3/4/2014. Setting up a trauma registry at your hospital: requirements, expenses, benefits. Goals
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1 Setting up a trauma registry at your hospital: requirements, expenses, benefits 3 rd Swiss Trauma and Resuscitation Day, 28 th February 2014 Dr Rebecca Hasler, MSc (Epi), Inselspital, Bern University Hospital and Zürich University Hospital Dr Nicolas Bless, University Hospital Basel Goals Everyone understands the advantages and pitfalls of a registry You get informed about the Swiss Trauma Registry You get an additional benefit for your own clinic Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 2 Do we need a trauma registry? What is a registry? Standardised way to collect patient data Data pool from several hospitals Benchmark for the evaluation of single or multiple center results There are registries for different specialities, e.g. cancer registries, heart disease registries or intensive care registries Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 3 Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 4 1
2 What are pros and cons? Experiences with implementing the UK trauma registry TARN at Inselspital Bern Comparison with standardised variables (e.g. injury severity or time to CT) Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 5 Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 6 Time to CT for head injury patients: Bern vs TARN Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 7 Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 8 2
3 Follow-up of steps in trauma care and identification of weaknesses Case I 28 (male) winter sports injury Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 9 Scientific publications Setting up a trauma registry team Romana Businger Study coordinator UNZ Brigitte Martinolli Data entry Prof. Aristomenis Exadaktylos Lead Dr. Rebecca Hasler, Msc Project team PD Dr. Beat Schnüriger Project team Dr. Laurence Klenk Project team Livia Braunsdorf Data entry Caspar Breitenstein IT-support Sabina Utiger Data extraction Margrit Fontana Case opening, data collection from other clinics Surgical clinics Intensive care Anaesthesiology Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 11 Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 12 3
4 Costs for data collection and annual registry retention fees Consider inclusion criteria Around Swiss francs per year Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 13 Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 14 How much trauma do we need? Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 15 Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 16 4
5 Calculation of the ISS Datum PID: Ankunftszeit OA / AA UNZ Rettungsdienst (RD) Exitus : Uhr Status / Interventionen Präklinik (bei Erstbeurteilung durch RD = *) Eintreffen RD im Unfalldatum..20 Unfalluhrzeit : Uhr : Uhr Schockraum Crico-/Tracheotomie Frei* Obstruiert* Intubation Larynxmaske Airway HWS Halskragen SO2 %* O2-Gabe AF min Dyspnoe* Apnoe* Breathing Ventilation CPAP Thoraxdrainage links rechts Thorax BD* / HF* Volumengabe /min ml Krist. ml Koll. Vasopressoren Weitere Medikamente Circulation Abdomen* Becken* Beckengurt Extremitätensplint CPR GCS* (vor Intub.) Punkte Pupillen Schädel Disability Log Roll Spineboard Vakuummatratze Andere Opiate BZ Zuhause Industrie Büro Strasse Öffentlicher Ort Wasser Auf dem Land Environment stumpf Ja Traumaart Einklemmung Temp. penetrierend Nein Status / Interventionen Notfallzentrum crico-/tracheotomiert frei obstruiert intubiert Larynxmaske Intubation im Crico-/Tracheotomie Airway Extubation : Uhr UNZ im UNZ Entfernung HWS Halskragen : Uhr Halskragen SO2% O2-Gabe AF /min Dyspnoe Apnoe Breathing: Ventilation CPAP Thoraxdrainage links rechts Thorax BD / HF Volumengabe: min ml Krist. ml Koll. Blut: EK FFP Tc Weitere Vasoaktiva Medikamente Antikoagulanzie n: Circulation: Abdomen Becken Tetanus Beckengurt Extremitätensplint CPR Wundversorgung Antibiose GCS A V M Pupillen Disability: Schädelverl. Log Roll Andere Steroidgabe Hämoccue : Uhr BZ : Uhr Temp : FAST : Uhr LODOX : Uhr CT : Uhr Kontrastmittel Extras: Schädel Gesicht HWS BWS LWS Thorax Abdomen Becken Extremität Weitere : Uhr Bildgebung 16=25??? Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 17 Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 18 Bias If you study the wrong people Swiss Trauma Registry Conference of Cantonal Health Directors: - Severe trauma is part of highly specialized medicine (HSM) - 12 clinics in Switzerland or get the wrong data from them USB KSA KSW USZ KSSG no amount of analysis will turn it right INSEL KSL KSGR CHUV HUG HdV EOC Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 19 Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 20 5
6 Project Steps Consensus conference Definition of parameters / Selection of benchmark registry for international benchmarking Detailed project specification Selection of industry partner Construction Testing Instruction Application Maintenance Development Respect the resources of participating hospitals! Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 21 Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 22 Include all your patients! Look after the documentation! Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 23 Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 24 6
7 Trained personnel only! Apply your information technology! Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 25 Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 26 Take home messages Discussion Trauma registry needs time, money, knowledge and dedicated people Trauma registry gives new insights and helps to improve trauma care Trauma registry is never finished Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 27 Rebecca Hasler, Nicolas Bless SETTING UP A TRAUMA REGISTRY AT YOUR HOSPITAL 28 7
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