Trauma Bands

MIF 409
Michael J. Nowak 2/27/2012

At issue among trauma researchers is the ability to conduct effective outcome research. Trauma care is a complex process which presents many logistic challenges when compiling data for analysis. The major logistic challenge is the linking of patient data from the scene to the hospital. The linkage problem resides in the available trauma data sets. The proposed project will serve as a pilot in order to determine whether a unique identification number can be used to link EMS data with data from the hospitals trauma registry and eventually rehabilitation data. These registries collect information that is mandated by Ohio law. Under the current environment the three data sets cannot be directly linked. There are three methods commonly used to match data sets. They are manual, deterministic and probabilistic. The manual method involves physically matching each record, deterministic involves matching specific variables and probabilistic is based on matching probabilities. Each method has its limitations based on sample sizes and accuracy. The process of matching each case by hand is the most accurate and may be workable at a single hospital but is not realistic for a large regional database. On the other hand the probabilistic method is very efficient but is not as accurate (Boyle, 2008). The landscape has changed with the advent of the electronic medical record (EMR) and electronic EMS data systems. These new electronic systems allow for data matching that is both more accurate and efficient in working with large datasets. The missing component of this matching process is a linking variable that is common to both datasets. Unfortunately, the most common matching variables such as name, address and SSN are often missing or different between data sets. This study will determine whether a unique identification number can be used to match these datasets. The study will also determine whether a wristband with the unique identifier can be used as the mechanism to get the number into both datasets. As a result of this study we will have the ability to connect EMS trauma codes to both hospital trauma activations and trauma admissions. This study will shed light on the perception of trauma at the scene compared to actual trauma assessment upon presentation at the hospital emergency department. The study also has implications for injury prevention research and programs. This dataset will provide numbers of both the occurrence and location of injury types. We will be able to follow up and provide feedback to EMS for educational purposeless. This study makes use of the advances in electronic information systems. Through advances in first responder electronic information systems and the electronic medical record we will be able to determine if these systems can be linked through a unique identifier. Upon the completion of the linking process we will have a dataset that contains all recorded information from the scene through hospitalization. This data set will be created using a seamless interface between the two systems which is critical when dealing with large datasets such as regional or statewide registries. Since there are a limited number of EMS software providers the software links that are developed can be applied to EMS department statewide. The key part of developing these links is that they are not dependent on the linking device. We expect that with advances in technology the nature of the linking component will change. For example, the wristband with a printed number will gradually add bar coding as that technology becomes more commonplace in both EMS mobile systems and hospital emergency rooms. Eventually the manual linking process will be replaced with wireless technology. When the ambulance pulls up to the emergency room the information will pass directly to the hospital information system. The final step in the process

would be to link this combined dataset with other data sources such as rehabilitation and burn registries. Wrist band technology has been used successfully in Oregon to link EMS with trauma patients. This study will build upon the success in Oregon and create a data repository which will link the EMS and trauma data with the electronic medical record, rehabilitation and county coroner databases. As best as we can determine this will be the first attempt to create a repository of this magnitude. This study will attempt to determine the utility of linking EMS data with hospital data via a unique identification number by determining the percentage of electronic run sheets captured at the hospital level. Research Design and Hypothesis/Variables All Cleveland EMS & Fire units will be equipped with trauma wrist bands containing a unique EMS linking number. A wrist band will be placed on the wrist of each trauma patient. This unique linking number will be entered into the Cleveland EMS pen base tablet system and transmitted electronically to the EMS server. Upon arrival at the emergency room the band number will be entered by hospital personnel into the electronic medical record. Metrohealth uses the Epic system. The unique identifier will contain in both the EMS server and the hospital server. The EMS information will be collected daily through an FTP site and linked to the electronic medical record through the unique linking number. The following numerator and denominator will be used to calculate the percentage of patients. The percentage of patients (independent variable) will be calculated for each month (dependent variable). Numerator = Denominator Number of patients with EMS run information Total number of trauma patients

An emergency room in a Level I trauma center such as Metrohealth gets 100,000 visits annually. In the inherent confusion the paper run sheets are often separated from the patients medical record causing a disjoint in the patients medical record. It is estimated that close to 40% of the run sheets at MetroHealth are lost in this manner. A major goal of this study is to increase the percentage of patients that have an electronic version of the run sheet. We hope that once the project is up and running that we will match 95% of the EMS trauma runs. In order to determine whether an electronic match can be made using a trauma band the following Hypothesis will be tested. H0: There will be no difference in the percentage of patients with EMS Run Documentation H1: There will be an increase in the percentage of patients with EMS Run Documentation

Analysis The analysis will be based on the number patients treated for trauma at MetroHealth Medical Center for a 12 month period from January 2012 through December 2012. Cleveland EMS & Fire will begin using trauma bands on July 1, 2012. The study will compare the mean percentage of patients with run information prior to trauma band implementation with the mean percentage of patients with run information after trauma band implementation.

An independent t test will be used to determine if there is a significant difference between the means of the two samples. The following table will be used for the calculation. In the event that
1 2 3 4 5 6 Mean

Pre Banding
Post Banding

the sample distribution is not normal a non-parametric test the Chi-square

) will be used.

Summary The study will determine whether a trauma band with a unique identifier can be used to link prehospital and first responder data to the hospital electronic medical record. When linked the electronic record would include all information from the scene through hospitalization. The enhanced electronic medical record could be used to provide information on various EMS protocols and procedures impact patient outcomes. In addition, the study will also determine whether it is possible link EMS run information electronically thereby eliminating the need for a paper run sheet. The ability to replace the outdated paper system with all of its inherent deficiencies with an electronic system will be a positive outcome of this study. References Boyle,M.J. (2008). The experience of linking Victorian emergency medical service trauma data, BMC Med Inform Decis Mak , 8, (52).