Accurate data collection in trauma registries is crucial for maintaining state and national designation and verification but it can also enhance trauma patient care protocols and reduce mortality. These specialized databases allow for timely, ongoing analysis of all phases of care from the moment of injury through patient discharge and beyond.
By submitting trauma care details to Trauma Quality Improvement Program (TQIP), facilities can benchmark their trauma care against comparable facilities and make needed adjustments. However, for data-driven insights to truly improve patient care, the data must be accurate.
Data integrity ensures comparable benchmarking cohorts and can help accurately identify areas for further research or care protocol refinement. Trauma registry professionals contribute directly to these evidence-based innovations that enhance patient outcomes by maintaining high data quality.
Accurate data is the back-bone of empowering trauma centers to deliver optimal care but it’s not always easy to achieve.
Challenges to Data Accuracy in Trauma Registries
Typically, trauma registry teams rely on outdated technology that requires them to manually retrieve data from multiple sources and abstract into the trauma registry software. A significant amount of time is spent accessing and transposing information from various resources, including the electronic health record (EHR). When outdated systems can’t easily facilitate integration with EHRs, the abstraction burden is placed on Trauma Registry Professionals.
Manual Data Entry
This level of manual data entry is arduous, particularly considering the accuracy and completion standards necessary to meet national, state, and local standards by the closure deadline. These antiquated systems and looming deadlines not only increase the registry team’s workload, they may also contribute to high turnover, job dissatisfaction, and data quality issues.
Intense Workloads
The intense workload that old trauma registries require contributes to the burnout of the registry team. This makes maintaining accurate data that much harder. Inexperienced registry team members can also contribute additional stress because of extra scrutiny and frequent correction by senior registry team members.
2 Years
It takes almost two years for a new Trauma Registry Professional to truly understand the complexities of the trauma registry and how to use reporting to verify data accuracy. Outdated registry technology and the stress they create makes maintaining accurate trauma data a gargantuan task. Fortunately, there are resources to help trauma registry teams improve their data quality.
Best Practices for Ensuring Data Integrity
One effective strategy for maintaining accurate trauma data is participating in the Trauma Quality Improvement Program (TQIP). TQIP provides validated, risk-adjusted benchmarking for Level I-Level III trauma centers and it includes training for trauma registry staff to increase data quality. TQIP was created in 2008 by the American College of Surgeons Committee on Trauma and they provide excellent educational resources to help teams stay up-to-date on patient care best practices.
The “Grey Book”
The ACS recently released Resources for the Optimal Care of the Trauma Patient, 2022 Standards (“the Gray book”), which requires all verified trauma centers to have their own data quality plan (Standard 6.1). The plan should include appropriate data validation methods, including registry vendor software validation, data type, data completeness, data logic, and inter-rater reliability (IRR) processes.
Monthly Reviews
The ACS recommends that all data be run through both single variable and a multi-variable review on a monthly basis. The ACS education portal provides some excellent examples of facility data validation plans as well. The parameters for a data quality plan may differ for every verified trauma center but establishing standard practices is essential.
NTDS & Data Dictionaries
The ACS also created the National Trauma Data Standard (NTDS) to help trauma facilities develop best practices and standard methods of data collection. According to the ACS website, the NTDS “defines a standard set of clinical data elements in order to characterize trauma care at the national level, and to provide meaningful inter-hospital comparisons.”
The NTDS Data Dictionary offers standard names, definitions, and data types for specific data elements while also providing validation standards to reduce incomplete or missing data. Adherence to the NTDS data element definitions ensures data quality and completeness while standardization improves the statistical quality of comparisons between trauma centers for measurement and research.
Each trauma center should maintain their own, “data dictionary”, to standardize data element collection and validation for custom data elements beyond NTDS to enhance center-specific trauma care quality. These standardized tools help reduce variability and improve the consistency of the data, making it more reliable for tracking outcomes and implementing performance improvement initiatives.
Data Quality Training
Training is another key method that the trauma team can utilize to enhance their data accuracy. The ACS recognizes the importance and correlation of adequate TRP training to data quality. There are several new standards that define the minimum acceptable training and continuing education.
The ACS TQIP program provides monthly quizzes along with a FAQ resource to ensure accurate definitions and criteria. The American Trauma Society (ATS) provides an excellent basic trauma registry course and trauma specific ICD 10 coding courses that meet the requirements of the new ACS standard. The Association for the Advancement of Automotive Medicine (AAAM) provides required AIS coding courses as well.
Helpful Tools
While there are many ways for trauma registry team members to establish internal procedures to maintain data integrity, technology can also be very helpful in this arena. There are trauma registry platforms like National Quality Systems (NQS) that can automatically flag inconsistencies or missing data within patient records and seamlessly integrate with your EHR to reduce manual entry inconsistencies.
Trauma Registry Professionals are integral to maintaining data quality and they deserve tools to make their jobs more efficient. When trauma centers create a data quality plan, invest in education, utilize standard operating procedures, and have user-friendly tools to boost their productivity, accurate data can be quickly mobilized to improve patient outcomes.
Impact of Data Accuracy on Patient Outcomes and Healthcare Decisions
When data is accurate, trauma teams can more effectively track patients through phases of care, identify performance improvement opportunities early, and adjust guidelines or protocols accordingly.
For example, a 2021 study conducted by Stanford University showed accurate data collection through TQIP has led to significant improvements in reducing mortality rates, major complications risks after care and venous thromboembolism incidences through evidence-based policy changes. (Jeff C, Garrison C, Aussama N, et al.The impact of trauma systems on patient outcomes. Curr Probl Surg. 2021Jan; 58(1): 100849. Published online 2020 Jun 10. doi: 10.1016/j.cpsurg.2020.100849)
PIPS
Data-driven performance improvement guidelines like those used in Performance Improvement and Patient Safety (PIPS) have also shown major benefits on patient outcomes. A 2016 study conducted by The Journal of Trauma and Acute Surgery asserts accurate injury severity assessments and patient characteristics data have led to significant reductions in unnecessary imaging, thereby lowering patients’ exposure to radiation and reducing their long-term cancer risks. (Christopher C, John Y, Lynn E, et al. Performance improvement and patient safety program–guided quality improvement initiatives can significantly reduce computed tomography imaging in pediatric trauma patients. Journal of Trauma and Acute Care Surgery 81(2):p 278-284, August 2016)
Trauma registry data is used to drive significant evidence-based changes in practice which highlights the importance of high quality data. Trauma teams should be able to access and implement trauma data to easily develop insightful reports that identify protocols or guidelines that may need enhancement. If registry data is not accurate, the trauma team may be improperly basing decisions leading to ineffective changes to the program and the stagnation of the overall quality of patient care.
Technological Advances and Future Trends in Trauma Registry Data Management
Technological advancements offer exciting opportunities to further enhance the accuracy and utility of trauma registry data.
Clinical Intelligence Tools
The NQS trauma platform has been developed using clinical intelligence to assist with accuracy and efficiency with the goal of minimizing data inconsistencies. NQS can also create one-click drill down reports that can be accessed through the cloud making it easier for trauma professionals to access real-time data and collaborate between trauma teams, researchers, and policymakers (Schedule a demo to learn more about the NQS platform).
As these technologies evolve, adopting them will be key to championing operational quality and efficiency in trauma patient care.
The collection and maintenance of accurate trauma registry data is integral for improving care across the country. The precision that the trauma team brings to the registry creates opportunities for performance improvement, supports better patient care today and paves the way for important advancements that will improve all future patient outcomes.
