While information management should be a cornerstone of the trauma care
system enabling research, care management, and performance improvement,
often the existing databases and information management systems have
serious shortcomings.
There are gaps in existing trauma data registries at the national level.
The National Trauma Databank is based on samples of hospitals that choose
to submit data. However, the size of these databases (NTDB included nearly
500,000 cases in 2002) may offset some concerns about their representativeness.
This creates limitations both in terms of monitoring and evaluating the
quality of care and determining the epidemiology of injury. The Pediatric
Trauma Registry needs to be linked with the National Trauma Databank
at the data element level. The database should be internet accessible
and universally available.
Finally, there is a need for more evidence regarding the overall value
of trauma care as well as for data regarding the contribution of individual
components of a trauma system and what value each provides to the effectiveness
of the system. Trauma system advocates need better data in order to garner
support from legislators and local policy makers.
While trauma systems historically have set an example for performance
improvement, there is a need to change the culture of quality improvement
from punishment to system performance improvement. There is building
public concern regarding patient safety and error reduction in all of
health care. Patient records are essential to performance improvement
(including patient safety information) and such records must be accessible
for these purposes, while being protected from inappropriate disclosure.
• A national database and uniform data standards will be
used to facilitate hospital operations and provide regional and national
information regarding availability of post-hospital care. Existing resources
should provide the foundation to be built upon. Applicable data sets
should be revised as necessary and there should be increasing use of
computerized medical records.
• Trauma care will be designated as a specific research area
for epidemiological study. Predictive models will be developed regarding
outcomes and will be used in making funding and resource deployment decisions.
• Pre-hospital and functional outcomes will be tracked and
used in a Total Quality Management initiative to improve policies, procedures,
and processes throughout the trauma continuum. Information will be used
to develop performance standards and measure system performance against
similar systems (benchmarking).
• Information related to the complete cycle of trauma-from
prevention to post-hospital care-will be collected, analyzed, and made
available to facilitate improvements in injury prevention, response times,
patient care, and rehabilitation.
• Information systems should be usable for multi-center studies.
• A standardized training course will be used to enable trauma
registrars to collect and categorize data in a consistent, comparable
manner.
• Clear evidence will exist to document the contribution
of an injury management system (prevention and treatment) to a community's
overall health, and additional research will demonstrate which components
of a trauma system provide the most value.
• Tools will be developed and region-specific injury data
will be available to assist communities in making decisions about their
specific needs related to trauma system development, particularly regarding
which components will best meet community health needs.
• The culture of quality improvement will shift from using
data to blame individuals to using the data to improve performance of
the system.
• Access to and appropriate protection of patient records
and quality improvement data will be addressed through legislative and
regulatory changes at state and federal levels.
• Efforts to enhance patient confidentiality should be balanced
with the need for strong research.