Alaska Trauma Registry Training Outcome Section

1. Alaska Trauma
Registry Training
TRAUMA PROGRAM
RURAL AND COMMUNITY HEALTH SYSTEMS
STATE OF ALASKA, DIVISION OF PUBLIC HEALTH

2. Outcome

3. Seven tabs
under Outcome:
Initial Discharge
If Transferred
Discharge Disability
If Death
Billing
Related Admissions
Notes

4. Let’s look at the registry

5. Outcome: Initial Discharge
• Discharge Order Date/Time
• Date discharged order was written from acute care phase of care
• Skipped if patient is a death or who leave against medical order

6. Outcome: Initial Discharge
• Discharge/Death Date/Time
• Death date/time is the date/time patient pronounced
• Death Date/time equals discharge date/time
• Date/time patient declared clinically dead and care turned over to organ
procurement team equals discharge date/time

7. Outcome: Initial Discharge
• ICU Days
• Cumulative amount of time spent in the ICU
• Each partial or full day should be measured as one hospital day
• Auto fills if Location Tracking screen is utilized
• If patient has multiple ICU episodes on the same calendar day, count that day as
one calendar day
• Utilizing NTDB calculation guidelines
• ICU days total can exceed total Hospital Days
• Two separate formulas for calculation

8. Outcome: Initial Discharge
• ICU Days
• Example where ICU days exceed Hospital Days
• Admitted to ICU 4/3/2020 at 1400
• Died in ICU 4/4/20 at 0800
• Two partial days in ICU = 2 days
• Hospital Days = 1 day

9. Outcome: Initial Discharge
• Vent Days
• Cumulative amount of time spent on the ventilator
• Each partial or full day should be measured as one hospital day
• Auto fills if Ventilator Tracking screen is utilized
• If patient has multiple ventilator episodes on the same calendar day, count that
day as one calendar day
• Utilizing NTDB calculation guidelines
• Vent days total can exceed total Hospital Days
• Two separate formulas for calculation

10. Outcome: Initial Discharge
• Hospital Days
• Auto-filled from arrival date to discharge date
• Uses hospital calculation formula
• Part of 1 days = 1 day (if admission and discharge on same day)
• Go over midnight to = 1 days; stay over two midnights = 2 days
• NTDB calculation difference
• ATR Hospital Days not sent to NTDB
• NTDB calculates from admission date to discharge date

11. Outcome: Initial Discharge
• Discharge To
• Destination upon discharge from the hospital
• Exact location discharge to regardless of previous living location
• NTDB different, follow ATR DD
• If multiple orders were written, report the final disposition order
• Discharge To Definitions included in data dictionary
• All NON-Medical Care Facilities should be entered as Home
• No need for medical care after discharge, i.e. Hotels, Domestic Violence
Center/Housing, Drug and Alcohol rehab, and any other housing that does not
provide medical care

12. Outcome: Initial Discharge
• Discharge To
• Assistance: Does not apply to family/friend’s help
• Discharge Home, Self Care vs Discharge Home, Health Care
• Rehab – must be licensed rehab facility
• Type of facility not reason for transfer
• To SNF for rehab = Discharge To is SNF

13. Outcome: Initial Discharge
• Discharge Condition
• General condition upon discharge
• Good, Returned to Previous Level of Function
• Temporary Disability, Expected to Return to Previous Level of Function
• Moderate Disability with Self Care
• Severe Disability, Dependent
• Persistent Vegetative State
• Auto-fills for deaths and transfer to acute care/burn center
• Mandatory field, you must determine from dictations
• Help – very thorough definitions in Alaska Data Dictionary

14. Outcome: Initial Discharge
• Discharge Impediments
• Reason patient discharge from the hospital was delayed
• Mandatory field
• None
• Financial
• Social
• Psychiatric
• Non-availability of rehab facility
• Non-availability of long-term care facility

15. Outcome: Initial Discharge
• Discharge Impediments
• None = no delay
• Not considered an impediment
• Continued medical care
• Mental health care for overdose patients

16. Outcome: Initial Discharge
• Report of Physical Abuse?
• Report of suspected physical abuse was made to law enforcement and/or
protective services
• Includes report of child, elder, spouse or intimate partner physical abuse as
defined by state/local authorities
• Report of Abuse – assault does not mean abuse unless it is by a family
member or intimate partner

17. Outcome: Initial Discharge
• Investigation of Physical Abuse?
• Investigation by law enforcement and/or protective services was initiated
because of the suspected physical abuse
• This includes, but is not limited to, a report of child, elder, spouse or intimate
partner physical abuse.
• Only complete when Report of Physical Abuse is Yes

18. Outcome: Initial Discharge
• Caregiver at Discharge (Pediatrics Only)?
• Pediatric patient was discharged to a caregiver different than the caregiver at
admission due to suspected physical abuse
• Only complete when Report of Physical Abuse is Yes, and
• Only complete for minors as determined by state/local definition (Age < 16) and
• Only complete for Discharge Status is Alive
• Skipped when age > 15 or death (greys out)

19. Seven tabs
under Outcome:
Initial Discharge
If Transferred
Discharge Disability
If Death
Billing
Related Admissions
Notes

20. Let’s look at the registry

21. Outcome: If Transferred
• If Transferred
• Tab opens when transferred to health care facility
• If Transferred, facility open for all transfers
• Remaining fields open for transfers to acute care & burn centers only

22. Outcome: If Transferred
• If Transferred, Facility
• Facility to which patient was transferred
• List by name or city of location
• Anchorage
• Seattle
• Do not use “unknown” or “99999”
• Ask for help
• May need to add a facility

23. Outcome: If Transferred
• Mode of Transport
• Main transport mode
• Medevac
• Ground ambulance to airport, medevac transport, ground ambulance to facility
• Ground ambulance entire way
• POV (non-medical)
• Greys out all other elements except “Reason for Transfer”

24. Outcome: If Transferred
• Transfer Initiated Date/Time
• Date/time first contact is made with a receiving facility and/or physician to
initiate the transfer process
• Sometimes difficult to locate
• Providers need to document
• Review process at your facility
• Unit clerk/nursing may note the time call made

25. Outcome: If Transferred
• Transfer Accepted Date/Time
• Date/time the receiving facility and/or physician accepts the patient in
transfers
• Sometimes difficult to locate

26. Outcome: If Transferred
• Transport Team Arrived at Sending Facility Date/Time
• Date/time the ambulance/transferring team arrives at sending facility
• When ground ambulance is utilized to transport the patient or transfer
medevac team to & from medevac aircraft
• Enter date/time the ground ambulance arrival at hospital

27. Outcome: If Transferred
• Transfer Reason
• Reason the patient was transferred to another facility
• Higher Level of Care
• Patient Request
• Insurance Coverage
• Disaster Triage
• OR Availability
• Physician Preference
• Other
• Medical Staff/ Resources Normally Available, Not Available for this Patient

28. Outcome: If Transferred
• Transfer Reason
• Medical Staff/ Resources Normally Available, Not Available for this Patient
• Ortho
• Neuro
• Plastics
• Other
• Diagnostic Equipment
• Staffed Bed
• Other Resources

29. Outcome: If Transferred
• Delay Reason
• Cause of patients transfer delay of > 6 hours
• Unexpected Patient Deterioration
• Surgery (performed Before Transport)
• Lack of Receiving MD
• Weather
• Prolonged Resuscitation
• Unavailability of Transport
• Patient or Guardian Refusal
• Delayed Diagnosis
• Complications Developed
• Other
• Planned Delay

30. Outcome: If Transferred
• Delay Reason
• Field opens if patient hospital stay > 6 hours
• If patient held at sending facility due to no need for immediate transport
enter “11, Planned Delay”
• Held for commercial flight next day

31. Seven tabs
under Outcome:
Initial Discharge
If Transferred
Discharge Disability
If Death
Billing
Related Admissions
Notes

32. Let’s look at the registry

33. Outcome: Discharge Disability
• Pre-existing Disability
• Feeding, Locomotion and Expression
• Capability PRIOR to this injury
• Score every patient except pediatric patients < 8 years of age
• Values:
• Dependent, Total Help
• Dependent, Partial Help
• Independent with Device
• Independent

34. Outcome: Discharge Disability
• Pre-existing Disability
• Data Dictionary has measurable definitions to help score each value
• Locomotion example:
• Dependent, Partial Help: If walking, requires standby supervision, cueing or
coaxing, minimal or moderate assistance to go as far as 150 feet in wheelchair or
operates manual or electric wheelchair independently at least 50 feet.

35. Outcome: Discharge Disability
• Discharge Disability
• Feeding, Locomotion and Expression
• Capability AFTER injury upon discharge from acute care phase
• Score every patient except:
• Transfer to another acute care facility
• Pediatric patients < 8 years of age
• Deaths
• Use Alaska Data Dictionary

36. Outcome: Discharge Disability
• Source of Final Anatomical Diagnosis
• Where were the final anatomical diagnosis obtained
• Autopsy
• Surgery
• Radiographic Studies
• Clinical
• Answer yes/no for each

37. Seven tabs
under Outcome:
Initial Discharge
If Transferred
Discharge Disability
If Death
Billing
Related Admissions
Notes

38. Let’s look at the registry

39. Outcome: If Death
• Was Autopsy Performed
• Hospital autopsy
• Medical examiner autopsy

40. Outcome: If Death
• Was Organ Donation Requested
• State law requires all deaths have organ donation requested
• Find out who is responsible to ask the family and where they document the
outcome of the request

41. Outcome: If Death
• Was Organ Donation Granted
• Granted doesn’t mean donation occurred
• Donation may be unsuitable, medical examiner denies donation
• Did family/legal guardian agree to donation

42. Outcome: If Death
• Organs Procured
• Check off all that apply
• Medical Examiner Refusal
• Unsuitable
• Single Organ
• Multiple Organs
• Tissue
• Cornea

43. Seven tabs
under Outcome:
Initial Discharge
If Transferred
Discharge Disability
If Death
Billing
Related Admissions
Notes

44. Let’s look at the registry

45. Outcome: Billing
• Charges Billed
• Total hospital charges for acute care phase
• Enter dollar amount only

46. Outcome: Billing
• Primary Payor
• Primary source of payment for this facility visit
• Medicare
• Medicaid
• Blue Cross/Blue Shield
• Private/Commercial Insurance
• Indian Health Services
• Military (active, dependent, VA) – This is Federal insurance
• Workers Compensation
• Auto Insurance
• Self-Pay
• Other Government (ward of state, prison)
• Fisherman’s Fund
• Victim’s Fund
• General Relief Medical

47. Outcome: Billing
• Primary Payor
• Identified by admitting staff
• Review list
• Blue Cross Blue Shield pulled out of Private/Commercial Insurance
• Military includes active, dependents and VA
• Other government includes ward of state, prisoner

48. Outcome: Billing
• Secondary Payor
• Select up to 3 additional payors
• Can leave blank when no additional payors
• Do not repeat the primary payor except for Private/Commercial Insurance
when the patient has a different second and/or third insurance policy
• Do not list Self Pay as an additional payor, the balance after primary payor
may or may not be charged to the patient

49. Seven tabs
under Outcome:
Initial Discharge
If Transferred
Discharge Disability
If Death
Billing
Related Admissions
Notes

50. Let’s look at the registry

51. Outcome: Related Admissions
• Related Admission
• Optional screen
• Enter previous or subsequent admission for the care and/or treatment of the
same injury/injury episode
• Enter yes to open the related admission grid
• Admission Date
• Admitting Service
• Charges Billed
• Discharge Date

52. Outcome: Related Admissions
• Total Readmission Days
• Auto-calculates from admission date to discharge date
• Optional

53. Thank You