Test webinar

After the presentation, participants will be able to:

• Discuss why Trauma Registry matters
• Detail the core functions of the Trauma Registry
• Show how the Performance Improvement cycle is supported by the Trauma Registry
• Discuss the real-world impact of Registry on PI

Date: January 28th

Time: 12:00 PM EST

It is the responsibility of the Trauma Registry Professional to be familiar with each hospital event to accurately identify and document the correct data points. Since hospital events can change from year to year, the Trauma Registry Professional must be adaptable to keep up with these changes.

Everyone has their own learning style. Some people grasp the NTDS document by reading it directly, while others find it more helpful to use an algorithm. Some key points to be aware of include learning how to correctly read the NTDS and reviewing the 2024 Hospital Event Algorithm flow chart. This is available for download from AKI TEST (facs.org). For the 2025 NTDS, the algorithms are integrated into the documentation.

When reviewing hospital events, extra effort is needed to identify specific conditions, such as Acute Kidney Injury. To comprehend what you’re examining, you might need to broaden your knowledge by learning about factors like what defines an eGFR.

Acute Kidney Injury Example:

Chronic Kidney Disease in Type 2 Diabetes | Kerendia® (finerenone) | Patient Site  (kerendia-us.com)

Understanding the language and structure of NTDS Hospital Event documentation is crucial for accurate data interpretation and reporting. The presence of “and/or” statements requires careful attention to ensure that the data is categorized correctly. Additionally, the flow of data within the algorithm can vary, highlighting the importance of a thorough review of each document. Familiarity with these nuances is essential for maintaining the integrity of the data and supporting effective patient care outcomes.

The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) plays a crucial role in enhancing patient care by collecting data on hospital events. This data is instrumental in identifying facilities with lower incidence rates, which can then serve as benchmarks for others. By analyzing and adopting the strategies of these leading facilities, hospitals can work towards reducing their own event rates, ultimately improving patient outcomes and elevating the standard of trauma care.

As acute care case managers, we face numerous challenges in ensuring patients receive optimal care and effective discharge planning. This blog highlights these barriers and offers resolutions and advice to overcome them. Many challenges are interconnected, often compounding one another, making it critical to approach them with a strategic mindset.

5 Challenges in Case Management

In the complex healthcare landscape, case managers play a pivotal role in ensuring seamless patient care transitions, particularly as patients prepare for discharge from the hospital. These professionals juggle multiple responsibilities, including patient advocacy and resource management, to navigate the intricacies of care coordination.

Below, we explore five key challenges faced by case managers, specifically discharge planners in acute care settings, along with practical solutions to address them effectively.

1. Managing Complex Patient Needs with Limited Resources

Studies from the Journal of the American Medical Association reveal that nearly half of Medicare beneficiaries have at least three chronic conditions, making them more medically complex patients. Coordinating care for these patients requires collaboration among various specialists—physical therapists, hospitalists, dietitians, pharmacists, and behavioral health providers, among others.

Coupled with staffing shortages, budget constraints, and limited availability of post-acute services, case managers often struggle to deliver optimal care and discharge planning.

Resolution Advice:

• Identify high-risk patients early during their hospital stay to allocate resources effectively and strategize care plans.
• Conduct daily interdisciplinary rounds led by case managers to facilitate discharge planning and ensure comprehensive care.
• Collaborate with insurance providers’ case managers to enhance resource availability and ensure tailored discharge plans.
• Implement a complex case manager model, assigning experienced social workers or case managers to handle the most challenging cases.
• Educate case management teams on up-to-date guidelines and resources, empowering them to provide holistic, informed care.

2. Staffing Shortages and Heavy Caseloads

The American Association of Colleges of Nursing reported the largest drop in hospital-employed nurses in four decades from 2020 to 2021. These shortages lead to heavier caseloads for case managers and the need to onboard inexperienced staff, which can impact the quality and continuity of care.

Resolution Advice:

• Invest in recruitment and retention efforts, including mentorship programs, continuing education, and competitive compensation.
• Evaluate department structures to delegate non-clinical tasks where possible and streamline workflows for less complex cases.
• Use contract staff to cover gaps, ensuring experienced professionals are available to manage workloads effectively.
• Create a supportive team environment by celebrating small wins and fostering collaboration among team members.

3. Combating Work Fatigue

Case managers face high levels of stress due to the urgency and complexity of their roles. Constant interruptions, emotional labor, and the need to juggle priorities can lead to compassion fatigue and burnout.

Resolution Advice:

• Advocate for manageable caseloads and implement policies promoting work-life balance.
• Incorporate wellness programs and regular team debriefs to support mental health.
• Encourage regular breaks during shifts, even during busy times, to recharge and reduce stress.
• Optimize daily workflows to improve efficiency and reduce unnecessary strain.

4. Maintaining Regulatory Compliance

Case managers must ensure safe, effective discharges while adhering to strict regulatory requirements. Frequent changes in federal regulations, public health policies, and payer guidelines add to the complexity.

Resolution Advice:

• Stay informed about updates to Medicare, Medicaid, and Department of Health regulations through ongoing education and collaboration with quality teams.
• Use standardized documentation templates within EMRs to ensure thorough and compliant records.
• Conduct internal audits and use feedback to improve compliance practices.
• Simplify discharge instructions for patients and families, allowing time for questions to ensure understanding.

5. Effective Communication

Strong communication is essential for case managers to coordinate care effectively. Challenges include language barriers, cultural differences, and cognitive or emotional factors affecting patients and families.

Resolution Advice:

• Build trust with patients and families through consistent, empathetic communication.
• Use active listening techniques and avoid medical jargon when speaking with non-clinical audiences.
• Leverage multidisciplinary rounds to discuss discharge readiness, identify barriers, and align next steps.
• Provide clear, detailed handoffs to post-acute care providers, ensuring continuity of care.

Conclusion

Addressing challenges in case management requires interdisciplinary collaboration, adaptable workflows, and supportive technology to streamline communication and resource allocation. By prioritizing education, team support, and proactive problem-solving, case managers can improve outcomes for patients and families alike.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/213908

https://www.aacnnursing.org/news-data/fact-sheets/nursing-shortage

Sometimes, the need for a massive transfusion in trauma patients is immediately apparent when they arrive in the emergency department trauma room. However, occasionally, a seemingly stable trauma patient may suddenly experience a drop in blood pressure, surprising the trauma team.

In the trauma data world, trauma registry professionals must come to know predictive tools that they must be able to document accurately. Such predictive tools would include Revised Trauma Score (RTS), Injury Severity Score (ISS), Glasgow Coma Scale (GCS). We are going to look at another predictive tool, Shock Index (SI) and break it down in what it is predicting.

Shock Index defined

Blood pressure and heart rate, when used individually, fail to accurately predict the severity of hypovolemia and shock in major trauma. The Shock Index (SI) is a straightforward calculation, derived by dividing the heart rate (HR) by the systolic blood pressure (SBP). This index can be quickly determined by Emergency Medical Services (EMS) and is valuable in assessing whether a patient needs transport to a trauma center. Additionally, in the Emergency Department triage area, SI helps identify patients at risk of hemorrhagic shock (HS) and the potential need for massive transfusions. It has been researched in patients who are either at risk of or experiencing shock due to various causes, including trauma, hemorrhage, myocardial infarction, pulmonary embolism, sepsis, and ruptured ectopic pregnancy.

Shock Index Levels

When it is broken down, the SI is looking at different levels of shock:

• No Shock: <0.6
• Mild Shock: ≥0.6 to <1.0
• Moderate Shock: ≥1.0 to <1.4
• Severe Shock: ≥1.4

Trauma Registry professionals should be able to understand all the predictive tools and help them know the SI and to not simply add it to the trauma registry should the trauma center be collecting the data but be able to know that the higher the SI, be looking for use of the massive transfusion policy (MTP) and find the type and number of units of different blood products being used.  Being able to link their critical thinking to potential performance improvement issues will make the trauma registry professional stand out and aid in better care for the trauma patient.

To read more about the SI, in 2010 the paper was presented at the 23rd Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma:

“Identifying Risk for Massive Transfusion in the Relatively Normotensive Patient: Utility of the Prehospital Shock Index”

*Vandromme, M. J., Griffin, R. L., Kerby, J. D., McGwin, G., Jr, Rue, L. W., 3rd, & Weinberg, J. A. (2011). Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index. The Journal of trauma, 70(2), 384–390. https://doi.org/10.1097/TA.0b013e3182095a0a

Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index – PubMed (nih.gov)

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)

“Leaders become great, not because of their power, but because of their ability to empower others.” – John Maxwell.

Cancer registry leaders are pivotal to the success of the oncology service line. Their role is not only to lead the registry team but also to manage registry data effectively. Strong leadership and management in cancer registries ultimately enhance the care received by each cancer patient and improve the quality of data that drives advancements in cancer care.

7 Principles for Success as a Cancer Registry Leader:

1. Data Integrity is Crucial
2. Standardization Enhances Collaboration
3. Data Utilization Drives Decisions
4. Visionary Leadership Propels the Team Forward
5. Feedback is Necessary
6. Emotional Intelligence Builds Strong Teams
7. Servant Leadership Supports Growth

Successful leaders share several traits regardless of industry:

• A clear vision and strategic direction.
• The ability to inspire and motivate their team.
• Demonstrating integrity and accountability in all actions.

These traits enhance team productivity and accuracy, increase morale and staff retention, and improve the accuracy and reliability of registry data.

Essential Leadership Skills for Cancer Registry Managers:

Communication

• Articulate goals and expectations.
• Foster open and honest dialogue with and among team members.
• Utilize multiple channels to communicate effectively across the organization.

Motivation and Engagement:

• Create a supportive environment that recognizes individual and team contributions.
• Encourage participation in decision-making to increase engagement.
• Set challenging yet attainable goals that motivate staff.

Problem-Solving:

• Approach problems systematically to identify root causes.
• Encourage creative solutions from team members.
• Use data-driven analysis to support decision-making.

Decision-Making:

• Gather comprehensive information before making decisions.
• Involve team members in the decision-making process to gain diverse perspectives.
• Be decisive and transparent about the reasons behind decisions.

Managing Cancer Registry Data

You are an interpreter, translator, and data manager as a cancer registry manager. When data is requested, take the time to understand what information is being sought. Your stakeholders, executives, and researchers may not fully articulate their needs. By understanding their goals, you can provide impactful data. Always provide a concise written summary that answers their questions and offers an interpretation of the data. Thoroughly review your data before sharing and address accuracy and workflow issues with your team.

3 Key Data Management Principles:

1. Data Integrity: Ensure the data’s accuracy, completeness, and reliability throughout its lifecycle. To maintain data quality, implement routine data validation checks, audit trails, and error-checking mechanisms.
2. Data Standardization: Ensure that data across different sources and systems is consistent and conforms to regulatory standards. Standardization ensures compatibility, improves data quality, and facilitates data sharing.
3. Data Usability: Design data systems and processes that make data accessible and usable for decision-making. Organize data clearly and logically and use tools that enhance data retrieval and analysis capabilities.

Empowering Your Team

As a leader in the Cancer Registry, it is imperative to empower your team. You are the department visionary, expert, and servant. Creating a specific cancer registry vision that aligns with your organization will inspire and motivate your team. Elevate your emotional intelligence and ensure you are building positive relationships. Communication and empathy are vital. Successful leaders are servants—your position is to serve your team.

Empower Your Team Through:

Training and Development:

• Provide ongoing education and training.
• Encourage professional growth.
• Utilize and create mentorship programs.

Delegation:

• Clearly define responsibilities and expectations.
• Match tasks with team members’ skills and career goals.
• Trust team members to perform, providing support but avoiding micromanagement.

Feedback and Recognition:

• Regularly provide constructive feedback to guide performance.
• Recognize and reward achievements in a timely and public manner.
• Foster a culture of appreciation and open feedback among the team.

3 Key People-Focused Leadership Strategies:

1. Empathetic Leadership: Cultivate the ability to understand, empathize, and be responsive to team members’ needs. This approach helps build trust and a supportive team environment.
2. Effective Communication: Develop open channels of communication. Ensure that information is disseminated promptly and transparently to facilitate informed decision-making and foster a positive and collaborative team culture.
3. Development and Empowerment: Focus on the continuous development of team members through training, mentorship, and opportunities for growth. Empower each team member by recognizing their strengths and providing professional development resources.

Feedback and Continuous Improvement

Effective leadership involves creating feedback loops where you can continuously give and receive feedback to improve. Avoid creating loops of only constructive criticism. Aggressive, demeaning, and highly critical leaders lead to stagnant teams, low productivity, low morale, and low retention.

Various methods can propel your team forward and improve data collection in the cancer registry. Implement one strategy at a time. Remember, we are not just capturing data; we are telling each patient’s cancer story in a statistically significant way that translates data into meaningful outcome improvements and programmatic developments.

Leading with excellence in the cancer registry involves managing data with precision and empowering your team to achieve their best. You can create a thriving, productive environment that improves cancer care and registry data quality by focusing on data integrity, standardization, usability, and people-focused leadership.

Embrace these principles and watch your team and the data they manage reach new heights of success.

Critical thinking skills are highly sought after today and are actively taught. With the constant influx of information from TV news and the Internet, it’s crucial to develop critical thinking skills to discern the truth. This is especially vital for Trauma Registry Professionals who handle abstracted information and processes within trauma services.

Critical thinking is defined as the “objective analysis and evaluation of an issue to form a judgment.” Key terms in this definition include objective analysis, evaluation, and judgment, which are essential components of the process. Critical thinking fosters effective problem-solving and creativity, and it underpins rational decision-making.

Below are realistic examples of how critical thinking resolved an issue for trauma registry professionals. The process of critical thinking involves five distinct phases.

5 Phases of Critical Thinking

1. Problem identification: clarifying the problem and determining the root causes between the current situation and the ideal outcome.
   • In the trauma service, a Trauma Registry Professional was tasked to find the missing EMS run sheets, often taking as long as 4 hours on Mondays.
   • EMS were not leaving the run sheets, causing delays in keeping concurrent.
2. Creative thinking: looking at the problem using outside the box thinking. Looking at possible solutions to the root causes through brainstorming, generating ideas.
   • The Trauma Registry Professional started brainstorming to figure out how to decrease the time a registrar must look for and request run sheets from EMS services.
   • Looking at if the trauma registry program can help.
3. Logical Analysis: testing assumptions, thoroughly evaluating options without bias, and ensure conclusions are not from incorrect beliefs and mistaken observation.
   • The registrars began to think outside the box. They reviewed EMS state regulations and found a regulation that said that EMS agencies must leave written documentation in the ED when dropping off the patient.
   • The registrars looked at how the trauma registry program can help.
4. Decision Making: criteria for deciding the path forward and done through team consensus that takes advantage of the knowledge and experience that assess risk and the chance of success and builds commitment to the proposed solution.
   • They found they can customize a single page report that they can send back to the EMS providers by secure email/fax within 24 hours of receiving the patient.
   • The report would be sent to the EMS agencies providing feedback for them. It would allow them to add a section for comments that could provide extra feedback like break out the Glasgow Coma Scale.
5. Coordination/Implementation: timeframes are set, assignments are assigned, and expectations are established.
   • The registrars worked with the PI nurses to create the report template that would pull the data from the registry and put it on the document for EMS feedback.
   • The Trauma Registry Professionals set a date when they would start to send out the reports initially, including the EMS regulation that reminds them to leave written documentation in the ED.

By employing critical thinking techniques, the trauma service was able to quickly obtain EMS trip sheets. Initially, when the trauma service began distributing custom reports, it took some time for EMS agencies to recognize their value. However, once they did, they eagerly incorporated the reports into their performance improvement processes.

Over time, EMS agencies began contacting the Trauma Registry Professionals within 24 hours of patient drop-off to inquire about their reports. If they hadn’t left a trip sheet, the registrar would inform them, and the EMS agency would promptly send it over within five minutes. This change significantly reduced the time the Trauma Registry Professional spent on Mondays calling for trip sheets, from up to four hours to just 30 minutes. As a result, the trauma service received the trip sheets immediately and could promptly deliver reports back to the EMS agencies, enhancing communication between the two parties.

While no one is perfect at critical thinking, consistent practice offers a significant advantage. Strong critical thinking skills enable us to understand ourselves and our opinions better, and to examine diverse perspectives without fear or bias. These skills are invaluable tools for proactively addressing problems in both personal and professional contexts.

First and foremost, data validation is an educational tool that sharpens the skills of the Trauma Registry Professional and in turn, develops better data for the trauma centers to use to improve patient care. Data validation highlights areas of weakness and motivates the registrar to pursue additional training, ensuring the accuracy of data points

There are many ways to do data validation on the trauma registry, so there are multiple tools that one can find to fit their trauma center needs. The main goal is to train the Trauma Registry Professionals to get the most accurate data from the EHR to the registry.

The Guidelines:

The National Trauma Data Standard (NTDS) serves as the essential data dictionary for all trauma registrars. It details all required data fields, providing definitions, element values, and additional information to ensure correct data entry. The NTDS includes a data source hierarchy guide, directing registrars to the appropriate documents for data retrieval. It also outlines associated edit checks, specifying that Level 1 and 2 edit checks must be corrected before data can be uploaded to the National Trauma Data Bank (NTDB). Statewide trauma data dictionaries, for states that track additional data, adhere to the same format as the NTDS.

Hospital-based data dictionaries are designed to indicate where to obtain data from the EHR. They should include an additional column specifying the exact location in the EHR to pull the data. This will assist new registrars in accurately entering data into the trauma registry.

According to the American College of Surgeons (ACS), up to 10% of the total charts per month must be validated. There are two schools in data validation of the trauma registry:

• 100% chart audit:
  • This is used for the new registrar. This will assist in finding out what areas they are weak in and in turn get them educated on those areas.
  • Some trauma centers still do 100% chart audits on all their records
• 20-25 data points:
  • Once the new registrar has shown proficiency in the 100% validations, you can then choose 20-25 data fields to perform the validation. You can choose what data fields to track, but it is important to cover the ones that help show the Probability of Survival.
    • Age
    • Mechanism
    • Blunt vs Penetrating
    • Revised Trauma Score
    • Injury Severity Score (ISS)
    • Based on 100%, you can add a percentage to take off for any missing or incorrect data that is found.
    • Inter-rater Reliability (IRR) is the percentage of accuracy the Trauma Registry Professional has obtained in the validation.

    If you select 20-25 data points and your registrars consistently achieves 100% accuracy, you can replace one of those data points with a new one to maintain engagement. Trauma Registry Professionals are aware of the data points being monitored, which helps ensure their integrity.

    One method to do data validation is that you have the data analyst and Trauma Registry Professional and PI RN, or other trauma registrar in the same room. The data analyst gives a registry number to the Trauma Registry Professional who in turn tells the PI RN the medical record number. After the PI RN opens the EHR, the analyst then goes through each data point that is being tracked. The PI RN finds it in the medical record, then answers the question and the Trauma registry Professional has to either acknowledge it as correct, or say it was missed in the registry. Then they can discuss where the registrar found the data.

    In data validation, you aim to identify patterns of missed or incorrect data. If a pattern is detected, you can guide the registrar to relevant courses to improve their understanding. Options include trauma registrar courses, ICD-10 courses, and AIS courses. Sharing validation scores on a shared drive allows the Trauma Program Manager and Trauma Medical Director to quickly review the inter-rater reliability (IRR) of the trauma registrars, ensuring high-quality reports from the registry.

    In conclusion there are many ways to validate a record for the Trauma Registry Professional. The main point is to be educational because no one is perfect. It should be a two-way street where the reviewer identifies the missing/incorrect data, presents it to the registrar and the registrar can show the reviewer where they got the data. All of this is done to help the registrar abstract and enter high quality data to help the hospitals improve the treatment of the injured patient.