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Mastering Data Validation: Essential Tips for Trauma Registrars

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.

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