There has been considerable discussion in trauma centers about the optimal number of charts a Trauma Registry Professional should close daily. Some hospitals impose high demands, leading to rapid turnover among registrars. While tracking productivity is essential, it’s crucial to balance the number of charts closed daily with the complexity of data points that need to be abstracted and entered, along with other duties they are asked to perform.
The primary role of a Trauma Registry Professional involves abstracting data from electronic health records (EHR), accurately entering this information into the hospital’s trauma registry, and adhering to national coding standards from the National Trauma Data Standard (NTDS) and other relevant courses like AIS courses. Trauma Registry Professionals must be well-versed in the NTDS data dictionary and may also need to follow additional state-specific data requirements. Additionally, they might have to abstract certain local hospital data points that programs want to track.
According to the American College of Surgeons’ 2022 Standards Resources for the Optimal Care of the Injured Patient, each trauma center must have at least 0.5 FTE dedicated to the trauma registry per 200–300 annual patient entries. The count of entries is defined as all patients who meet NTDS inclusion criteria, and those patients who meet inclusion criteria for hospital, local, regional, and state purposes.” Trauma program managers and directors all know this requirement.
It is in the Additional Information that the ACS adds, “Trauma centers must take into account the additional tasks, beyond the abstraction and entry of patient data, that are assigned to the registrar. Processes such as report generation, data analysis, research assistance, and meeting various submission requirements will decrease the amount of time dedicated to the meticulous collection of patient data. Electronic downloads into the trauma registry also create additional tasks, as does ongoing data validation before data acceptance. Additional staff will be required to perform these tasks to ensure the integrity and quality of registry data, which are used for prevention, PIPS, and other essential aspects of the trauma program.”
Is the additional information being included when the trauma service decides to put a charts per day number in place? Let’s remember that not everyone works at the same pace. Are those differences accounted for? Chances are the current TPM has not hired or supervised all the registrars since the trauma service was started. The registrars that are in place now are often products of another TPM. Some registrars are fast in how they abstract charts, some are more deliberate, making sure they capture everything, and some decide to chase every rabbit that presents itself, thus making them a lot slower. Accuracy and consistency are paramount, and productivity should be tracked alongside accuracy. Data validation parameters should be in place, and registrars should be evaluated based on their experience and certifications. Balancing the number of charts closed daily with data accuracy is crucial.
The 2022 Standards, item 6.1, requires all trauma centers to have a written data quality plan with at least quarterly reviews. Data validation is key to maintaining quality data. Sharing data validation results in a shared folder allows the TPM and Trauma Surgeon to monitor staff accuracy continuously. To begin the process of productivity, you need to obtain some data from the trauma registry. Run several reports that would show average ISS, average Hospital Days, and average ICU days. This baseline will help to be a determining factor in the productivity process.
A simple way to track productivity is to use an Excel sheet that Trauma Registry Professionals can update weekly and submit to the TPM. The sheet should include the following information:
- Trauma Registry Number
- Medical Record Number
- Start Date
- End Time
- ICU Days
- Hospital Days
- Comments (Death, multiple OR, anything that impacts time in chart)
By tracking the number of charts completed and the time spent on each, registrars can gain a clear understanding of their productivity. Without this data, both the registrar and the TPM lack insight into actual performance levels. This tracking system allows registrars to monitor their improvement over time, fostering a sense of increased productivity.
Once you have this data, you can determine a reasonable daily chart closure target that your staff can manage accurately. Productivity and accuracy should be the primary goals for each registrar. This approach will also help you justify the need for additional staff to the administration, especially in response to any increases in trauma cases, as you’ll have a clear understanding of the workload capacity.
Resources for Optimal Care of the Injured Patient | ACS (facs.org)
