healthcare the london for london trauma system launch
DESCRIPTION
The TRAUMA. Audit & Research. NETWORK. Healthcare The London for London Trauma System Launch. The Trauma Audit & Research Network. Maralyn Woodford. The Trauma Audit & Research Network. Background Measuring trauma severity Performance comparisons of trauma care - PowerPoint PPT PresentationTRANSCRIPT
Healthcare The Londonfor London Trauma System Launch
Maralyn Woodford
The TRAUMA
Audit & Research
NETWORK
The Trauma Audit & Research Network
The Trauma Audit & Research Network
1. Background
2. Measuring trauma severity
3. Performance comparisons of trauma care
4. Data Coordination across Networks
The London Trauma System Launch 10 th September 2009
TARNUniversities of Manchester & Leicester
• Non Profit making organisation - self funded through hospital membership fees in England, Wales, Ireland, Denmark & Switzerland
The TRAUMA
Audit & Research
NETWORK
• Established in 1990
• Core work - supporting improvements in trauma care through audit & research
ensure Quality Data coordination
provide regular and informative Feedback with adherence to Benchmarks & Standards
maintain a statistical base to support clinical governance offer responsive local reports & specific local improvement publish National reports to inform the planning of trauma services
Improvements in Trauma Care
The Role of The Trauma Audit & Research Network
Improvement in trauma care locally by:
• Reviewing outlier patients unexpected survivors – what did we do right? unexpected deaths – what did we do wrong?
• Compare outcomes through case-mix standardisation
• Compare processes of care through clinically-defined standards of trauma care
The Benefits of TARN
Measuring and monitoring trauma care
Assessment of Trauma Severity
Logistic regression modelling‘ – ‘weights’ those parameters that predict survival.
Anatomical Injury
ISSISS
Physiological Measure
GCSGCS
Age / Gender
Probability of survival of individual patients
Case mix standardised comparisons of actual and predicted outcome
An improved approach to outcome predictions
Where:GCS = Glasgow Coma Scale scoreISS = Injury Severity Scoreb0……..b26 are coefficients derived from regression analysis applied to data from TARN 2001 - 2006.b0 = constant 4.729b1 = 0 and applies when the GCS = 13 - 15b2 = -1.076 and applies when the GCS = 9 - 12b3 = -1.543 and applies when the GCS = 6 – 8b4 = -2.446 and applies when the GCS = 4 - 5b5 = -3.413 and applies when the GCS = 3b6 = -2.046 and applies when Intubatedb7 = -3.867b8 = -3.313b9 = 0 and applies when gender = maleb10 = -0.089 and applies when gender = femaleb11 = -0.083 and applies when Age = 0 – 5b12= 0.676 and applies when Age = 6 - 10b13 = 0.329 and applies when Age = 11 – 15b14 = 0 and applies when Age = 16 - 44b15 = -0.533 and applies when Age = 45 – 54b16 = -1.101 and applies when Age = 55 - 64b17 = -1.755 and applies when Age = 65 – 74b18 = -3.221 and applies when Age = > 74b19 = -0.237 and applies when Age = 0 – 5 and gender = femaleb20 = -0.216 and applies when Age = 6 – 10 and gender = femaleb21 = 0.042 and applies when Age = 11 – 15 and gender = femaleb22 = 0 and applies when Age = 16 - 44 and gender = female (or male)b23= 0.274 and applies when Age = 45 - 54 and gender = femaleb24 = 0.184 and applies when Age = 55 - 64 and gender = femaleb25 = 0.095 and applies when Age = 65 - 74 and gender = femaleb26 = 0.366 and applies when Age >74 and gender = femaleThe constant e = 2.718282 (the base of Napierian logarithms).
Comparing Outcomes
2005 - 2008
-10
-8
-6
-4
-2
0
2
4
6
8
10
Ws
& 9
5% C
I
Moresurvivors
Moredeaths
Average bottom10 TARN Hospitals (-
3)
95% Confidence Intervals
Average top 10 TARN Hospitals
(+2.5)
Incomplete
data collection
The Trauma Centre: A Speciality Hospital, not a Hospital of Specialities
R. A. Davenport et alBJS 2009accepted for publication
Current TARN Reports & Feedback
• Every 3 months - in depth analysis - themed: head, thoracic, orthopaedic, abdomen & spine- monitors the RCS / BOA & NICE Guidelines
- senior input in trauma team- timeliness and transfers- regional organisation
- role of the local hospital
• Electronic Reports & self production using the eDCR
• Network Reports
TARN Developments
• Improved data collection & reporting - eDCR
• Successful publication of performance comparisons
of standards of trauma care
The Trauma Audit & Research Network
www.tarn.ac.uk
Accessing a hospital from region
Completeness of Data
Data Accreditation
Standards of Trauma Care
• Injuries to the Brain & Skull Time to CT Transfer to Neurosurgical centres
• Injuries to the Spine Transfer rates of unstable spinal injuries
• Injuries to the Chest Most senior Cardiothoracic clinician attending patient
• Injuries to the Limbs & Pelvis Time to theatre for open limb injuries Most senior Surgeon attending to patient
Data Coordination The Electronic Data Collection & Reporting system
the eDCR System
• online system requiring no specialist software
• data is instantly validated
• Confidential, Secure, Encrypted data, Backup service
• PIAG approval
Data coordination across a networkRequirements:
• Resources - membership fees- data collection
• Comprehensive data collection dependant on:- skills- management- time - geography
Data Quality………..
is Important
√√√√ - indicators of data
completeness and accreditation
Outcome and Process
measures reviewed with confidence
Inequality in Trauma Care?
Royal College of Surgeons 1988
“….this report reveals significant deficiencies in the management of seriously injured patients…..”
“…..up to one third of trauma deaths potentially avoidable.”
Royal College of Surgeons 1988
Working Party on the Management of Patients with Major Injury
Royal College of Surgeons 1988
Proposals for change:
• Improve pre-hospital care• Introduce ATLS principles to improve resuscitation, especially
shock control• Invest in rehabilitation services
• Integrate trauma services• Clinical audit & research to review efficacy of care
Questions?
Acknowledgements• TARN staff
• Executive Committee and Board
• Clinicians and data co-ordinators at TARN participating hospitals
10th September 2009
Healthcare The Londonfor London Trauma System Launch