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Colorado Trauma Network

Spring 2019 Conference

PI/Registry Subcommittee

1

TPM/ TNC PI

Subcommittee • Chair :Stephanie Vega

• Wendy Erickson

• Robbie Dumond

• Valerie Brockman

• Sherrie Peckham

• Missy Sorensen

• Christine Thorkildsen

• Adriana Heins

• Valorie Peaslee

2

• Gwen Holland

• Heather Ditzler

• Jennifer Kraatz Landis

• Amber Lorman

• Meghan Cangley

• Steve Clayton

• Zoe Onyun

• Rochelle Flayter

• Karen Clark-Bond

• Laura Harwood

• Tiffany Moore

• Pam Vanderberg

3

34 Total Responses!

Everything: 1

Registrars: 10

Trauma Nurse Coordinator/Clinician: 7

Trauma Program Manager: 4

Trauma Director: 1

Clinical Quality Specialist/PI Coordinator : 5

Outreach Education: 1

Thank you for participating!

Survey

Hospital DC Date/Time

Q4) A patient arrives to your hospital at 2000 on

03.01.2019 assisted by family after he falls from a ladder

while cleaning gutters. He has an obvious deformity of the

wrist and a pelvis xray reveals a pelvic fracture.

The MD and trauma surgeon determine at 2130 that he

needs transfer to another trauma center. He departs with

EMS at 0100 03.02.2019 from your ED.

What do you report as the hospital discharge date and time?

5

Answer Not Required field value as the ED Disposition is discharge.

CDPHE Data Dictionary

Level I-III

Page 57

Level IV-V

Page 14

7

Sherrie Peckham

Trauma program manager Level I

Electric Scooters

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Scooter Codes – Survey Question

Q3) A patient is admitted to your hospital after striking a

parked car. He was riding an electric stand up motor

scooter that he rented using an app on his mobile device.

He was un-helmeted and travelling approximately 20mph.

What ICD 10 Cause E Code would you record in your

trauma registry?

10

Scooter Codes – Which code?

A. V00.182A Pedestrian on other rolling-type pedestrian

conveyance colliding with stationary object, initial

encounter

B. V00.832A Motorized mobility scooter colliding with

stationary object, initial encounter

C. V00.898A Other accident on other pedestrian

conveyance, initial encounter

D. V00.142A Scooter (nonmotorized) colliding with


Let’s take a look!

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Scooter Codes

• CTN – Winter Conference request

for unified code to support

research on the implementation of

the scooters in urban areas

• Electric powered

• Now regulated and required to

follow all traffic laws like bicycles

• Fort Collins is about to approve

implementation

• Registry staff discussion and

American Trauma Society

Webinar conclude:

15

Scooter Codes – Which code?

A. V00.182A Pedestrian on other rolling-type pedestrian

conveyance colliding with stationary object, initial

encounter

B. V00.832A Motorized mobility scooter colliding with


C. V00.898A Other accident on other pedestrian

conveyance, initial encounter

D. V00.142A Scooter (nonmotorized) colliding with


16

A. V00.182A Pedestrian on other rolling-

type pedestrian conveyance colliding with


Quiz Answer

17

Delay in Transfer

PI and Tracking Val Peaslee

Level III Trauma Program Manager

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Delay in Transfer

A. What does transfer delay mean?

• Facility defined

• Field must be answered yes or no

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Reason for Transfer Delay

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Delay in Transfer - PI

A. Review all transfers

B. Any delays should be investigated

C. Monitor delays from month to month

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Transfer delay mapping/tracking

3

1

4

3

2

1

0

2

3

1

2

2

1

3

2

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5

EMS Issue

Receiving Facility Issue

Referring Facility Issue

Weather/Natural Factors

Other

Transfer Delay Mapping Example

Month 3 Month 2 Month 1

Hospital Events

Meghan Cangley & Melissa Truax

Trauma Quality Specialist

Unplanned Admission to ICU

23

24

Survey Results:

Yes: 56%

No 38%

Unknown 6%

Correct Answer: Yes

Rationale: According to TQIP, it has to be determined

that the patient will require ICU care postop prior to

surgery

25

Survey Results:

Yes 0%

No 97%

Unknown 3%

Correct Answer: Yes

Rationale: According to TQIP, “may require” does not exclude this complication. Must be determined that patient “will require” ICU care post-operatively.

Further Clarifications

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No time limit for unplanned admission to the ICU

Initial admission location does not matter

How do you PI Unplanned

Return to ICU? 27

QUARTERLY ACTIVITY REPORTS

LOOK FOR TRACKS AND TRENDS.

LIT SEARCH WAYS TO PREVENT THE RETURN TO ICUS.

Trends:

28

Geriatric Femurs after OR

AMS after a TBI

CIWA

Preventing Returns to ICU

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Research

Alert

Communicate Trends

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Ventilator Codes and Vent Days

Meghan Cangley

Trauma Quality Specialist

31

CDPHE:

Total Ventilator Days [ImageTrend Tag: TR26.58] [NTDS Tag: O_02]

Definition: The cumulative amount of time spent on the ventilator.

Values: Whole number between 0-400

Additional Information: Each partial or full day should be measured

as one calendar day.

Excludes mechanical ventilation time associated with OR procedures.

Non-invasive means of ventilatory support (CPAP or BiPAP) should not

be considered in the calculation of ventilator days. If ‘Not

Applicable’ is entered, the value will appear blank upon import to

the state.

NTDB:

The cumulative amount of time spent on the ventilator. Each partial

or full day should be measured as one calendar day.

Vent Days: State Aligns with

NTDB Definition

32

Scenario:

Patient arrives to ED 1/2/2019 and is intubated for altered mental status and

placed on vent at 2300.

They are taken to OR at 2330 for a femur fixation and then go to ICU post-op

at 0100 on 1/3/2019.

Their mentation clears and they are extubated at 1600 on 1/3/2019.

Since they were on the vent in ED would this count as a partial day of

ventilation?

Vent Days TQIP Clarification

TQIP Answer:

Yes. Even though it was only for 30 minutes in the ED on that

calendar day, the patient was still on the ventilator for a partial

day, so it should be counted as one full day towards the cumulative

total. If they were extubated at 1600 the following day, then “2”

should be reported to TQIP for the Total Ventilator Days data

element, assuming that the patient was not on mechanical

ventilation at any other point during their initial stay.

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Continuous Mechanical Ventilation ICD 10 Code

Only required to report first occurrence to NTDB/TQIP/CDPHE

- 5A1935Z for less than 24 hrs

- 5A1945Z 24 - 96hrs

- 5A1955Z if > 96 hrs

IF first occurrence was less than 24hrs but then patient is re-

intubated and it is a longer timeframe, only the first occurrence

of mechanical ventilation is required.

Performance Improvement

This may meet NTDB/State definition for unplanned intubation

and should be reviewed.

34

Performance Improvement Q&A

Valorie Brockman

Trauma Program Manager

35

What PI data can you get from the state?

Examples of filter lists from different facilities.

Question

36

Data Request Form

37

Data Request Form

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Data

Request

Form

39

Data

Request

Form

40

Data

Request

Form

41

When will the State be accepting the AIS 2015 codes?

NOW

Question

42

How are systems tracking the documentations on

transfers and recommendations that a resource facility is

communicating. How are they tracking that instructions

recommended by the resource facility are being

followed?

Question

43

Transferring Facility

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Trauma Transfers – PI Filters

45

Trauma Transfers – Documents

46

How are facilities incorporating the JCAHO

taxonomy of impact, type, domain, cause,

prevention and mitigation?

Question

Taxonomy

Have a reference sheet available for primary,

secondary and tertiary review to make

determinations on each case.

Make sure the registry PI screen matches the options

you have on your reference sheet so that it can be

added to the review in the registry.

If you keep minutes, separate from the registry,

include taxonomy on minutes.

47

Example from Univ. of Colorado –

Stephanie Vega

48

Front

49

Back

50

Taxonomy- PI in the Registry

51

Performance Improvement

Review Tool

Jamie Teasley

Trauma Nurse Clinician

52

• The chief cause of a trauma center’s verification failure is the lack of

adequate PIPS and event resolution.

• PIPS programs continuously evaluate trauma core measures through a

concurrent assessment of the process and outcome of patient care by

routine analysis achieved through Primary L1o, Secondary L2o and

Tertiary L3o levels of review.

• Once an event is identified, L1o review takes place concurrently, is

reported weekly in order to verify, validate and utilize a specific set

of core measure or “drill down” questions.

• If the provider or system events requires further investigation, then it

moves onto semi-monthly L2o with the Trauma Medical Director (TMD).

This includes a thorough review of the EMR, individuals involved, and a

timeline of events with the goal of prompt feedback and resolution.

• If resolution is not achieved then a L3o multidisciplinary peer review is

conducted to include, peer assessment of the efficiency, safety, and

efficacy of the trauma care with evidence based corrective actions.

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• We proposed that certain events could be closed at L1o

based upon impact/degree of harm or successful

corrective actions and event resolution.

• We projected that this lean and reliable L1o would

decrease the number of open events brought to L2o.

• We proposed that succinct and inclusive presentation of

each event would decrease the need for additional data

requested by the TMD at L2o and allow for prompt event

resolution.

• We desired to successfully implement a process to

stratify the degree of harm which would guide

consistent triage of events to L3o.

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• The result of defining drill down questions was a comprehensive list of core

measures available in a spreadsheet which includes: complications/audit

filters/clinical practice guidelines compliance which could be closed at L1o

or L2o, NTDB/institution specific definitions with stratification of minimal,

moderate, or severe degree of harm were included.

• Information was gathered concurrently from trauma service rounds, EMR,

EMS data, referring facilities, or provider discussions at morning handoff

report. Information is entered in the trauma registry PIPS module.

• This refined tool increased confidence and decreased the trauma staffs’

learning curve while streamlining analysis and resolution of events and

ensuring validity and inter-rater reliability.

• This drilldown tool continues to evolve as more Trauma PIPS event needs are

identified and level of harm defined.

• Clinical staff increased their review of more audit filters and events with

resolution at L1° review, resulting in fewer unnecessary events requiring L2°

review resulting in a leaner process.