data validation project Amy Svestka BA EMT CSTR Program Manager TQIP Data Quality American College of Surgeons Committee on Trauma GA Collaborative Data Validation Site Selection Random selection ID: 1044049
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1. GEORGIA TQIP State collaborativedata validation projectAmy Svestka, BA, EMT, CSTRProgram Manager, TQIP Data QualityAmerican College of Surgeons, Committee on Trauma
2. GA Collaborative Data Validation…
3. Site SelectionRandom selectionExcluded centers who had already undergone a data validation visit within the last 3-years.
4. What is a Data Validation Site Visit?Patient ListAll Deaths with a length of stay of 15 days or fewer.Patients with an ISS greater than 24, no major complications, and a length of stay of at least 1, but not more than 30 days Patients with a length of stay between 15 and 30 days with no major complications or deathPatients 64 years of age or more, no co-morbidities, and a length of stay of 15 or fewer days Patients on the mechanical ventilator for more than 7 days who had a length of stay of 30 or fewer days and no pneumonia Patients who survived with a GCS motor score of 1, no major complications, and a length of stay between 3 and 30 days.TQIP Data AbstractionComparison ReviewThe comparison review is for educational purposes.Recommendations
5. Agenda…
6. TQIP Data Validation Tool…
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11. Data validation findings
12. Results…Average scores90-100% overall average 80-89% overall average Below 80% overall averageSubmission Frequency ReportEducationStaffing
13. 90-100% Overall AverageDate of BirthGenderRaceICD-10 Primary External Cause CodeInter-Facility TransferPre-Hospital Cardiac ArrestInitial ED/Hospital SBPInitial ED/Hospital PulseInitial ED/Hospital GCS MotorED Discharge DispositionHospital Discharge DispositionCerebral Monitor DateCerebral Monitor TimeVTE Prophylaxis TypeVTE Prophylaxis DateTransfusion Blood (4 Hours)Transfusion Blood (24 Hours)Transfusion Blood MeasurementTransfusion Blood ConversionTransfusion Plasma (4 Hours)Transfusion Plasma MeasurementTransfusion Plasma ConversionTransfusion Platelets (4 Hours)Transfusion Platelets (24 Hours)Transfusion Platelets MeasurementTransfusion Platelets ConversionCryoprecipitate (4 Hours)Cryoprecipitate (24 Hours)AngiographyEmbolization SiteAngiography DateAngiography TimeSurgery for Hemorrhage Control TypeSurgery for Hemorrhage Control DateSurgery for Hemorrhage Control TimeWithdrawal of CareWithdrawal of Care DateWithdrawal of Care Time
14. 80-89% Overall AverageHighest GCS MotorGCS Assessment Qualifier of Highest GCS TotalMidline ShiftCerebral MonitorTransfusion Plasma (24 Hours)Cryoprecipitate Conversion
15. Below 80% overall AverageCo-Morbid ConditionsAIS Injury CodesHospital ComplicationsHighest GCS TotalInitial ED/Hospital Pupillary ResponseVTE Prophylaxis TimeLowest ED/Hospital SBP
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17. Co-Morbid ConditionsProvides a baseline heath status of the patientRisk-adjusted benchmarkingAverage Score62.96%
18. Co-Morbid Conditions Findings…“Not Applicable” was reported when patient’s past medical history was unknown“Not Known/Not Recorded” was reported when patient’s had no NTDS comorbiditiesDefinitions were not being followedCo-Morbid Condition were reported when the criteria was not metCo-Morbid Conditions were not reported when the criteria was met
19. AIS Injury Codes TQIP Patient Inclusion CriteriaRisk-Adjusted CohortsSevere TBIIsolated Hip FractureNon Risk-Adjusted CohortsFractureMid-shaft Femur FractureOpen Tibia Shaft FractureBlunt Splenic InjuryImportant for modelingHighest AIS by body regionSurvival Risk RatioAverage Score 53.44%
20. AIS 2005Abbreviated injury Scale 2005Update 2008
21. AIS Findings…Missed injuriesExternal InjuriesCerebral ConcussionLung lacerationPericardium hemopericardiumTorn “Vein of Labbe”Injuries coded incorrectlyLarge SDH reported (25). Documentation supported SDH NFS (9)Minor concussion reported (3). Documentation supported DAI (12)Single SDH NFS reported (9). Documentation supported small bilateral SDH (12)Simple open radius fracture reported (6). Documentation supported comminuted open radius shaft fracture (9)
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23. Importance of Hospital Complications…TQIP Benchmark ReportHighlights areas of opportunity, as well as areas of excellenceExcessive missingness could lead to exclusion from risk-adjusted complications modelsUnder reporting will lead to inappropriate labeling of high performanceOver reporting will lead to inappropriate labeling of low performanceAverage Score70%
24. Hospital Complications Findings…Missing Hospital ComplicationsNot Applicable was reported when there was documentation of reportable complications in the patient’s medical recordCardiac arrest with CPRUnplanned return to the ORDefinitions were not being followedHospital Complications were reported when the criteria was not metHospital Complications were not reported when the criteria was met
25. Importance of Highest GCS – Total…Used in the Severe TBI CohortAverage Score65%
26. Highest GCS – Total Findings…Collection CriterionMissed injuriesConcussionThe definition was not followedHighest documented score within 24 hours
27. Importance of Initial ED/Hospital Pupillary ResponseFuture - Severe TBI CohortAverage Score65%
28. Initial ED/Hospital Pupillary Response FindingsCollection CriterionMissed injuriesConcussionThe definition was not followedPhysiological response of the pupil size within 30 minutes or less of ED/hospital arrival
29. Importance of VTE Prophylaxis TimeTQIP Benchmark Report VTE Prophylaxis cohortAverage Score75%
30. VTE Prophylaxis Time FindingsThe time reported was the time ordered, not the time administered
31. Importance of Lowest ED/Hospital SBPTQIP Benchmark Report “Shock” cohortInitial ED/Hospital SBP between 0 and 90 mmHgAverage Score75%
32. Lowest ED/Hospital SBP FindingsDefinition was not being followedLowest sustained (>5 min) systolic blood pressure measured within the first hour of ED/hospital arrivalIncorrect values were reported
33. Submission frequency report findings
34. Submission Frequency Report…Provides frequency tables for each NTDB data variableProvides an opportunity for centers to see what their data looks like when it is received by the NTDBCatches mapping problemsData Validation
35. Submission Frequency Report Findings“Not Applicable” was reported in data fields where ALL patients apply.WeightInitial ED/Hospital SBPInconsistencies between related data variablesSurgery for Hemorrhage Control Type vs. Surgery for Hemorrhage Control Date/TimeClinical sense of associated Co-Morbid Conditions120 patients reported with “COPD” vs. 16 patients reported with “Steroid Use”
36. Causes of data discrepanciesHuman errorDocumentation issuesMapping problemsAbstractor not following or understanding a data field definitions
37. staffing
38. Staffing…One full-time equivalent employee dedicated to the registry must be available to process the data capturing the NTDS data set for each 500–750 admitted patients annually (CD 15–9). This staffing need increases if additional data elements are collected. Hospitals must also take into account the additional tasks, above the abstraction and entry of patient data, that are assigned to the registrar. Processes such as report generation, data analysis, research assistance, and meeting various submission requirements will decrease the time dedicated to the meticulous collection of patient data. Electronic downloads into the trauma registry also create additional tasks, as does ongoing data validation prior to data acceptance. Additional staff will be required to perform these tasks to ensure the integrity and quality of registry data that are used for prevention, PIPS, and other essential aspects of the trauma program.Resources for Optimal Care of the Injured Patient aka. The Orange Book, Chapter 1575% understaffed97 NTDS variables vs. 310 average variables
39. education
40. Education…The trauma registrar is a vital member of the trauma team. Ideally, the trauma registrar works directly with the trauma team and reports to the trauma program manager. Trauma registrars should receive initial training when they start the job.They must attend or have previously attended two courses within 12 months of being hired: (1) the American Trauma Society’s Trauma Registrar Course or equivalent provided by a state trauma program and (2) the Association of the Advancement of Automotive Medicine’s Injury Scaling Course (CD 15–7). Resources for Optimal Care of the Injured Patient aka. The Orange Book, Chapter 15
41. Education…A certifying examination is available through the sponsorship of the American Trauma Society’s Registrar Certification Board, leading to the designation of certified specialist in trauma registries (CSTR) or equivalent. Registrars should complete a minimum of 8 hours of registry-specific continuing education per year. The trauma registrar must demonstrate proficiency with the NTDS. Centers are encouraged to support trauma registrar training by providing educational offerings within the facility. For example, a lecture regarding organ injuries is appropriate training for registrars, because they are expected to code organ injuries, as well as the procedures performed to treat the injuries.
42. TQIP Education…Monthly Educational ExperiencesOne center has not participatedMonthly WebinarsOne center has not participatedTQIP Online Course50% completed the 2017 course
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