In looking at the year in review, 2016 has been a turning point for many trauma registrars. While some started the journey to ICD-10 coding in 2015, I think it would be safe to say that the majority started with their 2016 charts. Now some will be under the gun to begin ICD-10 coding with the advent of the new year. Whether you have been coding in ICD-10 for a long time or have yet to begin, I think now is a good time to reflect on the purpose of a trauma registry. Whether you work at an American College of Surgeons (ACS) verified trauma center or a regional hospital that collects trauma data, the purpose of the registry should be to provide information that can be used to improve the efficiency and quality of trauma care.
While ICD-10 may be the “new kid” on the block, we should be careful that we are not straying into territory that neglects our trauma roots. As an example, ICD-10 would tell you that if an exploratory laparotomy procedure was performed and the surgeon performs a splenectomy based upon what he encounters, you shouldn’t code the exploratory laparotomy because the real root operation was the removal of a spleen. ICD-10 logic would have you only code an exploratory laparotomy if the surgeon found nothing wrong and closed the patient back up. As trauma registrars, we can’t let this pass. How can we continue to provide relevant data in our registries if we don’t code all of the procedures that need to be captured?
We can’t check our minds at the door. We need to continually ask if we are serving our mission to provide the information that can be used to improve the efficiency and quality of trauma care. I have seen some discussion on the Google© NTDB (National Trauma Data Bank) forum regarding whether or not certain procedures should be coded. One such instance had to do with coding the cranial flap insertion into the abdomen, and the question was asked, “Why would we code this?” Well, what if this patient had some adverse consequence due to the placement of the cranial flap? Would this have a direct effect on this patient’s care? Isn’t the neurosurgeon who placed this flap (or trauma surgeon, or whoever does this at your facility) accountable to your trauma “team?” Should we only code this if it has a negative outcome so we can capture the complication? Then how can we provide data about all the times this procedure was done without a negative consequence? What about TQIP (Trauma Quality Improvement Program) hospitals? If they follow the TQIP data dictionary they are to capture all procedures in the OR (operating room). When does the cranial flap insertion into the abdomen become a non-procedure? What other procedures might we exclude?
While each hospital has to decide what it is they want to see included in their data registry, whether it be for TQIP, their region, their state or their own hospital, the thought process has to be thorough. Forums such as the Google© group are good sounding boards for such a thought process, but they should not be the only avenue one seeks. Too often these groups are voices to a few, while a vast majority sit back and “listen,” but don’t participate. The best advice for what should be included may be from the group who puts the data into the registry. But don’t forget those stakeholders who also want to get information out of your registry. You can’t run a report on something that is not included.
As you begin to think about your data registry for 2017, please consider what form you want your data registry to take. Maybe it is time to sit down as a group (if you are not a lone registrar) and discuss what procedures you want to capture. Start that long put off data dictionary so that everyone is on the same page when it comes to putting data in your registry. Set up those monthly meetings (or weekly) to make sure your team is capturing the same procedures with the same codes. Do those data validations to look back at the data that has been entered. Compare it to a period when you were coding in ICD-9 and see if you are still capturing a similar number of procedures. Take the time to evaluate the accuracy of your data collection.
Those of you who are registrars working at a hospital alongside their permanent employees, please let your voices be heard. You have something to say about the data you see going into a registry. If you see something that doesn’t make sense to you, ask your colleagues. If the answer you get is “because that is the way we have always done it,” it may be time to talk to someone at the next level, such as your lead trauma registrar, your performance improvement person or your trauma program manager. Remember, the goal is to provide information that can be used to improve the efficiency and quality of trauma care.
Susan Schmunk, CSTR, CAISS
Lead Trauma Registrar Consultant