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CONFERENCE
2013
Benchmarking Using the Trauma Registry
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CONFERENCE
2013
Objectives
Review use of registry as a benchmarking tool
Review importance of “Data Quality Management” in benchmarking process
Review trauma registry Best Practices
Review report writing & analysis basics
Review how benchmarking is used to support a PI process
Provide benchmarking examples
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2013
Trauma RegistryCornerstone of the Benchmarking Process
Evaluate quality of patient care
Data repository for the evaluation of injury care & preparedness
Aids in developing better injury scoring & outcome measures
Supports injury & prevention education
Supports local, regional, & national research/outreach initiatives
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CONFERENCE
2013
Data Quality Management
Benchmarking is only as good as the data used to support it
Garbage in = Garbage Out
Program data should be reviewed regularly by all trauma team members
Nothing should be a surprise when data is returned in aggregate form
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2013
Best Practices for Trauma Data Management
Data must be abstracted in accordance with a standard data set
Registry staff must possess a certain skill set
A team approach to data collection should be utilized
Data validation techniques must be applied
A concurrent method of data collection is preferred
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CONFERENCE
2013
Best Practices for Trauma Data Management
Implement a process to review all aspects of data management Staffing Work Processes Technology
This process should include trauma registrars, trauma program directors/managers and performance improvement staff
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2013
Staffing
Define Staffing Plans
Recruitment/Retention
Job Descriptions
Compensation
Orientation/Training
Continuing Education / Professional Growth
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Work Processes Data Abstraction/ Entry Model Role in Performance Improvement Policies & Procedures Data Validation Techniques Data Submission Guidelines Standard & Ad‐Hoc Reporting Quality Audits/Inter‐rater Reliability Clinical Documentation Requirements Standard /Custom Data Definitions Accreditation/Verification Support
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Technology Hardware/Software Requirements Network Configurations Use of Electronic Medical Records Implementing/Supporting Electronic Interfaces Portability Issues Software Upgrades User Defined Customization Routine Maintenance/Back‐Up Procedures
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2013
Report Writing & Analysis Process
Define Reporting Needs Who
Who is requesting the report and who will be reviewing the information
What What type of information is being requested and is it
available to report on
When What specific time frame is being requested
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2013
Report Writing & Analysis Process
Standard/Routine Monthly Statistics
Registrar Productivity
PI Reports
Audit Filter Compliance
ED LOS Tracking
Occurrence Reporting
Timeliness of Submission
Ad Hoc Research Requests
Injury Prevention/Outreach
Strategic / Business Planning
Benchmark Reports Self (Trending)
Regional System
State
National
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2013
Registry Use as a Benchmarking Tool
Performance Improvement Process
Issue Identification
Analysis of the Issue
Action Plan Development & Implementation
Re‐Evaluation
Data Benchmarking Process
Report Identification
Identify Comparison Group
Define Time Intervals
Generate Pre‐Intervention Data
Generate Post‐Intervention Data
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2013
Example #1 Emergency Department Length of Stay
Issue Identification
During the last verification visit, prolonged ED LOS was identified as an opportunity for improvement 0
12345678
Avg ED LOS(hrs)
ED LOS TrendingData Source – Trauma Registry
CY 2012
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
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CONFERENCE
2013
Example #1 Emergency Department Length of Stay
Analysis of Issue
• Data reveals a steady incline in overall ED LOS
• Additional data trending will be needed • Average ED LOS by Activation Level
• Average ED LOS by Day of Week & Time of Day
• Average ED LOS by Injury Type
• Average ED LOS by Hemodynamic Instability (SBP <90)
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CONFERENCE
2013
Don’t jump to conclusions simply looking at data, other factors must also be considered
when studying an issue!
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CONFERENCE
2013
Example #1 Emergency Department Length of Stay
Analysis of Issue
• A long ED LOS does not necessarily correlate to delays in care or poor care
• Hospital bed capacity is at 95% majority of the time
• Some ED’s can provide surgical intervention and provide critical care for extended periods of time
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CONFERENCE
2013
Example #1 Emergency Department Length of Stay
Action Plan Development & Implementation
• Identify working group responsible for this issue
• Discuss reporting needs
• Generate baseline data “Pre‐Intervention”
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CONFERENCE
2013
Example #1 Emergency Department Length of Stay
• Statistical Report
• Gather by “Activation Level”
0
2
4
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Trauma Activations Non‐Trauma Activations
Average ED LOS by Activation LevelData Source – Trauma Registry
CY 2012
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
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CONFERENCE
2013
Example #1 Emergency Department Length of Stay
• Statistical Report
• Gather by “Day of Week”
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2
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Average ED LOS by Day of WeekData Source – Trauma Registry
CY 2012
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
DI
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CONFERENCE
2013
Example #1 Emergency Department Length of Stay
• Statistical Report
• Gather by “Shift of Day”
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4
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1st Shift 2nd Shift 3rd Shift
Average ED LOS by Shift of DayData Source – Trauma Registry
CY 2012
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
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CONFERENCE
2013
Example #1 Emergency Department Length of Stay
• Statistical Report
• Gather by “Injury Type”
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Blunt Penetrating
Average ED LOS by Injury TypeData Source – Trauma Registry
CY 2012
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
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CONFERENCE
2013
Example #1 Emergency Department Length of Stay
• Statistical Report
• Query – “SBP<90”
0
0.5
1
1.5
2
2.5
SBP<90
Average ED LOS Hemodynamically Unstable Patients (SBP<90)
Data Source – Trauma RegistryCY 2012
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
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2013
So what have we learned by looking at this data?
ED LOS is longer in the non‐trauma activation population Triage seems to be an issue in some cases
ED LOS is longer on Fridays & Saturdays
ED LOS is longer on the 3rd shift
High risk populations appear to get through the system appropriately
DI
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CONFERENCE
2013
Example #1 Emergency Department Length of Stay
Action Plan Development & Implementation
• Present data to stakeholders• Action – share data results and identify areas of concern
• Talk to hospital administrator about bed capacity issues• Action – hospital is planning to expand ICU capacity by 20 beds
• Talk with ED leadership about potential staffing issues• Action – additional staff will be added to 3rd shift and weekends
• Re‐educate ED staff on proper triage criteria• Action – TPM re‐educates ED staff on triage guidelines
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CONFERENCE
2013
Example #1 Emergency Department Length of Stay
Re‐evaluation
• Generate data “Post‐Intervention”
• Run identical reports as used in the Pre‐Intervention
• Demonstrate improvement in ED LOS
• Continue to demonstrate that patients with prolonged ED LOS are cared for timely & appropriately
• Continue to trend to assure sustained improvement
DI
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CONFERENCE
2013
Example #2 Incidence of Pneumonia
Issue Identification
Review of complications reveals a steady incline of Pneumonia Rate over the last calendar year.
0.0
2.0
4.0
6.0
Pneumonia Rate
Incidence of PneumoniaData Source – Trauma Registry
CY 2012
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
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CONFERENCE
2013
Example #2Incidence of Pneumonia
Analysis of Issue
• In analyzing Facility A quarterly data, an increasing trend in Pneumonia rate is reflected
• Identify need to compare to benchmark data (state, regional, national)
DI
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CONFERENCE
2013
Don’t jump to conclusions simply looking at data, other factors must also be considered
when studying an issue!
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CONFERENCE
2013
Example #2Incidence of Pneumonia
Analysis of Issue – (other things to consider)
• Has there been any change in clinical practice relating to management of pneumonia
• Has there been any change in the patient characteristics within this patient population
• Data will be needed in the following areas:• Avg. Age of Patients, # of patients w/ Pulmonary PEC, # of patients
with chest injuries (AIS>3)
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CONFERENCE
2013
Example #1 Incidence of Pneumonia
Action Plan Development & Implementation
• Identify working group responsible for this issue
• Discuss reporting needs
• Generate baseline data “Pre‐Intervention”
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CONFERENCE
2013
NTDB Benchmark Comparison
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5.00%
Pneumonia Rate IncidenceHospital vs. NTDB
CY 2012
Facility A NTDB
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CONFERENCE
2013
NTDB Benchmark Comparison
0.00%
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16.00%
Age BreakdownHospital vs. NTDB
CY 2012
55‐64 65‐74 75‐84 > 84
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2013
NTDB Benchmark Comparison
0.00%
5.00%
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30.00%
AIS > 3: Thorax/Chest InjuryHospital vs. NTDB
CY 2012
Facility A NTDB
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CONFERENCE
2013
State Benchmark Comparison
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
# of Patients w/ Respiratory ComorbidityHospital vs. State
CY 2012
Facility A State
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CONFERENCE
2013
Example #2Incidence of Pneumonia
Action Plan Development & Implementation
• Present data to stakeholders• Action – share data results; it appears Facility A is caring for older,
sicker patients who sustain more chest injuries and therefore are at higher risk for developing pneumonia
• Talk to clinicians about any change in clinical protocols • Action – no change in clinical management. Aggressive pulmonary
protocols in place.
• Educate clinical staff about increase in pneumonia rate and need to continue aggressive pulmonary toilet
DI
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CONFERENCE
2013
Example #2Incidence of Pneumonia
Re‐evaluation
• Generate data “Post‐Intervention”
• Run identical reports as used in the Pre‐Intervention
• Continue to compare to state & national benchmarks
• Continue to provide aggressive pulmonary care in this patient population
• Continue to monitor characteristics of this patient population
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CONFERENCE
2013
Summary
Benchmarking only as good as the data supporting it
Team approach to data collection & analysis is pivotal
Consider all/other factors when studying an issue
In lieu of issues, use data to show care is timely & appropriate