Electronic Data Collecting & Reporting system (EDCR) overview

1. Data Entry: System structure The Trauma Audit & ResearchNetwork (TARN) Foundation sessionLog into: https://www.tarn.ac.uk

2. Electronic Data Collecting & Reporting system(EDCR) overview • Process of care & outcome data relating to eligible Trauma patients • Secure on-line system (www.tarn.ac.uk): • Username & password required • Patient confidentiality paramount: • Names, Hospital Numbers, Full Postcodes not seen by TARN • Location based system, following patient pathway: From scene to Discharge • Choice of datasets: Core or Extended

3. Submission Contains all the data relating to a Patient’s incident: • Patient • Incident • Location • Outcome • Injuries

4. Submission Summary screen • Screen showing current STATUS of all your Hospitals’ submissions • You can access any submission by clicking on number adjacent to Status • You can see all submissions created by any User linked to your Hospital

5. Submission Status • CREATED • DISPATCHED • APPROVED • REJECTED • RETURNED • REDISPATCHED • DISPATCHED & FLAGGED • AWAITING POST MORTEM • Incomplete submission, data being entered • Complete submission, TARN to check • Checked & coded by TARN (part of Hospital dataset) • Does not fulfil inclusion criteria • Additional information requested by TARN • Additional information supplied by User • Flagged awaiting matching Transfer or PM • PM to be sent to TARN at later date • (reminder email sent regularly) Only Approved cases are used in Reports

6. Searching for submissions • Use any fields on SEARCH screen. FIND • Results appear at bottom of screen • Access relevant submission by clicking on (12 digit) Submission ID • Click REPORT to convert to Excel

7. The Submission Process • Duplication check • Unique Submission ID generated • Choose Dataset: Core or Extended • Enter & Save data • Validate data • Dispatch electronically to TARN

8. Standard Screens Core dataset Extended dataset

9. Core Dataset • For standard cases • Most fields Mandatory • Contains: ALL Fields used in routine analysis and reporting • Generic screens: Pre Hospital, ED, Critical Care • Selected Observations & Interventions

10. Opening screen Surname & DOB will auto-populate using data entered into duplicate checking screen. Age will auto-calculate on saving. Help Text offers guidance for most fields. Click on field name to access E.g. Patient Postcode Pre-entered Will auto-calculate To find GP practice code: • CLICK ‘FIND GP CODE’ • ENTER FIRST PART OF POSTCODE: E.G. M44 • HIGHLIGHT CORRECT PRACTICE • PRESS: USE THIS CODE

11. Opening screen: 2019 Rehabilitation Prescription • Launched April 2019- mandatory from this point. • All patients admitted from April 2019 must have this section completed in order to be eligible for BPT. • Existing BPT rehabilitation questions will remain, and continue to determine BPT payment for all patients admitted before April 2019. Must be answered to ensure BPT payment for these patients. • Prescription matches TARN system exactly • Guidance document in Resources section of TARN website. • BPT flowchart document from NHS E & Professor Chris Moran available on website

12. BPT Eligible • Rehabilitation needs assessed- no needs identified • Rehabilitation needs assessed- needs identified: • rehabilitation prescription completed • Prescription contains core items • Prescription developed with patient/ family/ carer • Prescription discussed with patient where possible • Prescription given to patient, GP & next care provider • Rehabilitation needs checklist completed • 2019 Rehabilitation Prescription payment flow diagram available in 2019 BPT support document in resources section of website

13. Opening screen: Rehabilitation Prescription Pre April 2019 • These questions should be completed for all patients admitted before April 2019. • They continue to determine BPT payment for all patients admitted before April 2019. Must be answered to ensure BPT payment for these patients. • Once all patients admitted before April 2019 have been submitted to TARN we will remove these questions.

14. Incident Multiple responses: Use + button Select Yes only if the patient was involved in a Declared Major Incident.

15. Major Trauma Triage Tool: Pt MTC criteria assessed at scene. Positive: MTC criteria pt. Negative: Non MTC criteria pt. Ambulance or Helicopter= Yes: PRF question appears Ensure call date/time are recorded. Pre Hospital Pre Populate icon: Auto-populates date/time

16. Pre Hospital Attendants Multiple attendants: • ENTER DATA • SAVE • DATA SAVED IN CRUMB TRAIL • SCREEN REFRESHED • ENTER 2ND ATTENDANT

17. Pre Hospital Observations • GCS (Glasgow Coma Score) can be entered using individual components (E,V,M) or as Total score. • If GCS is less than 9 you will be asked whether intubation was considered, and if NOT you will be asked the reason.

18. Core Dataset: Generic Observations Pre-hospital, ED and Critical Care locations Observations: 1st taken

19. *GCS: Glasgow Coma Score: GCS • Measure of a patient’s level of consciousness, taken by assessing: • Eye, Verbal and Motor responses. • Ranges from 15 (normal functioning) to 3 (no responses). • Reduced GCS is an indication of a possible brain injury. • Used in the Probability of Survival model • Record: Pre Hospital, ED & at 1st hospital (Transfers in) • If GCS is less than 9 you will be asked whether the patient was intubated within 30 minutes (NICE Guidelines), and if not you will be asked whether intubation was considered. If it was not considered you will be asked the reason. • One of most important fields in EDCR: Part of the Data Accreditation % and Probability of Survival (Ps) calculation For Ps ‘Missing assumed normal’ treated as 15, ‘Missing assumed abnormal’ treated as missing

20. **Pupil Reactivity • Record: Pre Hospital, ED & Critical Care • Particularly important: When GCS is <15 or Head injury • Included in future Probability of Survival model • One of most important fields in EDCR: Part of the Data Accreditation % • Note: PEARL (Pupils Equal & Reacting to light) Record as BRISK • Non Reacting pupils: Record as Absent

21. Pre Hospital Interventions

22. Core Dataset: Generic InterventionsPre-hospital, ED and Critical Care locations * ED and Critical Care only

23. Documentation of GCS & Intubation • Rapid Sequence Intubation (RSI) sometimes performed Pre Hospital • RSI: sedation & paralysis of a pt prior to Intubation • GCS3 often documented in ED: THIS SHOULD NOT BE RECORDED • Users should record in ED: • Airway Status: Intubated • Breathing Status: Ventilated • GCS: No • Resp Rate: No

24. ED Trauma Team activation: If Yes, you will be prompted to answer who lead the Trauma team (More later on).

25. ED Observations • If patient arrives Intubated + Ventilated: • AIRWAY STATUS= INTUBATED • BREATHING STATUS= MECHANICALLY VENTILATED • GCS = NO • RESP RATE = NO • If GCS is less than 9 you will be asked whether intubation was considered, and if NOT you will be asked the reason.

26. ED Interventions

27. ED Attendants “Is this the Trauma Team leader” Question appears only if “YES” to Trauma team has been selected. Multiple attendants: • ENTER DATA • SAVE • DATA SAVED IN CRUMB TRAIL • SCREEN REFRESHED • ENTER 2ND ATTENDANT

28. Attendants: First from each specialty and most senior from each specialty • Trauma Team arrive at 10.00: • Consultant in Emergency Medicine • ST 6 in Emergency Medicine • Consultant in Orthopaedics • ST 7 in Maxillofacial Surgery • Later Attendees at 10.30: • Consultant in Maxillofacial Surgery • ST 7 in Emergency Medicine

29. Imaging ‘Provisional report date/time’: when initial report was written (any grade). ‘Review date/time’: when reviewed by Consulant Radiologist. 1st CT only

30. Operative session 1 Choose: BODY AREA: BOAST4 (SOFT TISSUE COVER) OPERATION 1: SKIN GRAFT – UNSPECIFIED Choose BODY AREA: BOAST 4 (SURGICAL STABILISATION) OPERATION 2: PRIMARY CLOSED REDUCTION & INTERNAL FIXATION

31. Operativesession 2 Choose: BODY AREA: THORACIC OPERATION: RIB FRACTURE FIXATION

32. Critical Care Only complete if Pt goes to Level 2-4 wards (HDU, ICU/CCU)

33. Ward 1 Observations, Interventions and Attendants not required on WARD

34. Ward 2 To enter multiple Ward stays: • Enter first stay • Save and Next • Click on WARD in menu bar • Add new section • Enter second stay

35. At Discharge Complications:Acute kidney injury (AKI) = Renal failure. It is not an injury (as name suggests) but a complication. PMC: Document all conditions (even in remission) DON’T ENTER LOS This will auto-calculate on SAVE and includes any readmission days.

36. At Discharge Readmission: Complete if patient is readmitted relating to initial incident. Never complete 2 submissions for one patient’s incident.

37. Specialist screensBOAST4Chest Wall* *Launched April 2016

38. Opening screen: Other audits

39. BOAST 4 Guidelines derived from BOA & BAPRAS Severe Open fractures of Tibia: Gustilo Anderson grade 3b or 3c • Guideline requires: • Early identification of severe open fractures of the tibia • Joint care from orthopaedic & plastic surgeons • Surgical wound debridement & operative fracture stabilisation within 24 hours • Definitive soft-tissue cover within 72 hours of injury

40. BOAST4 “Did the fracture have surgical stabilisation” & “Was definitive soft tissue cover of injury achieved” Only answer YES if procedures performed at your Hospital.

41. TARN Update: Chest Wall Trauma Specialist screen • One recent advancement in Trauma Care: Rib fracture plating • Not standard, nor widely practiced • CWTS screen developed to improve further care • Data on all patients collected - both operative & non-operative • Bespoke fields included on screen • Most information in CORE dataset • Complete CWTS screen for any patient with rib(s) &/or sternum fracture

42. Chest Wall Trauma Specialist screen • Screen appears if “Yes” selected on Opening screen for the question • “Did the patient have a chest wall injury – fractures of the rib(s) and/or sternum?”

43. Chest Wall injury Screen only appears if patient has Rib or Sternum fracture /s. Only 4 initial questions. Help text guidance is available on each field.

44. Core Dataset: Outcome Measures screen Note: This screen auto-populates post Injury Coding by TARN Users do not enter data into this screen

45. Validating and Dispatching Once data entry is complete: • 1.Click: Validate and Dispatch • 2. List of Validation errors appear: • Red errors: missing Mandatory fields or timeline errors. • Must be rectified prior to Dispatch. • Green errors: missing preferred fields. • Submission can be Dispatched using “Click here to Dispatch this submission to TARN with warnings”.

46. Chest Wall confirmation screen Asking users to confirm that no data is available for certain key data points associated with Chest wall trauma e.g. Thoracostomy. Simply tick to confirm if each data point is unavailable then click: Confirm & Dispatch. If data point has been missed, click: Back and enter missing data. Then re-validate submission.

47. View Diary* • Rejected submissions: Reason noted in Diary • Returned submissions: Reason noted in Diary • Re-dispatched submissions: Users should respond to TARN request in Diary & then Re-dispatch the submission

48. Awaiting Post Mortem** • Users should send Post Mortem to TARN when available • Particularly important: Deaths in ED • When sending PMs: • Annonymise • Include 12 digit submission ID • Email to: tarn.supportstaff@nhs.netor support@tarn.ac.uk • Post Mortems shredded by TARN after coding

49. Extended Dataset • Complex cases • Multiple ICU visits • Transfers in: bypass ED • Or ADDITIONAL data points e.g. Haematology, Blood Gases, Pelvic binder • All Observations, Interventions & Investigations shown • Core fields remain Mandatory • Extended dataset only fields: Not routinely analysed