Electronic Data Collecting & Reporting system (EDCR) overview

1. Data Entry: System structure The Trauma Audit & ResearchNetwork (TARN) Log into: https://www.tarn.ac.uk

2. Electronic Data Collecting & Reporting system(EDCR) overview • Process of care & outcome data relating to eligible Trauma patients • Secure on-line system (www.tarn.ac.uk): • Username & password required • Patient confidentiality paramount: • Location based system, following patient pathway: From scene to Discharge • Choice of datasets: Core or Extended: NOCA advise CORE dataset

3. Submission Contains all the data relating to a Patient’s incident: • Patient details* • Incident • Location • Outcome • Injuries * More later

4. Submission Summary screen • Screen showing current STATUS of all your Hospitals’ submissions • You can access any submission by clicking on number adjacent to Status • You can see all submissions created by any User linked to your Hospital

5. Submission Status • CREATED • DISPATCHED • APPROVED • REJECTED • RETURNED • REDISPATCHED • DISPATCHED & FLAGGED • AWAITING POST MORTEM • Incomplete submission, data being entered • Complete submission, TARN to check • Checked & coded by TARN (part of Hospital dataset) • Does not fulfil inclusion criteria • Additional information requested by TARN • Additional information supplied by User • Flagged awaiting matching Transfer or PM • PM to be sent to TARN at later date • (reminder email sent regularly) Only Approved cases are used in Reports

6. Searching for submissions • Use any fields on SEARCH screen. FIND • Results appear at bottom of screen • Access relevant submission by clicking on (12 digit) Submission ID • Click REPORT to convert to Excel • St Elsewhere • Admission Dates: 01/08/2015-02/08/2015 • Status: Created

7. Transfer notification system • TRANSFER NOTIFICATION: Submission Summary screen • Shows Missing transfers into/from your Hospital • Hover over Hospital name to show corresponding site coordinator details

8. The Submission Process: Example • New Submission: • Hospital: TARN Training Hospital • Surname: X • NHS Number: 8888888888 • Date of Birth: Your own (minus 10 years) • Date of Incident: 10/10/2016 • Date of Arrival: 10/10/2016 • Time of Arrival: 10.30 • CREATE NEW SUBMISSION

9. The Submission Process • Duplication check • Unique Submission ID generated • Choose Dataset: Core or Extended • Enter & Save data • Validate data • Dispatch electronically to TARN

10. Standard Screens Core dataset Extended dataset

11. Core Dataset • For standard cases • Most fields Mandatory • Contains: ALL Fields used in routine analysis and reporting • Generic screens: Pre Hospital, ED, Critical Care • Selected Observations & Interventions

12. Opening screen • Irish Hospitals should enter data in the Opening section as follows: • ED number and Hospital Patient Number: Blank • NHS Number: 8888888888 • Full Date of Birth: No • Short date of Birth: Yes * • Age: To remain • Patient postcode: ZZ99 3WZ • Does the patient have a GP?: Not Appropriate • * Agreed by NOCA Spring 2017 that Short DOB can now be entered. Will auto-calculate

13. Opening screen: 2019 Rehabilitation Prescription • Answer YES if the patient's rehabilitation needs have been assessed, NO if they have not.  • If Yes, you must also answer: Are there rehabilitation needs?  • If Yes, you must answer: Has a Rehabilitation Prescription been completed? Answer NO, to ensure you are asked no further questions.

14. Opening screen: Rehabilitation Prescription Pre April 2019 • Republic of Ireland sites: Yes if Rehab assessment is made, otherwise NO. 

15. Incident Multiple responses: Use + button

16. Pre Hospital

17. Pre Hospital Attendants

18. Pre Hospital Observations • GCS (Glasgow Coma Score) can be entered using individual components (E,V,M) or as Total score. • If GCS is less than 9 you will be asked whether intubation was considered, and if NOT you will be asked the reason.

19. Core Dataset: Generic Observations Pre-hospital, ED and Critical Care locations Observations: 1st taken

20. *GCS: Glasgow Coma Score: GCS • Measure of a patient’s level of consciousness, taken by assessing: • Eye, Verbal and Motor responses. • Ranges from 15 (normal functioning) to 3 (no responses). • Reduced GCS is an indication of a possible brain injury. • Used in the Probability of Survival model • Record: Pre Hospital, ED & at 1st hospital (Transfers in) • One of most important fields in EDCR: Part of the Data Accreditation %

21. **Pupil Reactivity • Record: Pre Hospital, ED & Critical Care • Particularly important: When GCS is <15 or Head injury • Included in future Probability of Survival model • One of most important fields in EDCR: Part of the Data Accreditation % • Note: PEARL (Pupils Equal & Reacting to light) Record as BRISK • Non Reacting pupils: Record as Absent

22. Pre Hospital Interventions

23. Core Dataset: Generic InterventionsPre-hospital, ED and Critical Care locations * ED and Critical Care only

24. Documentation of GCS & Intubation • Rapid Sequence Intubation (RSI) sometimes performed Pre Hospital • RSI: sedation & paralysis of a pt prior to Intubation • GCS3 often documented in ED: THIS SHOULD NOT BE RECORDED • Users should record in ED: • Airway Status: Intubated • Breathing Status: Ventilated • GCS: No • Resp Rate: No

25. ED Trauma Team activation: If Yes, you will be prompted to answer who lead the Trauma team (More later on).

26. ED Observations • If patient arrives Intubated + Ventilated: • AIRWAY STATUS= INTUBATED • BREATHING STATUS= MECHANICALLY VENTILATED • GCS = NO • RESP RATE = NO • If GCS is less than 9 you will be asked whether intubation was considered, and if NOT you will be asked the reason.

27. ED Interventions

28. ED Attendants “Is this the Trauma Team leader” Question appears only if “YES” to Trauma team has been selected. Multiple attendants: • ENTER DATA • SAVE • DATA SAVED IN CRUMB TRAIL • SCREEN REFRESHED • ENTER 2ND ATTENDANT

29. Imaging ‘Provisional report date/time’: when initial report was written (any grade). ‘Review date/time’: when reviewed by Consulant Radiologist. 1st CT only

30. Operative session 1 Choose: BODY AREA: BOAST4 (SOFT TISSUE COVER) OPERATION 1: SKIN GRAFT – UNSPECIFIED Choose BODY AREA: BOAST 4 (SURGICAL STABILISATION) OPERATION 2: PRIMARY CLOSED REDUCTION & INTERNAL FIXATION

31. Operativesession 2 Choose: BODY AREA: THORACIC OPERATION: RIB FRACTURE FIXATION

32. Critical Care Only complete if Pt goes to Level 2-4 wards (HDU, ICU/CCU)

33. Ward Observations, Interventions and Attendants not required on WARD To enter multiple Ward stays: • Enter first stay • Save and Next • Click on WARD in menu bar • Add new section • Enter second stay

34. At Discharge Complications:Acute kidney injury (AKI) = Renal failure. It is not an injury (as name suggests) but a complication. Pneumonia= is entered as Bronchopneumonia PMC: Document all conditions (even in remission) DON’T ENTER LOS This will auto-calculate on SAVE and includes any readmission days. Will auto-calculate

35. At Discharge Readmission: Complete if patient is readmitted within 30 days relating to initial incident. Never complete 2 submissions for one patient’s incident.

36. Specialist screensBOAST4Chest Wall* *Launched April 2016

37. Opening screen: Other audits

38. BOAST 4 Guidelines derived from BOA & BAPRAS Severe Open fractures of Tibia: Gustilo Anderson grade 3b or 3c • Guideline requires: • Early identification of severe open fractures of the tibia • Joint care from orthopaedic & plastic surgeons • Surgical wound debridement & operative fracture stabilisation within 24 hours • Definitive soft-tissue cover within 72 hours of injury

39. BOAST4 “Did the fracture have surgical stabilisation” & “Was definitive soft tissue cover of injury achieved” Only answer YES if procedures performed at your Hospital.

40. TARN Update: Chest Wall Trauma Specialist screen • One recent advancement in Trauma Care: Rib fracture plating • Not standard, nor widely practiced • CWTS screen developed to improve further care • Data on all patients collected - both operative & non-operative • Bespoke fields included on screen • Most information in CORE dataset • Complete CWTS screen for any patient with rib(s) &/or sternum fracture

41. Chest Wall Trauma Specialist screen • Screen appears if “Yes” selected on Opening screen for the question • “Did the patient have a chest wall injury – fractures of the rib(s) and/or sternum?”

42. Chest Wall injury Screen only appears if patient has Rib or Sternum fracture /s. Only 4 initial questions. Help text guidance is available on each field.

43. Core Dataset: Outcome Measures screen Note: This screen auto-populates post Injury Coding by TARN Users do not enter data into this screen

44. Validating and Dispatching Once data entry is complete: • 1.Click: Validate and Dispatch • 2. List of Validation errors appear: • Red errors: missing Mandatory fields or timeline errors. • Must be rectified prior to Dispatch. • Green errors: missing preferred fields. • Submission can be Dispatched using “Click here to Dispatch this submission to TARN with warnings”.

45. Chest Wall confirmation screen Asking users to confirm that no data is available for certain key data points associated with Chest wall trauma e.g. Thoracostomy. Simply tick to confirm if each data point is unavailable then click: Confirm & Dispatch. If data point has been missed, click: Back and enter missing data. Then re-validate submission.

46. View Diary* • Rejected submissions: Reason noted in Diary • Returned submissions: Reason noted in Diary • Re-dispatched submissions: Users should respond to TARN request in Diary & then Re-dispatch the submission

47. Awaiting Post Mortem** • Users should send Post Mortem to TARN when available • Particularly important: Deaths in ED • When sending PMs: • Annonymise • Include 12 digit submission ID • Email to: tarn.supportstaff@nhs.netor support@tarn.ac.uk • Post Mortems shredded by TARN after coding

48. Extended Dataset • Complex cases • Multiple ICU visits • Transfers in: bypass ED • Or ADDITIONAL data points e.g. Haematology, Blood Gases, Pelvic binder • All Observations, Interventions & Investigations shown • Core fields remain Mandatory • Extended dataset only fields: Not routinely analysed

49. Questions?