Grand Rounds Presentation Permissive Hypotension: Breaking the

Report
Kentucky Trauma Registry
Kentucky Trauma Symposium
Lexington, 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.
11
4
3 1
1
4
3
4
3
4
4
2
3
ED Length of Stay
Marcum and Wallace
160
140
120
100
80
60
40
20
0
Prior
Year 1
Year 2
st
1
Kentucky’s
Level 4 Trauma
Center Verification Visit
September 13, 2010; Marcum and Wallace Memorial Hospital, Irvine
Verification Team
Lisa Fryman, RN
Dick Bartlett, KHA
J.D. Richardson
Andrew Bernard
September 13, 2010; Marcum and Wallace Memorial Hospital, Irvine
Kentucky Trauma Advisory Committee Membership (18 Members)
Member
Representing
Organization
Phone
Email
Bill Barnes
KMA
Livingston Hospital
270-988-3298
[email protected]
Dick Bartlett
KHA
KHA
502-992-4305
[email protected]
Andrew Bernard
ACS, KY COT
UK
859-323-6346
[email protected]
Mary Fallat
Pediatric Trauma
Pediatric Surgery, UofL
502-629-8638
[email protected]
Terence Farrell
Level II (Seeking)
Pikeville Medical Center
606-218-3944
[email protected]
Glen Franklin
Level I (UofL)
UofL
502-852-1895
[email protected]
Lisa Fryman
Level I (UK)
UK
859-257-1231
[email protected]
Linda Gayheart
At Large
Citizen, Hindman
606-785-0606
[email protected]
Chuck Geveden
Transportation Cabinet
Office of Highway Safety
502-564-3730
[email protected]
William Hacker
KY Dept of Public Health
Commissioner of Health
502-564-3970
[email protected]
Sharon Mercer
KY Board of Nursing
KBN
502-429-3307
[email protected]
Earl Motzer
Level IV (Seeking)
James B Haggin Hospital
859-734-5441
[email protected]
Bob Hammonds
KY Board of EMS
KBEMS
859-256-3181
[email protected]
Charlotte O’Neal
KY Emergency Nurses Association
Frankfort Reg Med Ctr
502-226-7992
[email protected]
Chris Pund
KY Am Coll of Emerg Physicians
Marshall Emerg Serv Assoc
859-335-9041
[email protected]
Russell Travis
KY Board of Medical Licensure
KBML
859-224-2006
[email protected]
Carol Wright
Level III (Taylor Regional)
Taylor Regional Medical Ctr
270-932-2221
[email protected]
Julia Costich
KY Injury Prevention/Research Ctr
KIPRC
859-218-2026
[email protected]
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………
Kentucky
Trauma
Database
KIPRC
CDM
“TraumaBase”
1.
2.
3.
4.
Injury Dashboard
Performance Improvement
Education
Injury Prevention
Julia Costich
KIPRC
College of Public Health
Eddie Napier
KIPRC
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
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•
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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
[email protected]
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 Bernard
Chair, KY TAC
(Trauma Advisory Committee)
[email protected]
859-913-3613 cell

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