requested change - pa trauma systems...

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PTOS 2016 Registry, Manual & Collector Approved ChangesUpdated: 10/13/2015

# Requested/Change Notes PTSF Recommendations Committee Actions/Questions

PTOS Page #

Type of change

1 Add additional custom elements slots.

Requested by Dorris at 2014 Fall Conference Add additional slots for custom elements.

N/A N/A Software

2 Must K.00-obesity be documented by the physician, or can the registrar calculate the patient’s BMI using height and weight and assign K.00-obesity if appropriate?

Question received 9-09-14 via e-mail

BMI Categories: Underweight = <18.5Normal weight = 18.5–24.9 Overweight = 25–29.9 Obesity = BMI of 30 or greater

Calculator:http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm(standard vs. metric)

†

Allow registrars to calculate BMI using height and weight as long as a consistent formula/calculator is used.

New discussion at 11-6-14 meeting.

Approved at 11-6-14 meeting:Within Clinical section, add an element to capture BMI.*must calculate automatically within Collector.

Make PTOS ON ADMISSION – WEIGHT AND UNIT OF MEASUREMENT required for all patients.

Use NTDB Initial ED/Hospital height and PTOS Weight to calculate BMI automatically.

K.00 – Obesity definition needs to include “documented by a physician or a BMI of 30 or greater. “

Board approval 12/11/14.

67 & 132

Software/ Manual

3 Request to have Referring Facility

Question received 9/16/14 via e-mail Add field to automatically calculate referring facility


N/A Software

\word\trauma registry\PTOS\2015\2016 Change Document_Updated 10-13-15.doc 1


PTOS Page #

Type of change

Length of Stay calculate automatically just as ED Length of Stay (acute care section) currently does.

Would like to see this added alongside the Referring Facilities Discharge Date and Time fields (Referring Facility section) within Collector.

length of stay.Registry Committee approved at 11-6-14 meeting.

Board approval 12/11/14.

4 If patients are transferred from a “satellite ED” via ambulance, should they be considered transfer ins and captured as PTOS?

Is a satellite ED considered part of the hospital?

Question received 10/2/14 via e-mail. PTSF recommendation: Satellite ED’s should be treated the same as physician offices and urgent care centers. Patients from these types of facilities are not to be considered transfer ins.


Regstry committee agrees with PTSF recommendation. Add clarification to manual.

1 Clarification in Manual

5 10-03-2014

Standards Committee is requesting that the Registry Committee review the Transfer Out Criteria.

Last Registry Committee discussion was 6-28-2005:There have been requests to add more specialty hospitals to the PTOS patient criteria for transfers out. Prior to 2002 only patients transferred to another accredited trauma center were to be included. In 2002, the “transfers out” definition was extended to included patients transferred to a burn center. Some institutions in the past used to just submit every patient that was transferred out and some would just submit those transferred out to specialty hospitals. Examples of

No change to transfer out criteria (11-6).

Adopt NTDB criteria (2/12).

*It was determined that any patient transferred to Wills Eye Hospital does meet the inclusion criteria as a PTOS patient. Wills Eye Hospital


-Little to no feedback is provided from non-trauma centers

-Capturing all transfer outs could better follow the flow

1 Manual



PTOS Page #

Type of change

Transfer Out: Patient seen in Emergency Department at your facility and then admitted either to the Operating Room for emergency surgery or to the inpatient nursing unit. Then, due to a deteriorating condition, requires transfer to another accredited trauma center or burn center. Those patients must be included, as well as those patients who are admitted to the Emergency Department and then transferred to another accredited trauma center or burn center. Patients transferred out to any other hospital should not be included.Should we be capturing transfer outs to non-accredited trauma centers?

specialty hospitals that have been requested are Will’s eye, spine injury specialists and hand injury specialists.

Recommendation is to not include specialty hospitals and leave the definition as it stands. It will be difficult to determine what is considered a specialty hospital and there are few trauma centers that are specialty hospitals. Patients transferred to specialty hospitals are typically single system injuries with low severities of injury.

will be considered a department that routinely admits trauma patients. Thomas Jefferson University Hospital and Wills Eye Hospital now fall under the same facility ID code (1178-51).

within a health system.

-Recommend removing “due to a deteriorating condition” from the current criteria.

2-12-15 meeting discussion:

Volume impact needs evaluated.

All admitted transfers in and all transfers out

e.g. Any patienttransferred to (orfrom) yourhospital viaanother hospitalusing EMS or airambulance

Note: Patients transferred into your facility and then discharged home from your ED should not be included in the PTOS.

Board approved 3-12-15.

6 Result of discussion at 11-6-14 Registry Committee meeting.

It appears these elements were added to PTOS in 1998. No further documentation was found.

PTSF recommends the committee consider removing these elements.

New discussion at 2/12/15 meeting.

51-52 Software/



PTOS Page #

Type of change

The Registry Committee would like to discuss the possibility of removing all/some of the OR availability elements.

‘Was Operating room available when patient ready to transport from ED to OR?’

‘Was attending surgeon present when patient arrived in the OR?’

‘If no, specify arrival time’

‘Attending Surgeon Specialty’

‘Was there documentation that the attending anesthesiologist was immediately present in the OR?’


Make these elements optional and remove from the research download.


‘Was Operating room available when patient ready to transport from ED to OR?’

‘Was attending surgeon present when patient arrived in the OR?’


‘Attending Surgeon Specialty’

‘Was there documentation that the attending anesthesiologist was immediately present in the OR?’


Manual

7 Question received 1/26/2015 via e-mail.

When answering ‘DID PATIENT HAVE A CRANIOTOMY FOR TRAUMA

“A burr hole is performed to remove a hemorrhage (blood clot) from around the surface of the brain. Generally, when a blood clot is moderately old (at least two to three weeks), it may be drained through a small hole in the skull, and a large craniotomy flap (opening in the skull) might be avoided.”

http://www.neurosurgerypa.com/procedures/Burrhole.html

This procedure should be considered a ventriculostomy.

Recommend answering no to the craniotomy element.

Recommend coding to 01.09, other cranial puncture.


This procedure should not be considered a craniotomy. Recommend coding




PTOS Page #

Type of change

(EXCLUDING VENTRICULOSTOMY AND ICP)?’ would you answer yes for a patient who has burr holes with a subdural drain placed bedside in the ICU?

Would you use ICD-9 code 01.24 for the burr holes? This code is the same as the craniotomy code.

this procedure to 01.09, other cranial puncture.

8 Question received 12/3/14 via e-mail.

What is the appropriate ‘INTERHOSPITAL – PROVIDER’ for a patient that is transported from an outside facility via EMS wheelchair van?

EMS wheelchair van is run by an ambulance company.

The driver of the wheelchair van is an EMT.

No personnel in back of van with patient.

1 = Ambulance2 = Helicopter3 = Ambulance/Helicopter rendezvous4 = Police5 = Fire Rescue6 = Private Vehicle (personal car, tax, bus)7 = Walk-In (this does not include patients who walk into the ED after being brought to the ED by private vehicle, etc.)9 = Quick Response Service (QRS)U = Unknown (if mode of transport is not indicated)

EMS wheelchair vans should be considered a private vehicle when recording interhospital provider. Patient would therefore not be considered a transfer-in.


EMS wheelchair vans should be considered private vehicles with recording interhospital provider.


9 Concerns received1/16/2015 and 1/20/2015via e-mail.

When using the grid to calculate step down days, an error occurs when step down days exceeds hospital days.

The calculation for step-down days has not changed.

Step down days should be calculated by counting the actual days the patient spent time in step down. Step down days should not be calculated by subtracting the admission date from the discharge date.

For time being, registrars were told to match step-down days to hospital days in these situations by removing the start and end dates within the grid and manually entering in the days in the box underneath the grid.

PTSF understands that step down days should not exceed hospital days.

PTSF recommends a formula be set within COLLECTOR so that step down days cannot exceed hospital days.


Set a formula within COLLECTOR so that step down days cannot exceed hospital days.

77-78 Software/ Clarification in Manual



PTOS Page #

Type of change

2013-2014 PTOS data shows no instances of step down days exceeding hospital days.

10 Request to modify wording of ‘Was the first set of vital signs (pulse, RR, Systolic BP, and GCS) taken within the first 10 minute of patient’s arrival to ED?’

Proposed Change:‘Was the first set of vital signs (pulse, RR, Systolic BP, and GCS) taken within 10 minutes or less of patient’s arrival to ED?’

WAS THE FIRST SET OF VITAL SIGNS (PULSE, RR, SYSTOLIC BP, AND GCS) TAKEN WITHIN THE FIRST 10 MINUTES OF PATIENT’S ARRIVAL TO ED?•1 = Yes•2 = NoAdditional Information:•If the initial value for pulse, respiratory rate, systolic BP and GCS were documented within 10 minutes of the patient’s arrival to the ED then the response should be 1 (yes).•If any of the initial values for pulse, respiratory rate, systolic BP and GCs were documented greater than 10 minutes after the patient’s arrival to the ED then the response should be 2 (no).

PTSF recommends changing the wording of this element to include “10 minutes or less.”


Change the wording within this element to state, “10 minutes or less.”

71 Software/ Manual

11 Request to modify wording of ‘Injury Time’ definition.

INJURY TIMEThe time the injury occurred. Note: If the only documentation that appears on the patient run sheet is a data field listing the “approximate” time the injury occurred, this may be utilized to record the injury time. The NTDB also allows estimates of time of injury.“Estimates of time of injury should be based

Under Additional information of ‘Injury Time’ the PTOS Manual 2012 and prior stated, “If the time of injury recorded on the prehospital record or Emergency Department record is invalid, the time prehospital care personnel were notified of the injury may be used if it is known that there was not a substantial delay between the time of injury and the notification.”

The NTDB note added in 2012 contradicts that statement. The NTDB note states, “Note: If the only documentation that appears on the patient run sheet is a data field listing the “approximate” time the injury occurred, this may be utilized to record the injury time. The NTDB also allows estimates of time of injury. “Estimates of time of injury should be based upon report by patient, witness, family, orhealth care provider. Other proxy measures (e.g., 911 call time) should not be used.”

In 2014 the additional information was removed under

Remove the wording “Othery proxy measures (e.g., 911 call time) should not be used.”

Add a bullet under ‘Injury Time’ that reads, If the time of injury recorded on the prehospital record or Emergency Department record is invalid, the time prehospital care personnel were notified of the injury may be used if it is known that there was not a substantial delay between the time of injury and the notification.”


Add a bullet under ‘Injury Time’ that reads, If the time of injury recorded on the prehospital record or Emergency Department record is invalid, the time prehospital care personnel were notified of the injury may be used if it is known that there was not a substantial delay between the time of injury and the notification.”

19 Manual



PTOS Page #

Type of change

upon report by patient, witness, family, orhealth care provider. Other proxy measures (e.g., 911 call time) should not be used.”

•Collected as HH:MM, should be collected as military time. See Appendix 1 for a Time Conversion table for converting to military time.•Record the time of injury determined by prehospital personnel, police, report from the referring hospital, or as documented by Emergency Department personnel. The time of 00:00 can be entered as a valid time. This time is considered the beginning of a new day

‘Injury Time.’ Therefore, many new registrars do not know it is acceptable to record dispatch time as injury time.

12 Information from previous PTOS Manuals regarding international zip codes is missing from current manual.

2008 PTOS Manual: “Enter 88888 as the zip code of residence for any patient who resides in another country.”

Add the following note under the Zip Code of Residence element.

“Enter 88888 as the zip code of residence for any patient who resides in another country.”

Not taken to committee.

15 Manual

13 The trauma registry must assist in capturing Orange Book PIPS Indicators, which are

PTSF staff sent out an e-mail 5/21/15 regarding MTP. Received a response from about 15 centers.

Centers that are capturing turnaround time for MTP have created custom elements under the Clinical tab

The PTSF recommends adding elements within the Clinical Data tab to capture turnaround time for MTP

6/24/15:

MTP: The committee recommends that

N/A Software/ Manual



PTOS Page #

Type of change

effective October 2016

Standard 6: Performance Improvement and Patient Safety (PIPS) Program

Ancillary Services:*Timeliness of laboratory testing/blood availability -Turnaround time for MTP -Turnaround time for goal- directed component therapy

General PI:Geriatric Specific Indicators including abuse >64

such as ‘Was MTP initated?’ and ‘Time MTP initiated.’ The PI coordinator then follows these patients to track timeliness.

Some center’s blood bank personnel enter MTP related information following all MTP’s into a separate spreadsheet. This information includes: patient identifiers, start, stop, blood products, reversal agents, wasted products, and outcome.

The PTSF currently only captures information regarding child abuse (<18). PTOS does collect,‘IS THERE SUSPECTED ABUSE OR NEGLECT?’ This element only applies to burn injuries and is only required for burn patients at burn centers.

The PTSF recommends adding elements within the Outcome tab under abuse to capture geriatric abuse.

the element ‘Was Mass Transfusion Protocol Initiated’ be added to COLLECTOR within the Procedures 2 Tab above the surgery box. All remaining elements on the mockup be added in POPIMS. The POPIMS Standardization Committee should review these additional elements.

Geriatric Abuse: The committee approved the changes that were presented on the mockup. The word “child” will be removed from the current abuse elements on the Abuse tab so these elements will be applicable for all ages. The burn abuse element ‘suspected abuse or neglect?’ will be removed from the injury section. The two additional physical abuse elements under the additional NTDB screen area will also be removed.



PTOS Page #

Type of change


14 If a patient smokes electronic cigarettes, should S.02-current smoker be picked up as a pre-existing condition?

S.02 – Current Smoker – NTDB Co-Morbid Condition – utilize the 2015 NTDB definition, which is defined as a patient who reports smoking cigarettes every day or some days. Excludes patients who smoke cigars or pipes or use smokeless tobacco (chewing tobacco or snuff).

The PTSF recommends that electronic cigarette use be picked up as the S.02-current smoker pre-existing condition.

6/24/15: The committee approved electronic cigarette use be picked up as S.02-current smoker.

139 Manual

15 Can the terminology of pre-existing condition E.02 - Mental Retardation be changed to read “intellectual disability?”

E.02 – Mental Retardation – Mental retardation (MR) is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors. It has historically been defined as an Intelligence Quotient score under 70. Once focused almost entirely on cognition, the definition now includes both a component relating to mental functioning and one relating to individuals’ functional skills in their environment. As a

In 2011, the PA General Assembly updated and modernized the terminology of the Mental Health and Mental Retardation Act of 1966. The term “mental retardation” was replaced with “intellectual disability” throughout the act.

PTSF recommends changing the terminology used within E.02 from “mental retardation” to “intellectual disability.”

6/24/15: The registry committee approved changing the terminology used in pre-existing condition E.02 – Mental Retardation to “intellectual disability.”

134 Software/ Manual



PTOS Page #

Type of change

result, a person with a below-average intelligencequotient (BAIQ) may not be considered mentally retarded.

16 Can occurrence 77-septicemia be removed or combined into 76-sepsis?

76 = Sepsis: documented by a physician with at least two or more of the following conditions (which occur at the same time):

1. core temperature of > 380 C or < 360 C2. white blood cell count > 12,000 or < 4,000 or > 10% immature bands3. positive blood cultures (excluding contaminants)4. clinically obvious source of infection5. heart rate > 90 beats/min or respiratory rate > 20 breaths/min

77 = Septicemia: positive blood culture, excluding isolates that are thought to be contaminants.

There has been much confusion for registrars when coding sepsis vs. septicemia in the past.

ICD-10 replaced the term septicemia with sepsis.

The NTDB only captures ‘Severe Sepsis.’

The PTSF recommends occurrence 77-septicemia be removed from PTOS.

6/24/15: The registry committee approved the removal of occurrence 77-septicemia from PTOS.


123 Software/ Manual

17 Can a timeframe be added to the Urinary

The CDC’s Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and Non-

The PTSF recommends following the CDC guidelines.

6/24/15: The registry committee

123 Manual



PTOS Page #

Type of change

Tract Infection definition to clearly exclude UTI’s present on admission?

97 = Urinary Tract Infection (UTI) (not present on admission): clean voided or other catheter urine specimen with > 100,000 organisms/ml on C/S. Physician institutes appropriate therapy for a urinary tract infectionCDC guidelines used as reference.

Catheter-Associated Urinary Tract Infection [UTI]) and Other Urinary System Infection [USI]) Events Guidelines were used as a reference when creating this definition.

“An infection is considered Present on Admission (POA) if the date of event of the NHSN site-specific infection criterion occurs during the POA time period, which is defined as the day of admission to an inpatient location (calendar day 1), the 2 days before admission, and the calendar day after admission.”

Please see Handout #5 for complete CDC Guidelines.

recommends the exact terminology from the CDC guidelines be placed within the PTOS manual for clarification.

“An infection is considered Present on Admission (POA) if the date of event of the NHSN site-specific infection criterion occurs during the POA time period, which is defined as the day of admission to an inpatient location (calendar day 1), the 2 days before admission, and the calendar day after admission.”

18 Can an option for in-house Pediatric Unit be added to the Post ED Destination menu?

POST ED DESTINATION:

Record the patient’s final destination from the ED

Field Values1 = ICU/Critical Care Unit 2 = OR (including pre-op area)3 = Med/Surg Unit 4 = Prison Ward (In-House)5 = Step Down6 = Morgue (Coroner, death, DOA)7 = Transfer to Other Hospital/Trauma Center8 = Labor & Delivery9 = Burn Unit (In-House)10 = HomeUnit/Intermediate11 = Interventional Angiography

The PTSF recommends adding an option for an in-house pediatric unit to the Post ED Destination menu.

6/24/15: The registry committee approved of a Med/Surg “Pediatric Unit (In-House)” being added to the Post ED Destination menu.


53 Software/ Manual



PTOS Page #

Type of change

19 Can “during ED/resuscitative phase of care” be added to the ‘Was CT scan of head performed’ element on the Acute Care Arrival/Admission tab within COLLECTOR?

DID PATIENT RECEIVE A CT SCAN OF THE HEAD DURING THE RESUSCITATIVE PHASE? (FLTR 3)

Did the patient receive a CT of the head during the resuscitative phase

1 = Yes 2 = No

Additional Information The resuscitative phase is the time between ED

arrival and Time Transported to Post ED Destination If a CT scan of the head is done at the referring

facility, record “yes” This question must be answered in all cases The computer will match with GCS < 14 to identify

applicable cases for review

Not taken to committee. Request made via e-mail on 8/4.

56 Software

20 The Orange Book requires the arrival times of all advanced practitioners to be captured if consulted. Emergent response must be within 30 minutes.

For example:F. An attending Neurosurgeon or designee must be promptly available. If the attending Neurosurgeon is not in house when on call, they must be promptly available to come in house when requested by the trauma team leader. i. The Trauma Program must define the parameters of immediate response based on level of acuity. a. The immediate/ emergent response must be within 30 minutes.

The PTSF is required to comply with the ACS standards at a minimum. Elements must be added.

6/24/15: The registry committee thoroughly discussed this change. The PTSF will present the committee with a mockup of 3 options in August based upon the discussion.

Tabled to August.

8/31/15:The registry committee approved the draft version of Mockup 1for 2016. Mockup 1 expands both the ED Response and Consults screens to include AP specialties. ED Response and Consults will remain on separate tabs. The ED Response tab will

86 Software/ Manual



PTOS Page #

Type of change

now provide a popup menu so registrars can select to add appropriate AP options as needed. There will be a Called, Arrived, and PGY column. The registrar will also have the ability to copy the information entered on the ED Response tab to the Consults tab. The consults tab will now look like the ED Response tab. Rules defining when Called, Arrived, and PGY columns will be disabled will be addressed in the Consults element definition within the PTOS manual.

Board approved 9-17-15

21 The NTDB has released the 2016 NTDS Data Dictionary. Any 2016 changes must be reviewed and incorporated into PTOS if applicable.

See Handout 3. See Handout 3. New discussion 8-27-15.

The Registry Committee approved the following changes for 2016:

On Admission-Systolic Blood Pressure: Add “Measurement recorded must be without the assistance of

66-67, 136 & 121-125

Software/ Manual



PTOS Page #

Type of change

CPR or any type of mechanical chest compression device. For those patients who are receiving CPR or any type of mechanical chest compressions, report the value obtained while compressions are paused.”

On Admission (Pulse Rate/Minute): Add “Measurement recorded must be without the assistance of CPR or any type of mechanical chest compression device. For those patients who are receiving CPR or any type of mechanical chest compressions, report the value obtained while compressions are paused.”

Utilize the 2016 NTDB definition for Dementia for J.03= Alzheimer’s



PTOS Page #

Type of change

Disease and J.06= Chronic Dementia.

26=Pneumonia: Retire 26=

Pneumonia. Add an

occurrence for pneumonia utilizing 2015 definition with the addition of “does not include VAP.” Will be assigned 100 and placed in the pulmonary occurrences section.

Add an occurrence utilizing the 2016 NTDB name and definition for Ventilator-assisted Pneumonia. Will be assigned 207 and placed in the NTDB occurrences section.

97=Urinary Tract Infection (UTI) (not



PTOS Page #

Type of change

present on admission):

Retire 97=Urinary Tract Infection (UTI) (not present on admission).

Add an occurrence for Urinary Tract Infection (UTI) (not present on admission) with the addition of “does not include CAUTI.” Will be assigned 101 and placed in infection/ sepsis occurrences section.

Add an occurrence utilizing the 2016 NTDB name and definition for Catheter-associated Urinary Tract Infection. Will be assigned 208 and placed



PTOS Page #

Type of change

in the NTDB occurrences section.

Add an occurrence utilizing the 2016 name and definition for Central line-associated bloodstream infection (CLABSI). Will be assigned 209 and placed in NTDB occurrences section.

33=Deep Vein Thrombosis (DVT) / thrombophlebitis: Remove thrombophlebitis from the name of this occurrence. Will read, “Deep vein thrombosis (DVT).”

Add an element for Initial ED/Hospital Pupillary Response utilizing the 2016 NTDB definition. Will be placed on the Clinical tab under GCS-Total.



PTOS Page #

Type of change

Add an element for Midline Shift utilizing the 2016 NTDB definition. Will be placed on the Procedures 2 tab under the new MTP element.



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