The Queensland Trauma Registry

1. 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

2. The Queensland Trauma Registry Funding Partners The Queensland Trauma Registry (QTR) is a programme of theCentre 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 fromthe Motor Accident Insurance Commission, Queensland Health, CONROD and The University of Queensland

3. 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 • 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

4. 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

5. 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: • 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

6. QTR Data Collection The purpose of the QTR is to: • 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

7. 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

8. Identifying Trauma Patients The QTR strives to capture every eligible case: • QTR’s EDIS query produces a spreadsheet of potential trauma cases (hundreds++); admissions of less than 24 hours are excluded • 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 • 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 • In 2009, 30,000+ cases were manually reviewed across the 20 participating hospitals to find 17,000 eligible cases • (We are grateful to the medical records staff who supply our charts!)

9. 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: • Education, database validation rules and quality assurance checks • AIS accreditation and QTR specific training • Central coding help desk • Coders’ Quarterly • Statewide meetings & twice-yearly staff workshops • Annual site audits

10. Data Quality Processes • Database: • mandatory fields / flags unexpected data / auto calculation of LOS, ISS, TRISS, RTS • Data cleaning: • External Cause (ICD-10-AM) • Place of occurrence (ICD-10-AM) • Activity (ICD-10-AM) • Nature of main injury • Data verification: • Age - Disposition • Sex - Level Major • Blank Refer - Level Minor • Blank Interfacility - Dominant Injury Type • Score .9 - Null Values • Admission Date - Nature x Body Location • Discharge Date - Sequence Number • LOS - Audit Status • Duplicates - Age = 0 & 100+ • Hypothermia • ICU

11. 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

13. 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)

14. 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:

15. Snapshot of 2009 External cause

16. Snapshot of 2009 Place of injury occurrence

17. Snapshot of 2009 Activity when injured

18. QTR Data Reporting 2009 reporting is under way and is expected to be complete byend of year 2008 QTR annual statewide(aggregate) reports are on theCONROD web site • www.uq.edu.au/conrod In addition to the statewidereports, hospital-specificreports are publishedfor each participating site

19. 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)

20. Research Use of QTR Data Other QTR Research Activities • 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

21. Current Activities… Working with QH and Coroner’s: Data Dictionary / Data Linkages / 2009 ‘Statewide’ Trauma

22. Queensland Trauma Review Launched in 2010 • January - QTR Overview • February - Driveway Run Overs • March - Snake Bites • April - Easter RTCs • May - Assaults in Pubs & Clubs • June - Cyclists • July - Brain Injury • August - RTCs 2006-2009 • September - Horse-related injuries

23. Thank you