The Case for Concurrency –GMC experience

Monica Rozzell,RN,MS

Trauma PI Manager

Grant Medical Center

In the Beginning

GMC trauma registry started 1987 1.0 FTE Duties included abstraction, reporting

• Approximate volume 800 - 1000/annually

• Retrospective entered on average 90 days after discharge

• Data supported verification efforts

• Hours worked 0400 – 1230

For the next 14 years.. We maintained the status quo

After 14 years it began to dawn on us that we needed a new approach

First Solution – add more people!

In 2001 we added .5 FTE registrar

As our patient volumes began to increase we added FTE’s but did not change our retrospective process

In 2003 we added 1.0 FTE and in 2004 we added an additional 0.7 FTE

And yet.. We were still always

behind

Despite everyone’s best efforts and commitment we were still about 60 days behind

Data was not valued but– viewed as a necessary thing for the state & ACS

2005 the Start of Concurrency

TPM had experience with concurrency at NWCH & determined we were going to go concurrent

Hired additionally 1.0 FTE Trauma Information Data Analyst who had started the NWCH concurrent process

Our question “Was it possible to take a registry as large (4000+/year) as ours concurrent”?

So how did we do it?

Committed to one process for data collection

Reworked our paper abstract

Improved our ICD9 coding techniques

Improved our AIS coding skills

Picked a start date and went!

And we have never looked back!

So what does it mean to be concurrent?

In Math Lines that contain the

same point are called concurrent.  Concurrence is the concept of three or more lines intersecting in a single (common) point, having a single point of intersection.

What does being concurrent mean in the trauma data world?

We find, abstract, code and score all patients within 24 hours of presentation to our trauma center

We round on all admitted patients daily to find additional procedures

We complete all discharge information all patients within 48 hours of their departure from the trauma center

Our Daily Process

Find our peeps Set up for the day Utilize online resources—find, code and

score Go to the floor and find the chart –

progress notes Return and enter the data

Finding our Peeps

“The List”ED log bookOhiohealth

online resources

Morning report

Set up an abstraction gridDetermine who gets what!

Oct - Apr   May - Sep  

 Currently

have

Open for

Currently have

Open for

SICU 4 2 SICU 4 2 to 3

Stepdown 4 2 to 3

Stepdown 4 4

Floor 10 5 Floor 10 6 to 8

    9 to 10     12 to 15

Total Patients seen : 28        

         

Abstractor: EB KAQ MP JW

         

SICU: 1 2 0 2

TICU: 1 0 0 1

FLOOR 4 4 0 3

T & R: 1 1 7 1

         

Total Patients Per Abstractor: 7 7 7 7

Extract data from on line resources

ORB Columbus fire EMSTAT Midas

Go to the floor/unit and read the chart

Return to the office and feed the beast

Speed vs Accuracy

Appearance vs Reality

Data Entry –aka Feeding the beast

Validating & Reporting – aka Taming the Beast

Weekly Validation

Daily Census

Monthly Activity Reports

Performance Improvement Reporting

Referring Hospital Lee Ann

Dietrich, RN Referring Hospital Coordinator

Grant Trauma serves central, southern and eastern Ohio hospitals. Trauma receives patients from over forty-five counties as well as, West Virginia and Kentucky. Approximately 35%-45% of admitted trauma volume are from referral centers.

OSUNatwd. Children’s

Doctors West

Mt. Carmel WestMt. Carmel East

RiversideDublin

Fairfield Medical

Berger Hospital

Hocking Valley

Adena Medical Center

Pike Community

Southern Ohio Medical Center

Adams County

Highland District Memorial

Greenfield Medical Center

HolzerMedicalCenter–Gallipolis

HolzerMedicalCenter:Jackson

O’BlenessMemorial

Dr’s HospitalNelsonville

Marietta Memorial

Selby General

GoodSamaritanGenesis

Barnesville

SoutheasternOhio Medical

Center

CoshoctonCounty

Memorial

Licking Memorial

KnoxCommunity

Grady Memorial

MorrowCounty

Samaritan

GalionCommunity

MedCentralShelby

MedCentalMansfield

BucyrusCommunity

WyandotMemorial

Marion General

MemorialHospitalof UnionCounty

FayetteMemorial

St. Anns

HardinMemorial

BlanchardValley

Lima Memorial

St. Rita’s Memorial

Mary Rutan

Mercy Memorial

Community Mercy HealthPartners Madison

County

Referring hospitals have a access to a specialized phone line that connects the referring physician directly with the Grant ED attending physician for faster transfer time. The trauma attending surgeons accept all trauma referrals (no diversion policy). The trauma referral phone line plus the authority for the ED attending to accept all trauma patients has decreased the time and effort to transfer an injured patient to Grant Medical Center.

Grant Medical Center Trauma ProgramPercentage of Referrals by Month

2009

256 260 328 363436 396 440 413 423 360 328 346

4349

176 166 136 124177 181135119102106 128139

1689

41%

36%36%

39%

43%41%

34%

41%

39%39%

36%

41%

38%40%

45%

39%

45%

43%

46%

36%

45%46%

43%41%

39%

44%

0

500

1000

1500

2000

2500

3000

3500

4000

4500

J an Feb Mar Apr May J un J ul Aug Sep Oct Nov Dec YTD

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Total Trauma Patients # from Referring Hospital All Referral % Admitted Referral %

Research

Houston We have a problem

Opportunities for improvement

• Intra rater reliability

• Paperless

• Cross training of all staff

• Maintaining concurrency

Thanks and if you have a question … Call

Monica Rozzell, RN, MS

GMC Trauma PI Manager