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We’re excited to announce our upcoming webinar featuring special guest Kevin Shovlin, MBA, BSN, RN, TCRN, CHFP, NE-BC — Account Executive & Trauma Product Specialist.
The trauma registrar is far more than a data entry role, and this session proves it.
Kevin will walk through how trauma registrars can step into their full potential as active contributors to Performance Improvement, covering:
Blogs
Cancer Registry
Unlike many healthcare departments, cancer registries do not have a universally accepted productivity model. The work of the ODS does not generate relative value units (RVUs) or other traditional performance metrics, making completed cases the most common metric used to evaluate performance. However, case counts alone fail to capture the complexity of registry work or the full scope of an ODS’s responsibilities.
Rather than promoting a universal standard, this article presents a practical framework that measures the time required to complete the three core registry functions associated with a completed case:
The goal is to establish realistic productivity expectations while maintaining complete, accurate, and timely cancer registry data.
The ODS must interpret complex clinical documentation and apply multiple national coding guidelines and staging standards that are continually updated, including:
In addition to national standards, many organizations require collection of institution specific data elements to support accreditation, quality improvement, physician performance reporting, research, and strategic initiatives. These additional responsibilities further influence the time required to accurately complete each case.
Abstracting is only one component of the Oncology Data Specialist’s workload.
Depending on the organization, ODS staff may also be responsible for:
Each of these responsibilities reduces the amount of time available for abstract completion and should be considered when establishing productivity expectations.
One of the greatest challenges in measuring productivity is the variation in case complexity.
Factors that significantly influence abstraction time include:
For this reason, productivity should be measured using average hours per completed abstract, rather than a fixed number of cases per day. Our suggested expectation is an average of 2 hours per completed abstract.
A simple tracking tool should include:
Calculating ODS Productivity:
Productivity expectations should be based on actual abstracting time. Meetings, quality assurance, follow up, case finding, state reporting, accreditation activities, education, software issues, physician queries, and other assigned responsibilities reduce the number of hours available for abstract completion and should be considered when establishing productivity goals.
Productivity should encourage efficiency while maintaining the integrity of cancer registry data.
Organizations that establish realistic productivity expectations and recognize differences in case complexity create a more sustainable work environment, improve staff retention, and produce higher quality registry data.
A productivity benchmark of approximately 2 hours per completed abstract can serve as a practical operational target for many cancer registry programs. However, no single benchmark is appropriate for every organization. Productivity expectations should be defined by the cancer program.
Take the first step today. Review one month of registry activity, calculate your team’s average hours per completed case, assess quality outcomes, and determine whether your current productivity expectations accurately reflect the work being performed.
Productivity is not measured by the number of abstracts completed. It is measured by the ability to consistently produce accurate, timely, and complete cancer registry data while maintaining a sustainable workload for your Oncology Data Specialists.
Not sure where to start?
Velarity’s Cancer Registry Operational Assessment provides a comprehensive evaluation of productivity, workflows, staffing, quality, and operational performance. Our experienced cancer registry leaders identify opportunities to improve efficiency, strengthen data quality, optimize staffing, and prepare your program for long-term success.
Whether you need an operational assessment, strategic consulting, interim leadership, or experienced Oncology Data Specialists, Velarity HCS delivers customized solutions that help cancer programs build stronger, more sustainable registry operations.
Blogs
Clinical Documentation Integrity (CDI)
As healthcare continues its transition toward value-based care, the role of the clinical documentation integrity (CDI) specialist is expanding. Once primarily focused on MS-DRG optimization, CDI professionals are now central to ensuring documentation supports reimbursement, quality measurement, risk adjustment, and organizational performance.
In this evolving environment, understanding risk adjustment is no longer optional; it is essential to effective CDI practice.
The Centers for Medicare & Medicaid Services (CMS) defines risk adjustment as a methodology that adjusts payment based on a patient’s health status, expected utilization, and cost of care.
While historically associated with reimbursement, risk adjustment plays a much broader role. It supports equitable comparisons across providers by accounting for differences in patient complexity, ensuring that organizations treating sicker populations are not unfairly penalized.
Additionally, CMS emphasizes that risk-adjusted measures enable fair and meaningful performance comparisons across healthcare entities. For CDI specialists, this reinforces a key shift in focus: documentation does not simply determine payment, it defines how patient populations, provider performance, and outcomes are evaluated.
Risk adjustment models depend on diagnosis codes reported on claims, which originate from provider documentation. As such, the health record serves as the foundation for accurately representing patient complexity.
Models such as CMS-HCC rely on ICD-10-CM diagnosis codes to predict expected healthcare costs and establish risk scores.
Incomplete, non-specific, or unsupported documentation can result in underrepresentation of chronic conditions and severity of illness. This not only affects reimbursement but also distorts the patient’s clinical profile in downstream analytics. It is also important to recognize that CMS risk adjustment models are prospective. Diagnoses captured during one period influence future payment and benchmarking.
Implication for CDI: Ensuring clear, specific, and clinically supported documentation is critical, not just for the current encounter, but for future financial and quality outcomes.
AHIMA identifies clinical documentation as the cornerstone of healthcare data, supporting reimbursement, quality reporting, public reporting, and analytics.
Accurate documentation directly impacts severity-adjusted outcomes such as mortality, readmissions, and complication rates. Without proper capture of comorbidities, provider performance data may be skewed, making it appear as though outcomes are worse than they truly are.
CDI professionals play a crucial role in ensuring in a data-driven healthcare environment, the integrity of documentation ultimately determines the reliability of reported outcomes.
The rapid growth of Medicare Advantage has intensified the importance of risk adjustment across the healthcare continuum. CMS-HCC models use documented diagnoses to calculate risk scores that directly influence payment.
A critical distinction in these models is that conditions must be documented and supported on an ongoing basis. Because risk scores are recalculated annually, chronic conditions generally need to be captured each year to remain active contributors.
Failure to do so may result in:
This has shifted attention upstream, away from solely inpatient encounters and toward the settings where longitudinal patient care is documented.
As risk adjustment initiatives mature, one reality has become increasingly clear: much of the documentation that drives risk scores originates outside the inpatient setting.
Primary care visits, specialty clinics, and outpatient encounters are where chronic conditions are most consistently evaluated, monitored, and managed. These settings form the backbone of risk-adjusted data used in Medicare Advantage and other value-based programs.
For CDI programs, this represents a significant opportunity to broaden their scope beyond the hospital and into:
AHIMA emphasizes that CDI programs support accurate representation of patient status, reimbursement, and healthcare decision-making across the continuum of care.
In this expanded role, CDI professionals can:
This transition positions CDI as a bridge between inpatient, outpatient, and data analytics functions. This ensures continuity and accuracy in how patient complexity is recorded and reported.
To effectively support risk adjustment, CDI professionals should adopt a broader, more integrated approach to documentation improvement.
Key priorities include:
By extending CDI efforts into ambulatory and population health environments, organizations can better align documentation practices with the realities of value-based care.
The role of the CDI specialist continues to evolve alongside the healthcare landscape. Risk adjustment now influences not only reimbursement, but also quality measurement, provider profiling, and organizational performance.
As much of the documentation driving risk adjustment originates in outpatient and longitudinal care settings, CDI programs have a clear opportunity to expand their impact beyond the hospital walls.
CDI professionals who understand and engage in risk adjustment across the continuum of care are uniquely positioned to ensure that documentation accurately reflects patient complexity, and to serve as strategic partners in advancing both financial and quality outcomes.
In today’s environment, CDI is no longer confined to capturing CCs and MCCs. It is about ensuring the complete and accurate story of the patient is told wherever care is delivered.
Webinars
Trauma Registry
Couldn’t Join Us Live? Get Instant Access to the Recording & Slides
Led by Michael Trelow, CSTR, CAISS, this session was requested by our participants, and you won’t want to miss it!
Click here to download the slides!
Blogs
Utilization Management & Case Management
Let’s be honest! What does Case Management and Utilization Review look like in your Emergency Department?
When a patient comes into the ED, I know the last thing on your mind is documentation strategy. You’re focused on the care of the patient in front of you, getting orders in, managing the family, coordinating with the team. I get it, I’ve been a part of the ED team.
But the reality is that denial rates are at all-time highs. According to HFMA, initial denials are up from 11.41% in 2024 to 11.65% in 2025. Healthcare Finance News reports that in 2025, approximately 2,300 hospitals reported denial-related losses of around $48 billion.
Those aren’t just revenue cycle numbers, that’s real money that was supposed to support real patient care, slipping away because of gaps that often start at admission.
Having worked across level 1 trauma centers, community hospitals, and emergency departments in roles spanning utilization review, discharge planning, complex care transitions, and case management leadership, I can say with confidence that most of these denials are preventable. And it starts with what happens in the first few hours of a patient’s stay.
Here is what we can accomplish when you have engaged Utilization Review (UR) nurses and a team of admitting physicians.
A physician order to admit is just the beginning. What UR nurses need is the clinical picture, the acuity, the comorbidities, the reason this patient cannot be safely managed at a lower level of care. “Admit for chest pain” is a sentence. It’s not a story. Payers want to see why this patient, on this day, needed inpatient or observation-level care. The earlier you paint that picture, the better we can protect the stay.
This is one of the biggest misconceptions I run into. Status designation isn’t something that should be sorted out later by billing. The clinical documentation from the admitting provider directly determines whether a patient qualifies for inpatient status. When clinical findings that support medical necessity are not documented at admission, retrospective clarification efforts can make it harder to support the inpatient level of care. When the documentation does not clearly support the inpatient order, the UR team is left coordinating provider clarifications, resubmitting clinicals, and working against a shortened timeline to obtain a payer determination while the patient is still in-house.
And let’s face it, retrospective work is costing additional dollars. Front-line UR nurses are typically overwhelmed with completing first-day and concurrent reviews, along with sending clinicals. Once that initial denial is issued, you need an experienced appeals team working the denial and assisting with setting up peer-to-peers, if offered. It would absolutely be best practice to prevent the initial denial if possible. Understanding that in this current environment that may not always be possible, it is also important to have a meticulous and highly proficient appeals and denials nurse supporting your team.
Realistically, a patient admitted for pneumonia who also has COPD, Type 2 Diabetes, and heart failure is a completely different clinical picture than a patient with pneumonia alone. It’s a much more complex care plan that may require a longer length of stay. Every active condition being monitored or affecting treatment should be in the chart. For example, malnutrition is a diagnosis that sometimes gets under-documented. Depending on the documented severity, this could be the difference between a CC and an MCC that can directly impact the hospital’s reimbursement. These comorbidities help paint a complete picture of the patient’s clinical complexity and the level of care, monitoring, and resources required throughout the hospitalization. We can advocate much more effectively when the full complexity of your patient is visible.
I see the ED as the front line in identifying patient needs and helping shape the trajectory of care. Understanding that everything moves fast in the ED, it is helpful to the UR team when providers are capturing the full picture of what is occurring with the patient. And let’s not forget the severity of illness while the patient may have been en route in the ambulance! Many times, this is when the patient is at the peak of their medical crisis and is receiving vital treatment. Patient Care Reports from EMTs can also help paint the picture of just how sick the patient is and why hospital care was necessary. Their initial assessment allows for a supported, defensible admission that will, in the long run, save the hospital money.
UR nurses are not here to practice medicine or to create more work for an already stretched clinical team. Consider us your go-to resource when it comes to payer guidelines and an ally that helps with patient benefits and reimbursement. Our goal is to advocate for the patient — including their benefits — and part of that is making sure hospitals are appropriately reimbursed for the care delivered. When billions of dollars in revenue are lost, hospitals struggle to pay for basic needs to keep their doors open. According to the USDA Economic Research Service, between 2005 and 2023, over 140 rural hospitals closed their doors or were converted to non-acute care facilities. Becker’s reports that just this year, in 2026, 18 hospitals completed mergers and acquisitions with larger, more stable health systems. When these smaller rural hospitals close their doors, it’s the patients that suffer. Typically, it is at these hospitals where they can get lifesaving treatment quickly and then, if needed, transfer to higher levels of care.
The relationship between admitting physicians and UR professionals may be one of the most underleveraged partnerships in healthcare. When it works, everybody wins!
Whether you’re a utilization review nurse looking to sharpen your skills, an admitting provider seeking to better understand payer expectations, or a hospital leader focused on reducing denials, we’d love to connect.
We enjoy sharing insights on emerging trends, discussing common challenges, and learning what’s working across organizations.
Contact us today if you have any questions or inquiries!
Cass, A. (2026, June12). 18 hospital M&A’s finalized in 2026. Becker’s Hospital Review.
Morse, S. (2026, April 2). Hospitals’ Net Revenue Leakage Increase 25% Due to Denial Claims. Healthcare Finance News.
Rupasingha, A., & Cho, J. (2025). Federal assistance and rural hospital closings: The impact of the USDA Community Facilities Program (Report No ERR-344). U.S. Department of Agriculture, Economic Research Service.
Williams, J. (2026, January 30). Battle of the Bots intensifies over denials. Healthcare Financial Management Association.
Webinars
Trauma Registry
Missed our May webinar? Check out the recording and slides today!
Trauma programs manage an extraordinary volume of complex data, and effective data management is essential to ensure quality outcomes, regulatory compliance, and ongoing performance improvement.
In this session, Michael Trelow, Director of Trauma Quality, will share practical insights drawn from real‑world experience in trauma quality and data oversight.
Webinar objectives include:
Webinars
Clinical Documentation Integrity (CDI)
We hosted a webinar for the Indiana chapter of ACDIS (the Association of Clinical Documentation Integrity Specialists), missed it? Watch the full recording here.
What is covered:
If you’ve ever felt like the clinical picture was a little… muddled, this session will help you cut through the fog and sharpen your CDI insight.
Webinars
Trauma Registry
Couldn’t Join Us Live? Get Instant Access to the Recording & Slides
This webinar is a focused deep dive into the essential work of trauma registrars, led by Michael Trelow, CSTR, CAISS, and special guest Jennifer King, CAISS. Jennifer is a trauma registry expert with 20+ years of experience across Level I–IV, pediatric, and burn centers.
Topic: The Trauma Registrar: Where Chaos Becomes Data
What You’ll Learn:
Webinars
Trauma Registry
Couldn’t Attend? Get the Webinar Slides and Full Recording
Topic: Inside the Spine: Anatomy & Fracture Types
Date: March 25th
During this session, we will:
Click here to download the slides: Vertebral Spinal Injuries 1
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Utilization Management & Case Management
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Utilization Management & Case Management
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Utilization Management & Case Management
Tip Cards
Cancer Registry
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Cancer Registry
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Cancer Registry
Tip Cards
Clinical Documentation Integrity (CDI)
Download to unlock the full tip card and get the complete breakdown.
Tip Cards
Trauma Registry
Download to unlock the full tip card and get the complete breakdown.
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Clinical Documentation Integrity (CDI)
Tip Card- TEAM Guide Transforming Episode Accountability Model
Tip Cards
Clinical Documentation Integrity (CDI)
Webinars
Trauma Registry
Missed Our webinar? Watch It Here!
This session focused on abdominal gunshot wounds, led by our Trauma Quality Director, Michael Trelow, with special guest surgeon Dr. Christine Toevs, who will share her clinical insights.
Session Highlights:
A great opportunity for trauma registrars to sharpen skills and strengthen data accuracy!
Webinars
Trauma Registry
Catch Trauma Quality Director Michael Trelow’s session on how the Trauma Registry supports stronger performance improvement.
You’ll learn how to:
Take your expertise in trauma performance improvement to the next level with tips you can implement immediately in your quality and registry workflows.
Blogs
Health Information Management & Coding
Accurate ICD-10-PCS revision total knee arthroplasty coding is critical for compliance, reimbursement, and audit defense. However, revision knee cases, especially partial component exchanges, remain one of the most misunderstood and highly scrutinized areas in inpatient coding. Coders often struggle to determine whether a procedure should be reported using the Revision root operation or coded as a combination of Removal and Replacement.
This blog walks through a real-world clinical scenario involving a revision of a tibial component only. Using official ICD-10-PCS guidelines and best practices, we explain correct diagnosis selection, procedure coding, sequencing, and DRG impact. By the end, you will have a clear, practical framework to confidently code with similar encounters while reducing compliance risk.
A 79-year-old male is admitted for worsening pain and instability of a right total knee replacement that was originally performed six years ago. Imaging confirms mechanical loosening of the tibial component without evidence of infection.
During surgery:
The correct principal diagnosis is:
Although the surgeon uses the term “revision” in the operative note, ICD-10-PCS coding is based on what was done, not the procedure name. According to ICD-10-PCS guidelines, the Revision root operation is reserved for procedures that correct or adjust a device without removing it, such as repositioning or tightening.
In this case, the failed tibial component was completely removed and replaced.
Therefore, the correct approach is to code:
Together, these two codes fully and accurately describe the procedure performed.
Correct DRG Grouping- When coded correctly, this encounter groups to:
Misclassifying a partial revision as a full joint replacement or failing to code device removal can trigger payer audits, recoupments, and compliance exposure. Revision arthroplasty cases are consistently high-risk for denials.
To support compliant ICD-10-PCS revision total knee arthroplasty coding, coders and auditors should always:
Additionally, documentation must clearly support medical necessities, such as mechanical loosening, instability, or device failure. If infection is present, coding and DRG assignment change significantly and may introduce a major complication or comorbidity.
For further guidance, refer to official resources from the Centers for Medicare & Medicaid Services and the American Hospital Association.
Accurate ICD-10-PCS coding for revision knee arthroplasty requires careful document review, strong understanding of root operations, and adherence to official guidelines. Coding partial knee revisions correctly helps protect reimbursement and reduces compliance and audit risk.
Need help reviewing complex orthopedic cases or training your coding team?
Contact us today and learn how to code ICD-10-PCS revision total knee arthroplasty correctly, avoid denials, and ensure compliance with this step-by-step guide.
Webinars
Trauma Registry
Missed our recent webinar? You can now watch the full recording of “2026 NTDS Updates: Get Ready for the 2026 Dictionary.”
Led by our expert, Michael Trelow, this session walks you through the most important changes coming to the 2026 NTDS Dictionary.
In the recording, you’ll learn how to:
Whether you work in trauma registry, coding, data abstraction, or clinical workflow support, this recording will help you prepare for the upcoming updates with clarity and confidence.
Webinars
Trauma Registry
After the presentation, participants will be able to:
Date: January 28th
Time: 12:00 PM EST
Blogs
Trauma Registry
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.
Blogs
Utilization Management & Case Management
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.
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.
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.
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.
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.
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.
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.
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
Blogs
Trauma Registry
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:
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
Blogs
Trauma Registry
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:
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)
Blogs
Cancer Registry
“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:
Successful leaders share several traits regardless of industry:
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
Motivation and Engagement:
Problem-Solving:
Decision-Making:
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:
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:
Delegation:
Feedback and Recognition:
3 Key People-Focused Leadership Strategies:
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.
Blogs
Trauma Registry
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
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.
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Trauma Registry
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:
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.
