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Reducing Rejection rates

Reducing Rejection rates. TARN Rejections 2017-2018. Common reasons for rejection. Ineligible injuries: Closed upper limb or lower leg fractures Simple facial fractures Skin injuries Aged 65+ isolated Neck of femur, pubic rami or Intertrochanteric fractures

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Reducing Rejection rates

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  1. Reducing Rejection rates

  2. TARN Rejections 2017-2018

  3. Common reasons for rejection • Ineligible injuries: • Closed upper limb or lower leg fractures • Simple facial fractures • Skin injuries • Aged 65+ isolated Neck of femur, pubic rami or Intertrochanteric fractures • Non Traumatic or ambiguous incidents/spontaneous bleeds • Patients admitted for Rehabilitation only cases • LOS <3 overnight stays

  4. Inclusion Criteria Review

  5. The decision to include a patient should be based on the following 3 criteria being met: • Trauma patients: Irrespective of age • *Military personnel injured on active duty are excluded • Who fulfil one of the following length of stay criteria: • In hospital for >3 overnight stays • Admitted to a Critical care area (regardless of LOS) • Transferred out for specialist care or repatriation*(total LOS >3days) • Transferred in for specialist care or repatriation*(total LOS >3days) • Deaths (including deaths in ED, even if COD is medical) • *Patients admitted under care of Rehabilitation team only: Not included in TARN • AND whose isolated injuries meet one of the following criteria>>>

  6. Inclusion Criteria: injury inclusions/exclusions Red: Common isolated rejected cases

  7. HEAD Injuries

  8. FACIAL Injuries

  9. FEMORAL Injuries

  10. UPPER LIMB or LOWER LEG Injuries Excluding hands & feet Upper Limb: Scapula, Clavicle, Humerus, Radius, Ulna Lower Limb: Patella, Tibia, Fibula, Calcaneus, Talus Crush = Total destruction of bones, vessels/nerves & soft tissue

  11. OTHER INJURIES Once one injury is TARN eligible. All injuries must be documented in the submission.

  12. Inclusion Criteria: Quiz

  13. Inclusion Criteria: Quiz

  14. Reducing Return rates

  15. Reducing Returned for review cases: discussion • 9%of all dispatched cases were Returned during 2018: 8615cases nationally • 19%requested by Hospitals: information missing originally • Large number returned by TARN coders for injury confirmation: We can only code confirmed/traumatic injuries • To help reduce this TARN processing policy changed in late 2017 • At Discharge screen wording also changed to: ‘Confirmed injuries and source of confirmation’ • Sources of injury confirmation: Discharge summary, case notes, imaging, PM, coroners report or Clinically (including verbally). • All injuries documented are then taken as confirmed and submissions not returned. • Resultant minor overall reduction in return rate

  16. Reducing Returned for review cases: discussion XR Lumbar Spine: The bones are generally osteopenic. There is depression of the superior endplate of T11 with anterior wedging and reduced vertebral body heights by approximately 50% anteriorly. Appearances are consistent with vertebral fracture which may be osteoporotic. It is not possible to be certain whether it is acute or chronic on the plain radiograph. • Some examples of scans with unconfirmed injuries MRI Brain: Parenchymal signal changes are noted in the cortex and grey-white matter junction in the right temporal and frontal lobes peripherally, corresponding to the previously visible changes on the CT are most in keeping with haemorrhagic contusions with possible associated axonal injury at these sites.

  17. Reducing Returned for review cases Returns 2018: • Reducing this Returns rate further will be beneficial to all • These cases are processed twice by users and TARN: Dispatched & Re-dispatched • What else can we do to help reduce this rate: • Are you routinely providing injury ‘Source’ information? • Your advice is welcome?

  18. TARN recommendations • Review Returned submissions each week: • Submission Summary Screen: Search facility : Excel format • View Diary to respond: Please Re-dispatch them even if Not eligible! • Ensure you know who your Clinical lead/advisor is & meet with them regularly to review returns

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