TARN Foundation Trauma Audit & Research Network Electronic Data Collecting & Reporting System (EDCR) Overview

1. Data Entry: System structure The Trauma Audit & ResearchNetwork (TARN) Foundation sessionLog 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: • Names*, Hospital Numbers*, Full Postcodes* not seen by TARN • Location based system, following patient pathway: From scene to Discharge • Choice of datasets: Core or Extended * Not entered by NI users: more later

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

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. The Submission Process • New Submission: • Hospital: Treating Hospital • Surname: *Anonymised patient number (more later) • NHS Number: *9999999999 • Date of Birth: * Enter full DOB at this point (more later) • Date of Incident: Date incident occurred • Date of Arrival: Date patient arrived • Time of Arrival: Time patient arrived • CREATE NEW SUBMISSION * Northern Ireland users

8. Anonymised surname number • Patient name agreement with HSCNI: • First receiving hospital generates ‘pseudo code’: number representing the patient’s name • The same surname ID should be entered if the patient is treated at >1 hospital • 2nd treating hospital contact 1st treating hospital to request pseudo code • This helps TARN to more easily track transfers between hospitals • To clarify: Is this still the system in place?

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 Opening screen Blank • NI Users should enter data as follows: • ED & Hospital Patient No: Blank • Patient first name: X • Full Date of Birth/Short date of Birth: No • Age: Leave in situ • Patient Postcode: ZZ99 3WZ • Age will have auto-calculated from the duplicate checking screen, so DOB can be removed on this screen. • Age must remain as it’s a vital part of the Ps calculation and is based on the patient’s age on day of incident. • GP: Not Appropriate Anonymised Patient ID X Remove here Will auto-calculate: leave in situ ZZ99 3WZ

13. Opening screen: 2019 Rehabilitation Prescription • Launched April 2019- mandatory from this point. • Relates to new BPT standards for England • Existing BPT rehabilitation questions will remain for patients admitted prior to April 2019 • How would HSCNI like this section to be completed?

14. Opening screen: Rehabilitation Prescription Pre April 2019 • These questions should be completed for all patients admitted before April 2019. • Once all patients admitted before April 2019 have been submitted to TARN we will remove these questions. • Current Guidance Northern Ireland sites: • Yes: If patient is assessed by Rehabilitation services; then the 3 additional questions should be answered: Physical, Cognitive and Psychosocial factors. • No: If no rehabilitation assessment made. • Not appropriate: should not be used • *Agreed at NI CAG meeting on 20/02/18

15. Incident • NI Users should enter data as follows: • Incident postcode: Blank Blank Multiple responses: Use + button Select Yes only if the patient was involved in a Declared Major Incident.

16. Pre Hospital • NI Users should enter data as follows: • Major Trauma Triage Tool: Not Applicable • Patient Report form no : Blank • Vehicle call sign: Enter if documented • CAD number: 9999 Pre Populate icon: Auto-populates date/time

17. Pre Hospital Attendants Multiple attendants: • ENTER DATA • SAVE • DATA SAVED IN CRUMB TRAIL • SCREEN REFRESHED • ENTER 2ND ATTENDANT

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) • If GCS is less than 9 you will be asked whether the patient was intubated within 30 minutes (NICE Guidelines), and if not you will be asked whether intubation was considered. If it was not considered you will be asked the reason. • One of most important fields in EDCR: Part of the Data Accreditation % and Probability of Survival (Ps) calculation For Ps ‘Missing assumed normal’ treated as 15, ‘Missing assumed abnormal’ treated as missing

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. • GCS should be recorded within 30 minutes of arrival for al patients.

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. Attendants: First from each specialty and most senior from each specialty • Trauma Team arrive at 10.00: • Consultant in Emergency Medicine • ST 6 in Emergency Medicine • Consultant in Orthopaedics • ST 7 in Maxillofacial Surgery • Later Attendees at 10.30: • Consultant in Maxillofacial Surgery • ST 7 in Emergency Medicine

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

31. 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

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

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

34. Ward 1 Most Observations, Interventions and Attendants not required on WARD, but GCS should be recorded here if the patient is admitted straight to the ward If a patient leaves a ward to attend theatre or imaging and then returns to the same ward, this can be recorded as one ward admission

35. Ward 2 To enter multiple Ward stays: • Enter first stay • Save and Next • Click on WARD in menu bar • Add new section • Enter second stay

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

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

38. Specialist screensBOAST4Chest Wall

39. Opening screen: Other audits

40. 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

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

42. 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?”

43. 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.

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

45. 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”.

46. 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.

47. 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

48. 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

49. 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

50. Questions?