support its Chair
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
QTR Data Collection
The purpose of the QTR is to:
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Improve the in-hospital treatment of injury
Included on the QTR are people admitted for 24 hours or more to a
participating hospital for the treatment of an acute injury, including
transfers from any other hospital and those who die in under 24
hours (if treatment was commenced in hospital)
Not included on the QTR are injured people who are not admitted or
are admitted for less than 24 hours (except deaths), and those who
do not survive to hospital
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
QTR / Hospital Coding
QTR data are not a duplication of hospital coded data, but are coded via
chart audit to the international Abbreviated Injury Scale (AIS)
standard criteria by AIS-accredited QTR injury coding staff
QTR data undergoes extensive data quality assurance and verification
processes, and enhances hospital-coded data by including
information not currently available via hospital systems:
• QTR-eligible cases represent the entire pre-hospital through acute
hospital stay
• injury-specific coding items: ISS, TRISS, Revised Trauma Score
• clinical data items: pulse rate, BP, Sp02, resp rate, GCS, temp, CPR,
airway type, ICC, etc
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Identifying Trauma Patients
The QTR strives to capture every eligible case:
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QTR’s EDIS query produces a spreadsheet of potential trauma cases
(hundreds++); admissions of less than 24 hours are excluded
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QTR’s ‘Discharge Diagnosis Report’ is produced; this report checks
principal diagnosis on discharge and is intended to pick up cases
potentially not identified as trauma at presentation
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Examples of cases that are not eligible include: non-acute trauma
admissions; pathological fractures; spontaneous dislocations; injuries occurring
in hospital; treatment is for psychiatric/medical condition or complication of an
injury, or admission is for convalescence or social reasons rather than injury
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In 2009, 30,000+ cases were manually reviewed across the 20
participating hospitals to find 17,000 eligible cases
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(We are grateful to the medical records staff who supply our charts!)
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Data Quality Processes
QTR data collection is performed by QTR staff, ensuring standard
processes are followed and minimising pressure on hospital
resources
Other processes in place to optimise the reliability of QTR data are:
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Education, database validation rules and quality assurance checks
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AIS accreditation and QTR specific training
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Central coding help desk
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Coders’ Quarterly
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Statewide meetings & twice-yearly staff workshops
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Annual site audits
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Data Quality Processes
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Database:
– mandatory fields / flags unexpected data / auto calculation of LOS, ISS, TRISS, RTS
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Data cleaning:
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External Cause (ICD-10-AM)
Place of occurrence (ICD-10-AM)
Activity (ICD-10-AM)
Nature of main injury
Data verification:
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Age
Sex
Blank Refer
Blank Interfacility
Score .9
Admission Date
Discharge Date
LOS
Duplicates
Hypothermia
ICU
- Disposition
- Level Major
- Level Minor
- Dominant Injury Type
- Null Values
- Nature x Body Location
- Sequence Number
- Audit Status
- Age = 0 & 100+
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Trauma Review Committees
Use of QTR Data for Quality Assurance
The trauma review process is particularly important and is designed to
identify areas of educational need, improve patient care and to
review systems performance for those involved in trauma care
Trauma Review Committees at each participating hospital provide a
multidisciplinary forum to review patients who:
• ‘tripped’ a performance indicator
• died in hospital
• had an otherwise notable condition
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
QTR Cases 2002 - 2009
‘Total’ cases = those admitted for at least 24 hr for treatment of acute injury
‘Major’ cases only = ISS >16, plus deaths during admission (regardless of ISS)
(Note: Deaths from fractured NOF are included in ‘Total’ cases, not in ‘Major’ cases)
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Snapshot of 2009
Age & Sex
The injury event ‘picture’ was relatively consistent over the 5 years from
2005 to 2009
• Males consistently represented two-thirds of all injuries
• In 2009 the picture was the same:
Overall %
Average age
Male
64%
38.1 yrs
Female
36%
55.1 yrs
Overall
44.3 yrs
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Snapshot of 2009
External cause
External cause
W11 – Fall from ladder
Y04.09 – Assault by bodily force, unspecified person
W01.2 – Fall on same level from stumbling
W03 – Other fall on same level due to collision with, or
pushing by, another person
W25 – Contact with sharp glass
W10.9 – Fall on & from other & unspecified stairs &
steps
W18.8 – Other specified fall on same level
W01.0 – Fall on same level from slipping
W01.1 – Fall on same level from tripping
W19 – Unspecified fall
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% of patients
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Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Snapshot of 2009
Place of injury occurrence
Place of occurrence
Y92.03 - Home; bathroom
Y92.30 - Sports & athletics area; sporting grounds
(outdoor)
Y92.05 - Home; bedroom
Y92.7 - Farm
Y92.07 - Home; indoor living areas, not elsewhere
classified
Y92.14 - Residential institution; aged care facilities
Y92.01 - Home; outdoor areas
Y92.09 - Other & unspecified place in home
Y92.40 - Street &highway; roadway
Y92.9 - Unspecified place of occurrence
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% of patients
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Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Snapshot of 2009
Activity when injured
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
QTR Data Reporting
2009 reporting is under way and
is expected to be complete by
end of year
2008 QTR annual statewide
(aggregate) reports are on the
CONROD web site
• www.uq.edu.au/conrod
In addition to the statewide
reports, hospital-specific
reports are published
for each participating site
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Research Use of QTR Data
QTR data used in research on access and equity:
Characteristics and outcomes of injury patients in an Aboriginal and
Torres Strait Islander (Injury, Volume 41, Issue 9, September 2010,
Pages 964-969 Fumiko Irie, Cliff Pollard, Nicholas Bellamy)
What are the true costs of major trauma? (Rowell, D., Connelly, L.B.,
Webber, J., Tippett, V., Thiele, D. & Schuetz, M., Journal of Trauma,
Injury, Infection and Critical Care, (in press) accepted 17th June
2010)
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Research Use of QTR Data
Other QTR Research Activities
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Longitudinal Study
Extradural Haematoma Study
Trauma Tracking Study (with NCHIRT)
Obesity and Severe Injury Study
Impact of Complications in Trauma Study
Elderly Road Users Study (with CARRS-Q)
Incidence of Stabbings in Queensland Study
Fractures Paper
Liver Trauma Study
Assault in Young Children Study
Rick Hansen Trauma Registry Collaboration
2006 National Trauma Registry Consortium Report
Cost of Trauma Study
Brain Injury Atlas (Geo mapping) Collaboration
Use of Tertiary Survey Study
Hypopituitary Trauma Study
Provision of ISS / TRISS
Assessing Implementation of Red Blanket Protocol
Outcomes of ICU Head Injured Patients
Assessing Implementation of Massive Blood Transfusion Protocol
HECTIC Study
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Current Activities…
Working with QH and Coroner’s: Data Dictionary / Data Linkages / 2009
‘Statewide’ Trauma
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Queensland Trauma Review
Launched in 2010
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January - QTR Overview
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February - Driveway Run Overs
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March - Snake Bites
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April - Easter RTCs
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May - Assaults in Pubs & Clubs
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June - Cyclists
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July - Brain Injury
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August - RTCs 2006-2009
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September - Horse-related injuries
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine
Thank you
Queensland Trauma Registry, Centre of National Research on Disability and Rehabilitation (CONROD), UQ School of Medicine