Kentucky Trauma Registry

Kentucky Trauma SymposiumLexington, Kentucky November 11, 2010

Andrew Bernard, M.D.Chair, Kentucky Trauma Advisory Committee

Objectives

1. Trauma system overview

2. Kentucky Trauma Registry

3. Potential uses

Rural Trauma is DEADLY

• Rural /Urban: death risk 15:1

• MVC deaths inversely to population density

• Preventable deaths 30% higher if rural

Trauma System Components

• Verified Trauma Centers• Training- EMT’s, nurses, and doctors• Protocols-EMS & hospital treatment & transport • Data collection and surveillance• Performance Improvement (PI)• Injury prevention

Trauma system legislation in 2008.

111

33 4

3

4

4

4

1

32

4

ED Length of StayMarcum and Wallace

Prior Year 1 Year 2 0

20

40

60

80

100

120

140

160

Kentucky’s 1st Level 4 Trauma Center Verification Visit

September 13, 2010; Marcum and Wallace Memorial Hospital, Irvine

September 13, 2010; Marcum and Wallace Memorial Hospital, Irvine

Verification TeamLisa Fryman, RNDick Bartlett, KHAJ.D. RichardsonAndrew Bernard

Kentucky Trauma Advisory Committee Membership (18 Members)

Member Representing Organization Phone Email

Bill Barnes KMA Livingston Hospital 270-988-3298 wbarnes@tririvershc.com

Dick Bartlett KHA KHA 502-992-4305 Rbartlett@kyha.com

Andrew Bernard ACS, KY COT UK 859-323-6346 acbern00@email.uky.edu

Mary Fallat Pediatric Trauma Pediatric Surgery, UofL 502-629-8638 mary.fallat@louisville.edu

Terence Farrell Level II (Seeking) Pikeville Medical Center 606-218-3944 terence.farrell@pikevillehospital.org

Glen Franklin Level I (UofL) UofL 502-852-1895 glen.franklin@louisville.edu

Lisa Fryman Level I (UK) UK 859-257-1231 lisa.fryman@uky.edu

Linda Gayheart At Large Citizen, Hindman 606-785-0606 gayheart@tvscable.com

Chuck Geveden Transportation Cabinet Office of Highway Safety 502-564-3730 chuck.geveden@ky.gov

William Hacker KY Dept of Public Health Commissioner of Health 502-564-3970 WilliamD.Hacker@ky.gov

Sharon Mercer KY Board of Nursing KBN 502-429-3307 sharone.mercer@ky.gov

Earl Motzer Level IV (Seeking) James B Haggin Hospital 859-734-5441 emotzer@hagginhosp.org

Bob Hammonds KY Board of EMS KBEMS 859-256-3181 Bob.hammonds@kctcs.edu

Charlotte O’Neal KY Emergency Nurses Association Frankfort Reg Med Ctr 502-226-7992 Charlotte.O'Neal@HCAHealthcare.com

Chris Pund KY Am Coll of Emerg Physicians Marshall Emerg Serv Assoc 859-335-9041 cpund@mesaer.com

Russell Travis KY Board of Medical Licensure KBML 859-224-2006 htravis@mac.com

Carol Wright Level III (Taylor Regional) Taylor Regional Medical Ctr 270-932-2221 cmwright@trhosp.org

Julia Costich KY Injury Prevention/Research Ctr KIPRC 859-218-2026 jfcost0@email.uky.edu

Kentucky Trauma Registry

EMS Data Can Answer:

• Where did it occur?• How?• Who responded?• Who transported?• Where?• What happened in route?• Were the decisions/actions correct?• What was disposition? In state? Out? • Much more………

CDM“TraumaBase”

Kentucky

Trauma

DatabaseKIPRC

1. Injury Dashboard2. Performance Improvement3. Education4. Injury Prevention

Julia CostichKIPRC

College of Public Health

Eddie NapierKIPRC

Kentucky Trauma Registrar

Kentucky Registry Report 9-21-10

First Report• 13423 records from 2008 and 2009 • 5 basic questions initially investigated:

1. patients moving up the system – evidence of 'right patient, right place, right time’

2. ED discharge characteristics

3. overview of data from new level 4’s

4. In/out-of-state movement

5. duration in referring facility vs. community hospital

Items Investigated

• ICD9 (diagnosis) and AIS distributions• mortality rate• time spent in hospital• total time prior to hospitalization• age (> 55, <15) influences• pre-hospital transport (Ambulance or Helicopter)

characteristics• mechanism of injury• County of residence compared to county of injury• hypotension in the ED• ED disposition to OR or ICU

Conclusions-First Report

1. Appropriate movement in some patient groups.

2. Evidence of the impact that hypotension plays in mortality.

3. Apparent reduction in mortality for certain diagnoses for patients transferred in.

Who should be contributing to the registry?

Kentucky EMS Information System (KEMSIS)

• New software being implemented• Testing 1Q or 2Q 2011 • A few agencies to test the system • Then expand• kemsis@KCTCS.edu

How can the registry help me?

• Local PI– EMS– Hospital

• Regional PI• Leverage revenue and funding• Public education/media/marketing• Focus your prevention efforts• Research

How can I help the registry?

• Trauma centers: legislated• Non-trauma hospitals:

– External force ICD 9 codes – ‘e-codes’– 800-999

• EMS: prepare for KEMSIS

Conclusions

• Trauma systems save lives• Hospitals, EMS, protocols, data, training, PI• Kentucky has a trauma outcome problem

– Rural– Immature system

• You are the answer• We need complete, accurate data• We need to ask questions

Thanks

• TAC members

• Lisa Fryman, UK Trauma Coordinator

Thanks

Dick Bartlett, KHA

Andrew BernardChair, KY TAC

(Trauma Advisory Committee)

acbern00@uky.edu859-913-3613 cell