American College of Surgeons Committee on Trauma

							 American College of
     Surgeons
Committee on Trauma
Trauma Quality Improvement
     Program (TQIP)
TQIP principles
   The goal of TQIP is to improve the quality of
    care of trauma patients
     Leads to lower mortality
     Fewer complications
     Lower costs
   Uses existing trauma center staff and data
    collection infrastructure
     Based   on the National Trauma Data Standard
   Relies on collective expertise of COT sub-
    committees
Training
 In person training for registrars
 Online course continuously available
 Quarterly case studies to improve coding
 Web conferences
 Online registrar community
Standard/Validated Data Collection

 Based on National Trauma Data Standard
 Automated validation
 Quarterly data submission for ongoing
  validation
 External validation to improve coding at
  your site through site visits
Risk Adjusted Benchmarking


   Your
  Center         Identifies how
                 your center
                 performs
                 compared to
                 others
NTDB vs TQIP Benchmarking
NTDB                            TQIP
 Compares to trauma             Uses patient cohorts to
  centers of similar size         standardize comparisons
  and level                       across centers
 Raw data on patient            Includes Level I and II
  characteristics                 centers, adult patients
 Crude mortality does not       Risk adjusted outcomes,
  take into account data          including mortality and
  quality and injury severity     complications
Patient Cohorts
   Blunt multisystem injury
     Blunttrauma with severe injuries (AIS>3) in at least
      two body regions
   Penetrating truncal injury
     Severe   torso trauma due to GSW/stab/impalement
   Blunt single system injury
     Blunttrauma with a severe injury limited to a single
      body region
Patient Cohorts
   Each cohort challenges different aspects of
    clinical care
     Prompt  assessment & surgical intervention
     Multidisciplinary coordination

   Each population might be differently represented
    at any single trauma center
   Differential outcomes across the cohorts for a
    particular center– better focus PI efforts
Measuring Processes of Care

 What practices are associated with better
  outcomes?
 Fields in NTDS lack detail to capture
  specific processes
TQIP Process Measures
                       Indicator                    Measure
Traumatic      ICP monitoring in severe % of cohort with ICP monitoring
brain injury   TBI within 8 hrs of ED   w/in 8 hrs of arrival
               arrival
Hemorrhage     Time to hemorrhage       % of patients in whom
control        control                  hemorrhage control initiated
                                        within 2 hrs of arrival
VTE            Pharmacologic VTE        % with pharmacologic
prophylaxis    prophylaxis on or before prophylaxis by day 3
               day 3

Fracture Rx    Time to operative        Time to 1st/last definitive
               fixation                 fixation
               Time to irrigation and   Time to first I&D
               debridement of long
               bone fractures (open
               only)
Improved Outcomes

 Hospital mortality rates
 Hospital complication rates
 Utilization of resources compared to other
  trauma centers
     Hospital Length of Stay
     ICU Length of Stay
     Ventilator Days
Cost & Benefits
   Potential for cost sharing across several services
        e.g. Trauma (Gen Surg), Neurosurgery, Orthopedics
   Registrar training to ensure more accurate injury, complication &
    comorbidity coding
        Eliminate significant under-billing
   Demonstrates commitment to performance improvement
        May help contracting with third-party payers and employers
   Implementation of best practices leads to lower complications
        Potentially higher reimbursement in the emerging “P4P” environment
   Competitive edge in the emerging era of "public reporting"
Co-Morbid Conditions
   Each co-morbid condition documented
    and submitted may increase your
    reimbursement by $700 - $10,000
Decrease Complications

    Benchmarking complications with
     comparisons to other centers will help
     those with higher complications rates to
     learn from higher performing centers and
     reduce complications.
Decrease Lengths of Stay
 Active Care Coordination
 Early discharge planning
 Active social work
 Rapid radiology final reads
 Early spine clearance