10/27/2017

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© 2017 Lehigh Valley Health Network

Successfully Training A “Rookie” Registrar

Robin L. Schrader, CSTRTrauma Registry PI Coordinator

Trainer

▪ One Trainer-Too many too much!

▪ Approachable and Patient-Can be easily interrupted and be patient with repeated questions, etc.

▪ Accessible-Located close to trainee

▪ Knowledgeable (Seasoned Registrar)-Someone who has been doing the job for 5+ years

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What is the Trauma Registry? Why do we need Registrars?

▪ Explain why we collect data. • Registrars Role in Trauma Program• Who gets the Data

– PTSF– NTDB/TQIP– Institution

• What do they do with it– Research– Review Quality of Care– Compare Outcomes/PI– Peer Review

• Why is it important that data is clean/accurate

Getting Started

▪ Start with the Basics-Have an Orientation Packet ▪ Include copies of forms/information used often

– Trauma Registry Patient pick up criteria– Hospital Units/Floors– Consult List– Coding “cheat sheet”– List of Trauma/ED/Surgical residents with PGY listed– How to find EMS PCR’s – Currently in the process of making a step by step guide with screen shots of collector and where we find the

information in EPIC with a screenshot.• Daily Trauma patient pick up list

– What patient’s are Trauma Database “worthy”– What constitutes a “Trauma patient”– Specific injuries that are not picked up (i.e.. Fall same level-hip fx)– Use Teaching tools

– Patient pick up Algorithm– Daily check off sheet for pick up list duties

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REGISTRY INCLUSION CRITERIA

Trauma Alert / Code Red / Trauma Transfer

Seen by Trauma (will have a trauma log)

Transfer In Admitted to Trauma Service (On census) Seen & Referred to Med. Svc Discharged from ED Or sent home for medical condition Pick up Pick up in registry no injury – pick up – Non PTOS NON PTOS **Can be PTOS or NON PTOS** (Burn – do not pick up) (Tfr Tilghman to CC & d/c from ED – do not pick up)*

Patient with traumatic mechanism seen in ED

Seen by Trauma (Trauma 18 consult or regular consult)

Cleared / no injury or Injury, must be at least concussion Admitted to treat Medical- Minor (lac, abrasion, strain &/or recorded LOC and sent No injury sprain, “closed” head injury home Traumatic Injury or admitted without LOC) for medical Pick up in registry condition with AND Sent Home Pick up in registry minor injury Do not pick up, even if (Do not pick up burn ED D/C) There is a log Do not pick up (CHI by ED dr does NOT= in registry Concussion)

Patient with traumatic mechanism seen in ED

Not seen by Trauma

Sent home Admitted on non-trauma svc Medical – no injury To treat Traumatic injury or admitted for medical Do not pick up condition with minor (Includes Transfer in Pick up in registry injury for another service) Do not pick up in Registry Drownings NOT seen by Trauma Do not pick up Rev. 2/2015* The only SDH we do NOT pick up are those proven to be from dialysis or cancer

DAILY LIST CHECK/NOTE SHEET  

DATE:____________________REGISTRAR:__________________ 

TASK       ***remember to leave this on your desk for next day, and notes on back***  DONE 

Run EPIC DC List   

Mark the DC’s on the patient list and write Trauma #/Room/Registrar or __on the DC List   

Email DC list to “Trauma daily dc list” group on copier   

Pull DC’s from Active PT pile and write DC date on top of facesheet   

Enter DC patient    * date/time in collector   *PTOS or NON (if known, by length of stay, etc.)   

Assign charts to registrars (check calendar for who is working and who is on chart holiday)   

Email charts to registrars and put facesheets on desks   

Run EPIC BURN Census (my reports)   

Print Trauma Census (under patient lists/shared/daily census)   

Compare Burn and Trauma Census’ to our patient list/check for pts who may have moved off service or were dc’d and not removed, etc. (****remember to update any room # that still have ED or OR, and move any ED DCs to the unassigned dc list***) 

 

Print new Trauma admission list (patient lists, shared, 24 hour adm)   

Run LV ADT Daily Emergency Dept log‐Trauma‐review looking for trauma pick ups and off service pick ups 

 

Flag “Trauma” patients in EPIC   

Flag “Not a Trauma” for any Non Pick ups and add to non pick up sheet of patient list   

Print FaceSheets from EPIC   

Assign Trauma number to each patient on FaceSheet   

Enter new patients in Collector‐ Name/MR#/Acct #/Sex/DOB/Age   

Enter PTOS or NON PTOS if known (ie. ICU admission/Txfer in)   

Type of injury‐Blunt‐Penetrating‐Burn   

Two digit injury code   

Admission Service   

Transfer in‐yes or no/Transferring Facility   

Admitting MD   

Post ED Destination and Floor Number   

ED Arrival Date/Time 

Alert level‐ED Response Page; For Trauma Alert and Code Red, include MD times   

Diagnoses‐From H&P and initial X‐Ray/Scans only    

Go into Excel “Patient List” and Delete any DC’s that were already assigned to a registrar 

 

Cut and Paste any DC’s, that were unassigned, to the Unassigned DC tab on the patient list‐remember to keep in admission date order 

 

Delete any patients on the “unassigned dc” tab that have been given out   

Add new patients to the Trauma, Burn, off service tabs (keep in date order, ie‐4/5, 4/6, 4/7, etc.)   

Move any Mortalities to the Mortality tab, print, and hang on board   

Update any “no pick up or re admit” patients to that tab (no need to print this page)   

Complete the “dropped” tab if any patients were deleted, # reused, etc. (no need to print this page) 

 

Print the Census‐Trauma, Burn, Off Service, and Unassigned DC tabs   

Mark the Trauma number to start with on the top of the 1st page (Trauma pt census)   

Highlight all new patients on Trauma, Burn, and Off service pages in Yellow   

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The Registrars “Bible”

▪ PTSF Data Dictionary • Review preface and instructions

• Discuss PTOS (PA Trauma Outcome Study) Inclusion Criteria

• Have the registrar read over the Data sections and answer questions

• Review occurrences briefly at this time

• Review Pre Existing Conditions

• Discuss the importance of following the Data dictionary

Collector Database

▪ Introduce to Collector-review pages• Explain NTDB/Burn and Custom tabs

• Starting a new chart

• Closing a chart

• Drop down boxes– Use, but do not replace coding book

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▪ EMS PCR’s• Explain where your facility locates trip sheets

– EMS Charts

– ImageTrend

– Request from EMS squads

• Explain importance of trip sheets

• Go over scene provider vs transport provider and helicopter vs ambulance-helicopter rendezvous

AIS (abbreviated injury scale)▪ Review the AIS book (all new Registrars should be sent to

AAAM AIS Course between 6-12 months of employment)• Review Coder Instructions• Body Regions-What’s included• Explain what the code means=Pre-Dot code(body region/type

of anatomic structure/specific anatomic structure/level of injury) Post-Dot code=Severity

• How to calculate an ISS (1-75)• Why sizes are important (i.e.. SDH, codes to specific size, not

small, moderate, or large)• How to look up codes

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CHARTS

▪ Start with easy, NON PTOS, charts• Abstract the chart from the hospital database (EPIC, EMR, Etc.)

– Explain where in the hospital database you find the information to abstract

• Use the PTSF Data Dictionary as you go through each screen– Have the registrar make notes– Explain the “rules” of the dictionary must be met to use the data (i.e.. Pre-

Existing conditions)– Let the new registrar enter a chart on their own

– Abstract and “Correct” the chart and review with the registrar and explain “why” and “where”, etc.

– As trainee progresses, move on to 2 day charts, PTOS charts, and continue to move to more complex cases (burns, if applicable), and longer LOS.

▪ Charts• As the trainee progresses with charts, you can begin to check

less and less data (i.e.. Demographics, ED stay information, etc.)– Progress until just DX and Procedures are being checked

– When trainee is consistently at 95-100% accurate with charts, progress to independent

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Diagnosis Coding (Tricode)

▪ Discuss Traumatic Injuries

▪ Use of Tricode as a guide, always need to double check your codes!!!!

• Code only Traumatic Injury

• Laterality

• Open vs closed

• Descriptors, Grades, and sizes if known

• Review AIS codes in book

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Procedure Coding (ICD-10-PCS)

▪ Review the ICD-10-PCS book

▪ Explain procedures picked up as per PTSF and as per your institution

• Have a handy list with codes available (“Cheat Sheet”)

• Discuss the “locations” at your facility where procedures may be done

• Many procedures are “learn as you go” with each chart

IMAGING   CT HEAD NO CONTRAST  BW28ZZZ CT HEAD WITH CONTRAST  BW281ZZ CT BRAIN NO CONTRAST  B020ZZZ CT BRAIN WITH CONTRAST  B0201ZZ CT NECK   BW2FZZZ CT HEAD AND NECK  BW29ZZZ CT NECK (NO CONTRAST)  BW2FZZZ CT ABDOMEN NO CONTRAST  BW20ZZZ CT ABDOMEN WITH CONTRAST 

BW201ZZ 

CT CHEST AND ABDOMEN NO CONTRAST 

BW24ZZZ 

CT CHEST AND ABDOMEN WITH CONTRAST 

BW241ZZ 

CT CHEST/ABD/PELVIS WITH CONTRAST 

BW251ZZ 

CT ABD/PELVIS WITH CONTRAST 

BW211ZZ 

CT CHEST NO CONTRAST  BW24ZZZ CT CHEST WITH CONTRAST  BP2W1ZZ CT FACE NO CONTRAST  BN25ZZZ CT FACE WITH CONTRAST  BN251ZZ CT C SPINE NO CONTRAST  BR20ZZZ CT C SPINE WITH CONTRAST  BR201ZZ CT T SPINE NO CONTRAST  BR27ZZZ CT T SPINE WITH CONTRAST  BR271ZZ CT L SPINE NO CONTRAST  BR29ZZZ CT L SPINE WITH CONTRAST  BR291ZZ CT PELVIS NO CONTRAST  BR2CZZZ CT PELVIS WITH CONTRAST  BW2G1ZZ CT SI JOINTS  BR2DZZZ CT SI JOINT WITH CONTRAST  BR2D1ZZ CT SACRUM AND COCCYX  BR2FZZZ CT SACRUM AND COCCYX WITH CONTRAST 

BR2F1ZZ 

CTA HEAD AND NECK  BW291ZZ CTA NECK/w/wo contrast  BW2F10Z CTA THORAX  BW2410Z MRI BRAIN NO CONTRAST  B030ZZZ 

MRI BRAIN WITH CONTRAST  B030Y0Z MRI C SPINE NO CONTRAST  BR30ZZZ MRI C SPINE WITH CONTRAST  BR30Y0Z MRI T SPINE NO CONTRAST  BR37ZZZ MRI T SPINE WITH CONTRAST  BR37Y0Z MRI L SPINE NO CONTRAST  BR39ZZZ MRI L SPINE WITH CONTRAST  BR39Y0Z MRI BRACHIAL PLEXUS WITH CONTRAST 

BW3PY0Z 

MRI BRACHIAL PLEXUS NO CONTRAST 

BW3PZZZ 

MRA  NECK WITH CONTRAST MRA NECK WITHOUT CONTRAST 

BW3FY0Z BW3FZZZ 

MRA HEAD NO CONTRAST  B33RZZZ XR RIBS RIGHT  BP0XZZZ XR RIBS LEFT  BP0YZZZ X RAY RIGHT FEMUR  BQ03ZZZ PLAIN CHEST XRAY  BW03ZZZ PLAIN  XRAY PELVIS  BR0CZZZ BABYGRAM WHOLE BODY  BW0MZZZ XR ABDOMEN  BW00ZZZ BRAIN DEATH NUC MED SCAN  C0201ZZ EKG  4A02X4Z FAST  BW41ZZZ ECHO LEFT AND RIGHT HEART  B246ZZZ XR HIP    R‐BQ00…/L‐BQ01   XR FEM R‐BQ03 /L‐BQ04   XR KNEE R‐BQ07/L‐BQ08   VENOUS DUPLEX BIL LE’S VEINS (DOPPLER) 

B54DZZZ 

VENOUS DUPLEX BIL UE’S VEINS 

B54PZZZ 

US BIL KIDNEYS  BT43ZZZ US BIL KIDNEYS AND BLADDER  BT4JZZZ CAROTID DUPLEX HEAD AND NECK 

BH4CZZZ 

US PELVIS  BW4GZZZ US GI TRACT  BD47ZZZ 

US GALLBLADDER AND BILE DUCTS 

BF43ZZZ 

US BLADDER  BT40ZZZ US UTERUS 1ST TRIMESTER 1‐12 

BY49ZZZ 

US UTERUS 2ND TRIMESTER 13‐28 

BY4CZZZ 

US UTERUS 3RD TRIMESTER 29+ 

BY4FZZZ 

U/S ABD AND PELVIS  BW41ZZZ U/S BRAIN (TRANS CRANIAL DOPPLER) 

B040ZZZ 

Fetal Heart Tones (RATE)  4A0HXCZ SUTURE/STAPLE/REPAIR   

SUTURE SKIN SCALP  0HQ0XZZ SUTURE SKIN FACE  0HQ1XZZ SUTURE  EXTERNAL EAR RIGHT 

09Q0XZZ 

SUTURE EXTERNAL EAR LEFT  09Q1XZZ SUTURE NOSE  09QKXZZ SUTURE UPPER LIP  0CQ0XZZ SUTURE LOWER LIP  0CQ1XZZ SUTURE BUCCAL MUCOSA  0CQ4XZZ SUTURE  UPPER GINGIVA  0CQ5XZZ SUTURE LOWER GINGIVA  0CQ6XZZ Suture upper eyelid  R‐08QNXZZ/L‐

08QPNXZZ Suture lower eyelid  R‐08QQXZZ/L‐

08QRXZZ SUTURE MUSCLE  0JQ…. SUTURE SKIN  0HQ…. 

          

 

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▪ One Trainer-BE PATIENT!▪ Explain the Registrar Role in

the Trauma Program▪ Have “cheat sheets”/examples

available▪ Review PTSF data dictionary,

NTDB dictionary, AIS book, and ICD-10 coding books

▪ ***BE POSTIVE AND ENCOURAGING TO YOUR REGISTRY ROOKIE****

Contact Information:

Robin L. Schrader, CSTRTrauma PI Coordinator

Robin_L.Schrader@lvhn.org