Balancing Productivity and Accuracy for Trauma Registry Professionals

Balancing chart closure and data accuracy is vital for Trauma Registry Professionals to ensure quality data and improve patient outcomes in trauma care.

By Michael Trelow, CSTR, CAISS

Trauma centers across the country have debated the optimal number of charts a Trauma Registry Professional should close daily. While productivity is important, it’s crucial to balance the number of charts closed with the complexity of the data being abstracted, entered, and the additional duties assigned to these professionals. Excessive demands can lead to burnout and high turnover rates among registrars, which negatively impacts both data quality and staff retention.

The Role of Trauma Registry Professionals

The primary responsibilities of a Trauma Registry Professional include:

Abstracting data from electronic health records (EHR)
Accurately entering the data into the hospital’s trauma registry
Adhering to the National Trauma Data Standard (NTDS) and other coding standards like Abbreviated Injury Scale (AIS) courses

In addition to the NTDS data dictionary, Trauma Registry Professionals must comply with state-specific data requirements and track specific local hospital data points when requested. Their role is vital to ensuring that trauma centers maintain accurate records, meet regulatory requirements, and use data to improve patient outcomes.

American college of surgeons Guidelines for Trauma Registry Staffing

According to the American College of Surgeons’ 2022 Standards for the Optimal Care of the Injured Patient, trauma centers should allocate at least 0.5 FTE (Full-Time Equivalent) for every 200–300 annual patient entries that meet NTDS inclusion criteria. This standard acknowledges the critical role that registrars play in maintaining trauma registry integrity and ensuring patient care quality.

However, the ACS also recognizes that registrars have other responsibilities beyond data entry, including:

Report generation
Data analysis
Research assistance
Meeting various submission requirements
Data validation before registry acceptance

These additional tasks reduce the time available for patient data collection and highlight the need for additional staff to maintain both accuracy and productivity.

The Importance of Data Validation and Quality

Data validation is a critical aspect of maintaining the quality of trauma registries. The 2022 Standards require all trauma centers to have a written data quality plan with at least quarterly reviews. By sharing data validation results in a central location, Trauma Program Managers (TPMs) and trauma surgeons can continually monitor the accuracy of staff data entry. This ensures that the data used for prevention, performance improvement, patient safety (PIPS), and other vital program aspects remains reliable.

Tracking Trauma Registry Productivity

To manage and track productivity, it’s essential to establish a system for monitoring the number of charts closed daily while ensuring accuracy. A simple solution is to use an Excel sheet where registrars can log their work weekly. This productivity tracker should include:

Trauma Registry Number
Medical Record Number
Start Date
End Time
ICU Days
Hospital Days
Comments (e.g., death, multiple surgeries, anything that impacts time spent on the chart)

By analyzing this data, TPMs can assess both the quantity and quality of work completed, making it easier to identify trends in productivity and areas for improvement.

Finding the Right Balance: Accuracy vs. Speed

Registrars work at different speeds, with some prioritizing quick data abstraction while others take a more methodical approach to ensure they capture every detail. It’s essential to account for these differences when setting productivity targets. Accuracy should never be compromised for speed, as the integrity of the data is vital for effective trauma care and program success.

Setting Reasonable Productivity Goals

Once the necessary data has been collected, trauma centers can establish reasonable daily chart closure goals that their registrars can realistically meet while maintaining data accuracy. For example, by running reports that show the average Injury Severity Score (ISS), hospital days, and ICU days, you can gain a better understanding of the average time required to process each chart.

This data-driven approach not only ensures that productivity goals are achievable but also provides justification for additional staff if necessary. If trauma cases increase, the workload must be adjusted to ensure that registrars can maintain high-quality data entry without being overburdened.

Justifying the Need for Additional Staff

By using tracked productivity data, trauma centers can clearly demonstrate to administrators when additional staff are needed. This approach ensures that trauma registries remain adequately staffed, especially during times of increased patient volume or when the complexity of cases rises.

Trauma Registry Professionals play a critical role in maintaining the quality of trauma care. Balancing chart closure targets with data accuracy and registrar well-being is essential to fostering a productive work environment.

By Michael Trelow, CSTR, CAISS

What is Critical Thinking?

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.

Phases of Critical Thinking

Problem identification

The first step in critical thinking is clarifying the problem and identifying the root causes.

In the trauma service, for instance, a Trauma Registry Professional was tasked with finding missing Emergency Medical Services (EMS) run sheets, a process that often took up to four hours on Mondays due to EMS agencies not leaving the required documentation.

Creative thinking

Once the problem is identified, creative thinking allows professionals to look for out-of-the-box solutions.

They explored whether the trauma registry program itself could offer a solution.

Logical Analysis

During this phase, assumptions are tested, options are evaluated without bias, and conclusions are drawn based on factual observation.

The registrars reviewed state EMS regulations and found that EMS agencies were required to leave written documentation in the Emergency Department (ED) after patient drop-off. This finding highlighted an opportunity for the trauma registry program to play a more active role.

Decision Making

With all available information, a decision-making process ensues, often involving team consensus to leverage collective knowledge and experience.

The Trauma Registry Professionals decided to create a custom one-page report to send back to EMS agencies via secure email or fax within 24 hours of patient arrival. This report included feedback and reminders, such as breaking out the Glasgow Coma Scale (GCS).

Coordination/Implementation

Finally, timeframes are established, assignments are made, and expectations are set for successful execution.

The Trauma Registry Professionals collaborated with Performance Improvement (PI) nurses to create a report template that pulled data from the trauma registry. A start date was set for sending these reports, and EMS agencies were reminded of their obligation to leave written documentation at the ED.

Results and Impact 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.

By Michael Trelow, CSTR, CAISS

Data validation serves as a critical educational tool for Trauma Registry Professionals, enhancing their skills, improving data quality for trauma centers, and ultimately contributing to better patient care. The process of validation highlights areas of weakness and encourages registrars to seek further training, ensuring that data entry remains accurate.

Various methods of data validation exist for the trauma registry, allowing trauma centers to select tools that best fit their needs. The primary goal is to ensure Trauma Registry Professionals extract the most accurate data from the electronic health record (EHR) and transfer it 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).

Some states use statewide trauma data dictionaries that adhere to the NTDS format while tracking additional data fields. Hospital-based data dictionaries are designed to indicate where to obtain data from the electronic health record (HER). 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 Ideal for new registrars, a 100% audit helps identify areas of weakness that require additional education. Some trauma centers continue performing this audit across all records to maintain high standards.

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)

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 achieve 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.

Data Validation Process

One effective validation method involves collaboration between a data analyst, a Trauma Registry Professional, and a Practice Improvement Registered Nurse (PI RN) (or another registrar). The process works as follows:

1.The data analyst provides a registry number to the Trauma Registry Professional, who locates the corresponding medical record number for the PI RN.

2.The PI RN opens the EHR while the analyst reviews each tracked data point.

3.The PI RN finds the data in the medical record, allowing the Trauma Registry Professional to either confirm its accuracy or identify it as missed.

4.A discussion ensues to clarify the location of the data.

Continues Improvement through Validation

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, International Classification of Diseases Courses (ICD-10), and Abbreviated Injury Scale Courses (AIS). 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.

Want to enhance your trauma registry operations?

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