Frequently Asked Questions
May, 2007
NOTE:
This is an evolving
document. As significant questions and
issues arise they will be added.
Trauma
Registry Website Address: https://witrauma.han.wisc.edu/wiweb/witrauma.isa
1.
Which trauma patients are to be entered into the State
Trauma Registry?
Answer:
Only those patients listed on
the inclusion criteria should be entered into the State Trauma Registry. Please note the "AND" and
"OR" in the inclusion criteria.
If the patient is admitted for "social" observation or
potential injuries that could develop they should not be entered. They would be entered if they are admitted or
transferred for their injury. If you
activate your trauma activation procedure you put the patient into the
registry. This will help you track
under/over triage.
2. What
qualifications should the data entry person have?
Answer:
It is recommended that the
person submitting the data have anatomy and physiology knowledge, medical
terminology and the ability to extract data from the patient's chart. People who may have a strong background or
training in these areas include the following: RHIA (Registered Health
Information Administrator), RHIT (Registered Health Information Technician), RN
(Registered Nurse), LPN (Licensed Practical Nurse), or CSTR (Certified
Specialist in Trauma Registry). This
list is not inclusive. Others may be
qualified for this position.
3.
What is the Trauma Registry Liaison's role?
Answer:
The Trauma Registry Liaison is
responsible for determining who in his/her trauma care facility has access to
the trauma registry and whether the user(s) may:
·
View data only
·
View data and
access Reports
·
Enter data and
access Reports
·
Enter data but
not access Reports
To
enter a new user or to change a role, the Trauma Registry Liaison should
contact Marianne Peck. There is no limit
on the number of users a facility may authorize but be aware that maintenance
is required for each user authorized to access the trauma registry. Maintenance tasks include adding new users,
resetting forgotten passwords, changing roles and facilities, and deleting
users. Information entered into the trauma
registry is confidential health care information; therefore, access must be limited
to those who have a direct responsibility for the Trauma Registry and for Performance
Improvement (PI).
4.
How often am I required to send data to the State?
Answer: According to HFS 118,
January, February and
March - due the end of April
April, May and June -
due the end of July
July, August and September
- due the end of October
October, November and
December - due the end of January
5.
What is a completed, closed record?
Answer: A completed,
closed record has all possible data entered and verified. There is no other data to be added to the
record.
6.
Where can I find information on the State Trauma
Registry?
Answer:
At this time, the most
efficient way to get information regarding the trauma registry is to contact Marianne
Peck, State Trauma Care System Coordinator, at 608-266-0601 or via email at peckme@dhfs.state.wi.us. There is a plan in the future to have
information available on the trauma system website at http://dhfs.wisconsin.gov/ems.
7.
When a patient is transferred to our facility from
another facility or if we transfer a patient to another facility, who enters
the data on the patient?
Patients Admitted to your facility: If your trauma care facility (TCF) is admitting the
patient to your facility, your facility must put the data in for that
patient.
Patients Transferred to another facility
out of State: If your TCF is transferring the patient to
another hospital in another state, your TCF must put the data in for that
patient.
Patients Transferred to an ACS Verified
Trauma Center (Level 1 or 2) or a Level III Trauma Care Facility with an
In-House Registry: If you are transferring the patient to an American
College of Surgeon (ACS) Verified Trauma Center or a Level III facility with an
in-house trauma registry (a list of ACS Trauma Centers and Level III facilities
with in-house registries is at the end of this document) your TCF has the
option of entering the data yourself or having the Receiving Facility enter the
data for you. However, you must select one option then always submit the data
according to the option you selected.
You may not decide to have the receiving facility enter the data one day
and your facility enter the data the next.
Patients Admitted to a Level III or IV facility
and then Transferred to an ACS Verified Trauma Center (Level 1 or 2) or a Level
III with an In-House Registry: If a
Level III or IV admits the patient to the trauma care facility and then
transfers that patient to a Trauma Center or Level III with an in-house registry
another day, the Level III or IV that first admitted the patient must enter the
data on the patient.
Patients Transferred
from a Level III to another Level III or Level IV: If the patient is transferred from a Level IV to a
Level III or from a Level III to a Level III, the receiving facility (not the transferring facility) should enter the
data on the patient.
8.
What factors should we consider in determining whether
our facility or the
Answer:
9.
Do we put in all the diagnosis codes for the patient
or only the ones that fall into the inclusion criteria?
Answer:
You will enter all
injuries. For example, if the patient
sustains injuries that fall within the inclusion criteria such as a subdural
hematoma or a pneumothorax, but also sustains an ankle fracture, you would
include the ankle fracture in your injury narrative (diagnosis code). The patient that sustains an isolated ankle
fracture and no other injuries does not meet the inclusion criteria and would
not be entered into the registry. If the patient has injuries that meet the
inclusion criteria and other injuries that do not, all injuries should be included in the injury narrative (diagnosis
codes). It will have an impact on the
results of the coding and hence on the analysis of injuries in
10. If a traffic
collision occurs on an interstate what do I put in for the Injury Site E-Code?
Answer:
It would go in under Street/Highway
11. What is the
Secondary E-Code?
Answer:
The secondary e-code is the cause
of an injury that contributed to the patient’s overall condition but it is not
the primary cause of the injury. For
example, a patient is in a motor vehicle collision, hits a bridge then goes
into water. The patient suffers
hypothermia from the cold water. The motor
vehicle collision is the primary E-code and the hypothermia is the secondary
E-Code. Another example: driver has an MVC, striking a telephone pole,
while fleeing the police, and sustains a fractured arm. The patient flees the scene and falls over an
embankment suffering a fractured femur.
The
secondary E-Code is rarely used.
12. Under
Protective/Safety Devices, do you mark Airbag if it exists in the vehicle or only
if it was deployed?
Answer:
Enter “airbag” only if it was
deployed. The majority of times,
13. What is a
First Responder?
Answer:
According to HFS 113,
Wisconsin Administrative Code, a First Responder means, “a person who provides
emergency medical care to a sick, disabled or injured individual prior to the
arrival of an ambulance as a condition of employment or as a member of a first
responder service." A First
Responder Service Provider means, “any organization which provides prehospital
emergency medical care, but not patient transportation."
A
First Responder may include law enforcement and fire. If a First Responder group is state-certified
to provide medical first response, it will be on the list available in the
Trauma Registry dropdown list. If you are
unable to locate the group that provided care to the patient, select “other” then
type in the name of the First Responder group.
14. Who is the
Primary
Answer:
The primary
15. Who is the
Secondary
Answer:
The secondary
16. What do we
do if we do not have the
Answer:
This is a statewide issue that
will be addressed through education of
Currently,
First Responders are not required to create written reports but they should
share information verbally with ambulance services. The Department of Health and Family Services
(DHFS) and the EMS Advisory Board are working on this issue.
If
you gain access to the Wisconsin Ambulance Run Data System (WARDS) through
17. What is
meant by the Referring Facility?
Answer:
The Referring Facility is the trauma
care facility that receives the patient first
if the patient is later transported to another trauma care facility for further
acute care. The facility that the
patient is transferred to secondarily will fill out the referring facility
screen on the facility that first received the patient.
18. What do we
do if the facility is not on the facility list?
Answer:
Please enter the name of the
facility under "Other."
19. How do we
enter data on patients that may have had a seizure, myocardial infarction or
diabetic reaction etc., that caused the injury?
Answer:
This information should be
entered under External Cause Code (E-Code) in the free text for "Cause of
Injury." Example: "Patient
suffered a tonic-clonic seizure during which the patient's car struck a
tree."
20. What is
meant by intubation?
Answer: The patient is
intubated if they have an endotracheal tube, or a non-visualized airway in
place, such as a Combitube, King LT or LMA. Intubation does not include nasal or oropharyngeal
airway.
21.
Whom do we contact for which issues?
Answer: For program
issues on data, coding and using the data in your hospital, you may contact the
trauma center registrars who have agreed to serve as resources in your
region. (See attached list)
For
upload questions or if you cannot login into the Web application, or page
cannot be displayed, contact the Digital Innovation HelpDesk at:
(800) 344-3668 - Option 4
Email:
support@dicorp.com
For
in-house registry questions or if you cannot get into the Internet, contact
your local HelpDesk or IT support.
For questions on when or how to enter a particular
trauma registry patient, contact the Wisconsin Help Desk at:
(608) 261-4400
(866) 335-2180 (toll free)
(888) 845-4160 (TTY only)
Email: helpdesk@wi.gov
22.
How can our trauma care facility staff view the video
recorded at the June trauma registry training?
Answer:
Go to the following website, http://media1.wi.gov/dhfs/viewer/. Then
search by the date of
23.
What is needed to calculate RTS, ISS, AIS and TRISS?
Answer: RTS (Revised Trauma Score) requires
Respirations, Systolic Blood Pressure, and the total Glasgow Coma Score (GCS). ISS (Injury Severity Scale) requires none of
the above information, although sometimes GCS is useful in assigning an Abbreviated
Injury Scale (AIS) to a head injury. ISS is auto-calculated in the trauma
registry. It is the sum of the squares
of the highest AIS injury value in each of the three most severely injured ISS
body regions. The Trauma Injury Severity Score (TRISS)
requires patient age, whether the injury was blunt or penetrating and the RTS
score. The RTS is auto-calculated in the
ED/Admission section. Unfortunately, for
severely injured patients who are intubated where an unassisted respiratory
rate is unknown, the RTS, and therefore the TRISS, cannot be calculated. An ISS is also required to obtain the TRISS.
24.
Are there any interface capabilities with hospital
information systems?
Answer: The State Trauma Registry is a web-based system. Information may be submitted electronically through individual uploads by facilities that have in-house registries (i.e., Collector, NTRACS, Lancet) or be entered directly to the web-based application by facilities that do not have in-house registries. It is a self-contained system and there are no additional interface capabilities seen in the near future.
25.
Are any fields mandatory or can I proceed with
incomplete records? If I forget the “check”
feature will it still accept the record?
Answer: The “Check”
feature within the State Trauma Registry software is a convenience to verify
the accuracy and completeness of a record before closing it. Please remember that this function, if it
exists in your in-house registry may work differently than it does in the State
Trauma Registry. The “check” is required
to close a record; however, it is not necessary to fix all the checks before
closing the record.
26.
What is the process for confirming consistent data?
Answer: The process for
identifying consistent data will evolve over time. Some of the steps to ensure consistent data
entry include your attendance at RTAC meetings and Trauma Registry workshops, through
the work being done by the Ad Hoc Sub-Committee and through the report process. It is your responsibility as part of
performance improvement to attend any meetings offered that will allow
opportunities to participate in the data consistency process, such as the
Trauma Registry Workshops and the RTAC meetings.
27.
Can we enter a tracking number? If so, where and how? (i.e.:
triage tags)
Answer: No, not at
this time.
28.
Do we enter a patient who was DOA that is transferred
to our hospital?
Answer: If the patient
was registered and meets the inclusion criteria, information should be entered
into the registry. If the patient is
taken directly to the morgue and no information is collected, there is no
information to enter into the registry.
29.
What is the process for suggesting enhancements?
Answer: We welcome
suggestions for enhancements; however, please be aware that the State does not
determine what enhancements should be made without consulting the Ad Hoc
Sub-Committee and other data experts.
This reduces the risk that an enhancement that works well for one or
several facilities is not having unintentional effects on other facilities.
30.
How long are the records retained on the Show All screen?
Answer: At this time, records
will be retained indefinitely.
31.
How will we be informed about updates?
Answer: The following
communication tools are in place: the
announcement section on the State Trauma Registry homepage, e-mail updates from
Marianne Peck, RTAC meetings, STAC meetings and Trauma Registry workshops.
32.
Where do we find general system information such as
abbreviations and passwords?
Answer: A list of
abbreviations will be available under the Contact
Support which is on the Welcome page
on the website. Other system
information is already available under this section, including password
information.
33.
Is there a pop-up calendar to enter the date
throughout the module vs. typing it in?
Answer: Not at this
time. The vendor is investigating if
this is possible in the web-based application.
34.
Is it possible to flag multiple patients from the same
incident?
Answer: Not at this
time.
35.
Under the
Answer: The
36.
Can we retrieve a deleted record?
Answer: Not at this
time.
37.
Can you click on a message when checking results and
go directly to the screen that needs correcting?
Answer: Not at this
time.
38.
How will the State Trauma Registry avoid duplicating
trauma numbers of organizations with Collector?
Answer: The State Trauma
Registry uses the facility number and the trauma number together to identify a patient
record.
39.
Can counties designate their own order for drop-downs
so their county is on top similar to
Answer: Not at this
time.
40.
Will trauma care facilities and
Answer: The goal of
the State Trauma Registry Program is to improve quality of patient care. The State Trauma Registry collects data from
state facilities but the software is not intended to allow sharing of data
without the same restrictions and protections currently in place by individual
hospitals. The sharing of information to
evaluate quality, as well as performance improvement, must be initiated by
partners and not dictated by the state.
Aggregate reports generated from the State Trauma Registry may guide performance
improvement (PI) and quality assurance work.
Trauma care facilities will be working through their performance
improvement process in their RTACs to obtain information for PI purposes.
41.
Can scene/meeting location and time be calculated from
GPS?
Answer: Not at this
time.
42.
What about readmits?
Answer: If a person
meets the inclusion criteria, the patient should be entered into the Trauma
Registry.
43.
We don’t record the blood alcohol level. We only indicate if the patient was
tested. Is this a problem?
Answer: Every facility
has procedures that work for them. The
State Trauma Registry accepts any data that is submitted by a facility. However, as everyone involved with the Trauma
Registry examines reports and quality assurance is done on the data,
discrepancies between how information is reported will be identified.
44.
What is the impact of closed vs. active cases on DHFS
reporting? Should we wait until we have all
necessary information before we enter it into the Trauma Registry?
Answer: Facilities
using the web-based application may have open records at various levels of
completeness unless there is a local decision not to enter any data until all
information is collected. When reports
are run, only closed records will be included.
Facilities with in-house registries select records to be electronically
submitted so they likely will not have open records in the registry.
The
timing and amount of information to be gathered before entering data is made by
the facility based on its operations, workload and procedures.
45.
Do you code any pre-existing conditions which might
affect outcomes for example, diabetes or history of transplant?
Answer: There is no place
to enter pre-existing conditions at this time; however, it will be considered
as an enhancement in the future.
46.
Is military time used?
Answer: Yes.
47.
If a record is entered by one user and edited by
another user, does the system keep track of who made changes?
Answer: No, there is
no tracking for changes to individual records within the State Trauma
Registry. Tracking may be part of an in-house
registry.
48.
Can multiple terminals at the same facility have a
short-cut to Collector?
Answer: A short-cut to
the web-based State Trauma Registry may be put on any terminal if there is
access to the internet. Facility policies
likely dictate how short-cuts should be applied for in-house registries.
49.
Can a T be used to enter today’s date rather than
entering all the numbers?
Answer: No.
50.
Can data be printed for hard copy for future
reference?
Answer: There are two
ways to print data from the State Trauma Registry. First, you may print each screen. Secondly, you may run the facsimile
report. The facsimile report is
available only to facilities and contains all data entered on a trauma patient.
51.
On the demographics screen – when the age is
automatically calculated – if I open that record a year later, will the age
change, or does it remain fixed at the age at date of injury?
Answer: The age will
not change as long as the Date of Birth or Arrival Date is not changed. These are the dates from which age is
automatically calculated.
52.
Trauma Registry Number – is it unique to the patient
or to the encounter? For example, if a
patient has an injury that meets the inclusion criteria in 2006 in
Answer: The Trauma
Registry Number is unique to the encounter.
It is a combination of the submitting facility’s number plus a unique
trauma registry number. In the above scenario, the person would have two
different trauma registry numbers. If
those two trauma facilities decide to share data to identify this person, they
would need to use other identifying information, such as name and date of birth.
53.
How often should the password be changed?
Answer: The system
will not force a password change; however, it is recommended your password for the
Trauma Registry be changed on the same schedule as your other system passwords.
54.
Are temps in F or C?
Answer: Both
temperature measurements are available.
55.
If initial facility enters data and transferring
hospital enters different conflicting data – what will this affect?
Answer: The records will be kept separate and a decision must be made when producing aggregate reports. Discrepancies in the data may be discovered through data analysis and may lead to contact with one or both facilities. The State Trauma Registry will not alter any facility’s data. It is not the intent of the State Trauma Registry to replace current PI procedures.
56.
Will the data be saved when a “time out” occurs during
entry of a record? (Incomplete records)
Answer: The Trauma Registry auto-saves data every 15 minutes as well as when the user moves from screen to screen.
57.
What if the IDC-9 is a combination code, i.e., fracture
of the ulna and radius?
Answer: Enter each
injury on separate lines.
58.
How are we suppose to enter a Swing Bed Unit upon
discharge from the facility?
Answer: Swing
Bed Units operate under the Nursing Home regulations so I would enter Nursing
Home unless it is strictly Rehabilitation and your judgement is under Rehab.
Tri-Code
59.
Can Tri-Code be revised if a Registrar knows a
different AIS is more accurate?
Answer: No.
60.
On Tri-code, are there indicators for procedures
performed or for a diagnosis?
Answer: The diagnosis
is included, i.e., fractured femur, but no procedures are coded.
61.
Does Tri-code prompt if information is unclear or if
there might be more than one meaning?
Answer: The Tri-code
conversion function is very forgiving and unless the injuries entered are too
vague or if unrelated language is used, it will usually produce a result.
62.
Is it necessary to cross-check ICD-9 codes with actual
injuries to confirm accuracy? Is there a
quick way to generate a list of ICD-9 diagnoses based on the text entered in
Tri-code?