I have been working at my clinical coordinator job for over six months now, and while I miss being on the ambulance during my desk job days (I still do 40 hours a week in 3 nondesk job days as a field medic), I am enjoying some aspects of the job — particularly the patient follow up and the data collection. (I remain at times distraught over the QI – torn between having to second guess medics and upholding certain standards of care and documentation). I did not realize when I interviewed for the job that part of my duties included being the trauma data collector, and when I had it explained to me, I was not happy about. I have however, come to appreciate the insights this duty has given me. As the trauma data collector, it is my job, per the data collection section of the Connecticut Trauma Regulations to input information from prehospital run forms, the ER records and the in house records for all admitted trauma patients at the hospital. Trauma, in Connecticut is defined as, “a wound or injury to the body caused by accident, violence, shock, or pressure, excluding poisoning, drug overdose, smoke inhalation, and drowning.” To identify the patients, I sort through the ED data base to identify admitted patients with trauma diagnoses. I then open up each record and record information like time in the ED, procedures done, vitals, etc. If the prehospital run form has been scanned into the record, I can capture that information as well. Later I go down to medical records and pour through the charts to discover what procedures the patients had, how long they were in the hospital and what their outcomes were. Since I work for a smaller, non trauma center hospital, the amount of information I enter is much less than it would be for a trauma center. At the end of the year, the information is sent off to the state, which collects and complies it. The trauma patients who come to our hospital are predominately elderly and predominately the victims of low falls. (Major traumas in the area go to one of two trauma centers). I have been curious to read about other state’s trauma registries, and to discover that many exclude hip fractures from their registry. I guess there is a debate between surgeons on the issue. Some say a hip fracture is trauma, others that it is merely the end of a natural aging process. The bone becomes brittle and breaks almost of its own. Whether or not hip fractures are included can widely alter a state or hospital’s statistics. As I may have mentioned before, I have been keeping a separate data base on hip fractures to record pain scales and time to analgesia both prehospitally and in the ED. Prehospitally, over a four month period, we received 39 hip fractures from EMS, only 4 (10%) of whom received prehospital analgesia. 87% needed analgesia in the ED. Part of the reason the prehospital number was so low is many of the area services utilize paramedic intercepts and medics in many cases are not even dispatched to the hip fracture calls. On the other hand, often a medic ambulance is sent and the medic ends up driving while the basic techs. Maybe unknown to the medic, but the basic is recording 9/10 and 10/10 pain scales for many of these patients, which is certainly a QI red flag. I recently asked the state trauma data collector to try to ferret out the statewide stats on pain management, and the statistics were somewhat difficult for him to get from the collected data and are of somewhat uncertain reliability, but enlightening nonetheless. There were 34,260 traumas patients admitted (admitted, died in ED or transferred to another acute hospital) to Connecticut hospitals between 2005 and 2007. 1,260 of these trauma patients received prehospital pain or sedation meds. (3.6%) 5,288 trauma patients had ICD-9 codes for hip fractures. 267 of these hip fracture patients received prehospital pain and sedation meds.(5%) The problem is some hospitals evidently didn’t enter hip fractures, some prehospital run forms are missing, some patients, with no prehospital run form found, have prehospital meds listed from the ED records. Much depends on the quality of the data entry person and the quality of the records. The true number could be higher, but it is unlikely to be high enough to escape the “you have to be kidding me is this anyway to treat our elderly number!” Speaking of QI, I just read an article where a research project was done where medics were paid $100 if they met certain QI objectives. In this study, with the promise of seeing cold hard cash, 100% of medics were in compliance with their “appropriate treatment of patients with traumatic hip pain” guidelines. The bottom line of the study was money talks more than a simple “Job Well done!” That’s something to ponder. Pay-for-Performance Incentives Might Improve Compliance
