Welcome The Trauma Audit & Research Network (TARN) Data Collection session.

Welcome

The Trauma Audit & Research Network (TARN)

Data Collection session

Today

Background

Inclusion criteria

Identifying cases

Quality Assurance: Data Accreditation and Completeness

Data Entry

Injury scoring & calculating the ISS (Injury Severity Score)

Ps14 (Probability of Survival) & Hospital Survival rate (Ws)

TARN

Largest European Trauma registry

Over 500,0000 injured patients with more than 46,000

injured children

Review and monitor processes of care & outcomes

Report to trusts & commissioners

Inform changes in practice: Improve Trauma Care

TARN Team Administrator/PA:Gemma Reed

Coding team:Laura BlakeleyNaomi BrookPaul GembarskiPhil Hammond (Supervisor)Corinne TilleyVictoria Zagrodnik

Training & Audit Manager:Laura White

Financial Accountant:Jean Hodkinson

Projects Manager:Victoria Phillipson

Registry Manager:Tom Jenks

Systems Analysts:Marisol FragosoSophie JonesTom LawrenceMike Young

Medical Statistician:Omar Bouamra

Executive Director:Maralyn Woodford

Operations Director & Deputy to the Executive Director:Antoinette Edwards

TARN

Academic: University’s of Manchester, Sheffield and Leicester

Non Profit making

100% membership in England and Wales

Members in Southern Ireland, Denmark and Switzerland

Clinically led

BOARD and Executive Committees

Research and Audit Committees

TARN Research Committee

Director: Professor Fiona Lecky, Clinical Professor & Honorary Consultant in Emergency Medicine (EM) at ScHARR and Salford Royal NHS Foundation Trust

11 members including: Executive Director, Medical Statistician, Registry Manager, Data Analysts, Clinical Research Advisor, Research Fellows, Pre-hospital research advisor.

Meet Monthly to review: Ongoing Research projects

New Research proposals

Meetings & teleconferences with researchers

Have you got a Research idea?

Complete Request form or email [email protected]

TARN Audit Committee

Director: Dr Dhushy Kumar, Consultant in Critical Care, Pre-hospital Care and Anaesthesia at University Hospital Coventry.

15 members - National representation: Clinicians, TNCs, Data Coordinators, Rehabilitation, TARN Executive Director, TARN Registry & Training Managers

Meet 6 times per year to discuss audit changes Have you got an audit request?

Email [email protected]

The beginning

1988: Report by RCS: The Management of patients with Major Injuries“Serious deficiencies in the management of severely injured patients”

Enhancing pre-hospital care, ensuring appropriate medical intervention Rapid transfer to the best local facility Assessing the use of helicopters Adopting ATLS principles Integrating trauma services within and between hospitals Investing in rehabilitation services

System of Auditing & Research

TARN Established in 1989: Based Salford Royal Hospital

Major Trauma reports 2000: Joint report by RCS and BOA: Better Care for the Severely Injured

“Standards & outcome measures developed, against which institutions can audit the

outcome of treatment”

2007: NECPOD: Trauma: Who cares?“Given the importance of evaluation of processes and outcomes in the trauma patient, all units providing treatment for severely injured patients should contribute to the Trauma Audit & Research Network”

Major Trauma Network development

Public Accounts Committees March 2010Chief Executive of NHS on public record as ......

Committing to development of Major Trauma Networks across England by end of 2011/12

Mandating TARN membership

Most Major Trauma Networks “live” April 2012

17 Major Trauma Network and Major Trauma Centres (MTCs)

Thames Valley

Wessex

Severn

Peninsula

East of England NetworkAddenbrooke’s Hospital

East Midlands NetworkNottingham University Hospital

Yorkshire & HumberLeeds General HospitalSheffield Teaching Hospital NHS Trust Sheffield Children’s Hospital Hull Royal Infirmary

NorthernJames Cook University HospitalRoyal Victoria Infirmary, Newcastle

Sussex Network Royal Sussex County Hospital

Greater Manchester NetworkSalford Royal HospitalWythenshawe HospitalManchester Royal Infirmary Royal Manchester Children’s Hospital

Merseyside & Cheshire NetworkUniversity Hospital of AintreeWalton Centre for NeurologyRoyal Liverpool University Hospital Alder Hey Children’s Hospital

South Cumbria & Lancashire Network Royal Preston Hospital

West Midlands Network

North West Midlands NetworkRoyal Stoke University Hospital

Centre of England NetworkUniversity Hospital of Coventry & Warwickshire Birmingham and the Black Country NetworkQueen Elizabeth Hospital, BirminghamBirmingham Children’s Hospital

Severn Network Southmead HospitalBristol Royal Children’s Hospital

Peninsula Network Derriford Hospital

Thames Valley Network John Radcliffe Hospital

Wessex Network Southampton General Hospital

NE London Network Royal London Hospital

NW London Network St. Mary’s Hospital

SE London NetworkKings College Hospital

SW London NetworkSt. George’s Hospital

Sussex

London

East of England

East Midlands

Yorkshire & the Humber

North East

S. Cumbria & Lancashire

Greater Manchester

Merseyside & Cheshire

N.W. Midlands

Centre of England

Birmingham & Black Country

What has changed On scene patient triage: Positive

Direct to MTC (< 45 mins travel)

Indirect Transfer(>45 mins, time critical intervention)

MAJOR TRAUMA CENTREConsultant led trauma teamImmediate operating theatreAll specialties: neurosciencesImmediate CT scanInterventional radiologySpecialist critical care

Trauma UnitTrauma teamImmediate CT Resuscitate, Assess & ? Transfer

TARN

Major Trauma Centre: Best Practice Tariff Year 3 (14-15)

Additional payment made to Major Trauma Centres only

Based on Injury Severity

Moderate Trauma (ISS>8): £1,500

Major Trauma (ISS>15): £3,000

Payment conditional on Best Practice criteria being met

Major Trauma Centre: Best Practice Tariff Year 3 (14-15)

Level 1 (Moderate Trauma): Injury Severity Score >8

TARN data is completed and dispatched within 25 days of discharge/death.

Rehabilitation prescription completed for each patient & recorded on TARN.

Tranexamic acid (TXA) administered within 3 hours of injury for any patient receiving blood: Exclusions: Isolated Serious (Severity 3+) Head injuries

Non-emergency transfers: Patient must be admitted to MTC within 2 calendar days of referral from Trauma Unit

Major Trauma Centre: Best Practice Tariff Year 3 (14-15)

Level 2: (Major Trauma) Injury Severity Score >15Level 1 criteria and following additional criteria met:

Direct admissions or emergency (<12 hour) transfers: Patient must be seen by Consultant within 5 minutes of arrival

Direct admissions: Head CT performed within 1 hour of arrival for patients with SeeAIS1+ Head injury & GCS <13 in ED (or intubated pre-hospital)

Exclusions: patients requiring emergency surgery or interventional radiology within 1 hour of admission

Additional BPT fields added to TARN database

Web-based Trauma Data Collection

Electronic data collection & reporting system Secure on-line system through patient pathway Data Collection AND Reporting

TARN Reports Clinical Reports: Published March, July, November. Email notification to all users

Performance Comparisons: Updated March, July, November. Available to all.

Online Reports: Self produced reports

Ad Hoc analysis: Available any time

Separate Reporting

Training session

Questions?