Quality Indicators for Trauma Outcome and Performance

Transcription

1 2010 The Trauma Audit & Research Network Quality Idicators for Trauma Outcome ad Performace The TRAUMA Audit & Research NETWORK DEVELOPING EFFECTIVE CARE FOR INJURED PATIENTS THROUGH PROCESS AND OUTCOME ANALYSIS AND DISSEMINATION

2 CONTENTS Itroductio 3 Quality Idicators Head Ijuries 4 Cardiothoracic Ijuries 6 Abdomial & Spial Ijuries 9 Limb ad Pelvic Ijuries 11 Comparative Outcome Aalysis 13 Quality Assurace Procedures 14

3 Itroductio The purpose of this documet This documet details the quality idicators that aim to moitor the stadards of trauma care ad outcome performace at participatig hospitals of the Trauma Audit & Research Network. The Idicators are take from the Royal College of Surgeos ad British Orthopaedic Associatio Better Care for the Severely Ijured 2000, BOAST4 Stadards of Care ad NICE Head Ijury Guidelies alog with a umber of idepedet quality measures that are also moitored by the Trauma Network. They are used i the Quarterly reports that are produced every 3 moths ad also the Stadards of Care results published uder the Performace Compariso sectio of the TARN website: The Trauma Audit & Research Network The Trauma Audit & Research Network (TARN) aim to facilitate the developmet of trauma services thereby reducig the associated burde of death ad disability. TARN curretly have the participatio of over 60 of all NHS Trusts across Eglad a Wales. TARN s mai purposes are to: ecourage best practice withi the emergecy care settig by moitorig stadards recommeded by the Royal College of Surgeos & British Orthopaedic Associatio provide participatig trusts with a assessmet of the procedures ad treatmet admiistered to the ijured patiet produce aalysis for cliical ad epidemiological data ad thereby provide a statistical base to support cliical audit support multidiscipliary cliical audit by aalysis of case maagemet provide cofidetial comparative statistics to cliicias ad cliical goverace upo patiet outcome performace Maitai a successful ad respected Research Portfolio 3

4 Quality Idicators: Head Ijuries RCS/BOA Stadard: There should be pre-hospital or i hospital spie protectio Measuremet: Spial protectio give pre-hospital or i hospital Patiets presetig with major head ijuries AIS3+ at 1st receivig hospital or Trasfers i. Spie Protectio Pre Hospital Not recorded Spie Protectio I Hospital Not recorded Hospital process compared agaist atioal database Direct admissios: Number of patiets pre hospital ad i hospital who received: 1) Spie Protectio 2) No Spie Protectio recorded TARN Database Trasfers i: Number of patiets who received: 1) Spie Protectio 2) No Spie Protectio recorded Spial protectio: Trasfers i TARN Database RCS/BOA Stadard: All receivig hospitals must have direct access to 24 hour CT scaig with o-call radiologists Time to CT Sca Measuremet: Time to CT Sca Isolated Head Ijuries AIS 3+ Head Ijuries AIS 3+ with other ijuries Patiets presetig with major head ijuries AIS3+ at 1st receivig hospital. Patiets with isolated head ijury ad CT Sca No/Not Recorded CT Sca No/Not Recorded those with multiple ijuries (icludig head ijury) are separated for this aalysis. TARN Database Media Time to CT Sca Hospital process compared agaist atioal database - Number of patiets who received: TARN Database 1) CT Sca 2) No CT Sca/Not recorded - Media time to CT Sca 4

5 Quality Idicators: Head Ijuries RCS/BOA Stadard: Patiets with severe head ijuries or focal sigs should be trasferred to the care of eurosurgery uits regardless of whether they eed surgical itervetio Trasfer of patiets with head ijuries Measuremet: Trasfer of patiets with head ijuries Isolated Head Ijuries AIS 3+ Head Ijuries AIS 3+ with other ijuries Patiets presetig with major head ijuries AIS3+ at 1st receivig hospital. Patiets with isolated head ijury ad Direct Admissios Trasfers i Trasfers out Direct Admissios Trasfers i Trasfers out those with multiple ijuries (icludig head ijury) are separated for this aalysis. TARN Database Hospital process compared agaist atioal database Number of patiets with serious head ijuries who have bee trasferred i or out. TARN Quality Assurace Measure: Glasgow Coma Scale Measuremet: Glasgow Coma Scale recordig for patiets with serious head ijury Head ijury AIS3+: Direct admissios Patiets presetig with major head ijuries AIS3+ at 1st receivig hospital or Trasfers i. Patiets with isolated head ijury ad those with multiple ijuries (icludig head ijury) are separated for this aalysis. TARN Database GCS=15 GCS<15 Not Recorded Head ijury AIS3+: Trasfers i Hospital process compared agaist atioal database Number of patiets with serious head ijuries with a recorded Glasgow Coma Scale i the Emergecy Departmet GCS=15 GCS<15 Not Recorded TARN Database 5

6 Quality Idicators: Cardiothoracic Ijuries RCS/BOA Stadard: Examiatio of the chest is a fudametal compoet of the cardiopulmoary assessmet of the seriously ijured ad should be supervised by the most experieced cliicia Measuremet: Most Seior Doctor treatig thoracic ijuries i the Emergecy Departmet Most Seior Doctor treatig thoracic ijuries i the Emergecy Departmet Patiets presetig at 1st receivig hospital with thoracic ijuries AIS 3+ isolated ad i combiatio with ijuries affectig other body regios TARN Database Cosultat STR 1 FY/Other 2 recorded Grade ot Hospital process compared agaist atioal database Number of patiets see by: 1) Cosultat 2) STR 3) FY/Other 4) Grade ot recorded STR 1 = icludes Seior Registrar, Staff Grade, Associate Specialist ad Research Fellow FY/Other 2 = icludes SHO, House Officer, Emergecy Nurse Practitioer ad Cliical Assistat RCS/BOA Stadard: Moitorig must iclude pulse oximetry ad serial blood gas aalysis to detect hypovetilatio. A 12 lead ECG is essetial Measuremet: Pulse Oximetry Patiets presetig with thoracic ijuries AIS 3+ isolated ad i combiatio with ijuries affectig other body regios Pulse Oximetry Recorded Yes Not Recorded Hospital process compared agaist atioal database Number of patiets where 1) Pulse Oximetry recorded i the Emergecy Departmet 2) Pulse Oximetry has ot bee recorded i the Emergecy Departmet TARN Database 6

7 Quality Idicators: Cardiothoracic Ijuries RCS/BOA Stadard : Surgical airway, chest tube compressio ad pericardiocetesis skills must be available i every trauma team Measuremet: Chest Drai i the Emergecy Departmet for patiets with Haemo/Peumothorax Patiets with Haemo/Peumothorax at 1st receivig hospital isolated or i combiatio with ijuries i other body regios Chest Drai i the Emergecy Departmet for patiets with Haemo/ Peumothorax Yes Not Recorded Hospital process compared agaist atioal database Number of patiets where 1) Chest Drai received 2) Not Recorded TARN Database TARN Quality Assurace Measure: Time to Chest X-Ray Measuremet: Time to Chest X-Ray for patiets with isolated ad o isolated thoracic ijuries AIS 3+ ISOLATED THORACIC INJURIES NON ISOLATED THORACIC INJURIES Patiets presetig with thoracic ijuries AIS2+ isolated or i combiatio with ijuries i other body regios at 1st receivig hospital X-Ray performed Yes No/Not Recorded X-Ray performed Yes No/Not Recorded TARN Database Hospital process compared agaist atioal database - Number of patiets where 1) X-Ray performed 2) Not Recorded Number of X-Rays performed with details of time preset MEDIAN TIME TO X-RAY - Media time to X-Ray TARN Database 7

8 Quality Idicators: Abdomial ad Spial Ijuries RCS/BOA Stadard: Abdomial Ijuries I a hospital receivig severe trauma, the iput of a geeral surgeo ito the resuscitative team is essetial Measuremet: Presece ad Grade of Geeral Surgeo withi the Resuscitative Team for Childre ad Adults. CHILD Cosultat STR FY/Other 2 recorded Grade ot Patiets presetig with abdomial ijuries AIS 3+ at 1st receivig hospital TARN Database Hospital process compared agaist atioal database 1) Presece of Geeral Surgeo withi the Resuscitative Team for Childre 2) Presece of Geeral Surgeo with the Resuscitative Team for Adults. 3) Number of patiets treated by Geeral Surgeos categorised by grade: i) Cosultat ii) STR iii) FY/Other Iv) Not recorded TARN Database ADULT Cosultat STR FY/Other 2 recorded Grade ot STR 1 = icludes Seior Registrar, Staff Grade, Associate Specialist ad Research Fellow FY/Other 2 = icludes SHO, House Officer, ad Cliical Assistat, ENP & Other (GP) RCS/BOA Stadard: Ustable Spial Ijuries Immediate referral must be made to the appropriate spial ijury service if there is evidece of partial or complete spial cord or cauda equia lesio ISOLATED CORD INJURY Measuremet: Trasfer of patiets with spial cord ijury Trasferred i Trasferred out Not trasferred Deaths at 1st Hospital Total Patiets presetig with isolated cord ijury ad cord ijury with other ijuries AIS 2+ at 1st receivig hospital TARN Database Hospital process compared agaist atioal database Number of: NON ISOLATED CORD INJURY 1) Patiets trasferred i 2) Patiets trasferred out 3) Patiets ot trasferred Trasferred i Trasferred out Not trasferred Deaths at 1st Hospital Total 4) Deaths at 1 st hospital TARN Database 8

9 Quality Idicators: Abdomial & Spial Ijuries RCS/BOA Stadard : Abdomial Ijuries A immediate respose from a seior geeral surgeo of sufficiet experiece to perform life-savig emergecy laparotomy is essetial. Where the ifrequecy of emergecy calls does ot allow the o-call geeral surgeo to be free from all other duties, practices must be agreed to adequately ivestigate the at risk abdome Measuremet 1: Grade of Operatig Surgeo Grade of Operatig Surgeo Patiets at 1st receivig hospital presetig with AIS 3+ abdomial ijuries ad require operatio Cosultat STR FY/Other 2 recorded Grade ot Hospital process compared agaist atioal database Number of patiets treated by Geeral Surgeos categorised by grade: 1) Cosultat 2) STR 3) FY/Other 4) Grade ot recorded TARN Database STR 1 = icludes Seior Registrar, Staff Grade, Associate Specialist ad Research Fellow FYOther 2 = icludes SHO, House Officer, ad Cliical Assistat, ENP & Other (GP) Grade of Aaesthetist Measuremet 2: Grade of Aaesthetist Cosultat STR FY/Other 2 recorded Grade ot Patiets at 1st receivig hospital presetig with AIS 3+ abdomial ijuries ad require operatio TARN Database Hospital outcome compared agaist atioal database Number of patiets treated by Aaesthetists categorised by grade: 1) Cosultat 2) STR 3) FY/Other 4) Grade ot recorded STR 1 = icludes Seior Registrar, Staff Grade, Associate Specialist ad Research Fellow FYOther 2 = icludes SHO, House Officer, ad Cliical Assistat, ENP & Other (GP) 9

10 Quality Idicators: Abdomial & Spial Ijuries RCS/BOA Stadard: Abdomial Ijuries Where visceral ijury requires operative maagemet, the start of the operatio must be possible withi 60 miutes of admissio i all cases. Measuremet: Time to Theatre for abdomial operatio for visceral ijury Time to Theatre for Abdomial Operatio Abdomial Operatio Other Operatio No Operatio Patiets at 1st receivig hospital with visceral abdomial ijuries receivig abdomial operatio TARN Database Hospital process compared agaist atioal database - Number of patiets who received: 1) Abdomial Operatio 2) Other Operatio 3) No Operatio TARN Database Media Time to Theatre (hrs) (Where time recorded) = - Media Time to abdomial operatio for patiets with abdomial ijuries 10

11 Quality Idicators: Orthopaedic Ijuries BOA: Boast 4 Stadard: All patiets (adults ad childre) with high eergy ope tibia &/or fibular fractures. The woud, soft tissue ad boe excisio (debridemet) should be performed by seior surgeos withi 24 hours of ijury. Measuremet 1 : Time to theatre Time to Theatre for ope lower limb ijuries Patiets with ope tibia &/or fibular ijuries at 1st receivig hospital Operatio No Operatio recorded Hospital process compared agaist atioal database - Number of patiets where: 1) Operatio performed 2) No operatio/ot recorded - Media Time to theatre for patiets with ope limb ijuries TARN Database TARN Database Media Time Measuremet 2: Grade of Surgeo ad Aaesthetist Grade of Operatig Surgeo Patiets with ope tibia &/or fibular ijuries at 1st receivig hospital SURGEON Cosultat STR FY/Other 2 recorded Grade ot Hospital process compared agaist atioal database - Number of patiets operated o by: 1) Cosultat 2) STR 3) FY/Other 4) Grade ot recorded TARN Database GRADE OF ANAESTHETIST Cosultat STR FY/Other 2 recorded Grade ot TARN Database STR 1 = icludes Seior Registrar, Staff Grade, Associate Specialist ad Research Fellow FY/Other 2 = icludes SHO, House Officer, Emergecy Nurse Practitioer ad Cliical

12 Quality Idicators: Orthopaedic Ijuries TARN Quality Assurace Measure: Grade of relevat specialities i the Emergecy Measuremet: Grade of Emergecy speciality ad Orthopaedic speciality attedig patiets with Ope limb ijuries Cosultat STR 1 FY/Other 2 speciality ot Grade ad/or recorded Patiets presetig with Ope limb ijuries (excludig trasfers i). Hospital process compared agaist atioal database Number of patiets atteded to by Emergecy or Orthopaedic specialities categorised by grade: 1) Cosultat 2) STR 3) FY/Other 4) Grade ot recorded TARN Database STR 1 = icludes Seior Registrar, Staff Grade, Associate Specialist ad Research Fellow FY/Other 2 = icludes SHO, House Officer, Emergecy Nurse Practitioer ad Cliical Assistat RCS/BOA Stadard : Pelvic ad Acetabular fractures The immediate applicatio of a Pelvic exteral fixator is idicated for the combiatio of haemodyamic ad mechaical istability relatig to Pelvic fracture/dislocatio. Measuremet: Mortality rates ad Pelvic fixatio. : Patiets presetig with AIS4+ Pelvic or Acetabular fractures at first receivig hospital. - All Operatios show for AIS4+ pelvic fractures. Media Age Mortality Media Legth of stay Show for Natioal Database 12

13 Quality Idicators: Orthopaedic Ijuries RCS/BOA Stadard Pelvic ad Acetabular fractures: Imagig is required to determie the role of surgery ad the eed to trasfer. A AP Pelvis radiograph ad CT sca are required for pelvic disruptios. Measuremet: Time to CT Sca or AP ad Judet radiograph Patiets presetig with Pelvic or Acetabular fractures AIS3+ CT Sca/AP Judet radiograph Not Recorded at 1st receivig hospital. Hospital process compared agaist atioal database - Number of patiets who received: 1) CT Sca/AP Judet 2) No CT Sca/AP Judet recorded - Media time to CT Sca/AP Judet TARN Database Media Time TARN Database 13

14 Quality Assurace Procedures Iteral Quality Assurace Data Validatio The EDCR (Electroic Data Collectio System), has a i-built validatio system that checks for accuracy i date/time sequecig, physiological ad ivestigative measuremets. The EDCR prevets users from electroically dispatchig submissios with icomplete obligatory data fields. Codig Validatio All ijury coders are traied i ijury codig ad their work is routiely checked util deemed fully competet i codig upo a regular basis. All coders have a sample of their codes double checked to esure accuracy ad cosistecy. This validatio ad iteral quality procedure is performed each week. TARN also holds mothly i-house Quality Assurace sessios; all coders are required to re-code a small sample from the TARN database, this esures cosistecy betwee coders. Exteral Quality Assurace Data Accreditatio - Quality TARN moitors percetage of CORE data fields completed by each Trust ad shows this as both Cliical ad Demographic data accreditatio figures. These figures are updated every 3 moths ad show uder the Performace Compariso sectio of the TARN website. Data Completeess - Quatity TARN also moitors umber of expected versus umber of actual cases received from each Trust. The expected umber of cases is gaied from ICD10 codes submitted each year by Trusts to HES (Hospital Episode Statistics). The data completeess figures are show as a series of gree ticks uder the Performace Compariso sectio of the TARN website ad are updated every 3 moths. The ticks rage from 1: <21 of expected cases received to 4: >65 of expected cases received. Data completeess should be cosidered whe comparig the validity of Hospital Survival rates. Data Quality Checks TARN collects data from source to validate poorly performig trusts ad to evaluate trusts with high quality performace. 14

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