Trauma Program Managers

Tracy Johns
MSN, RN-BC, CPHQ

Excerpts from our Interview

Tracy: Last year we saw 3,600 trauma patients at this hospital. I’ve got full-time people tracking the data.

ImaCor: What TQIP software do you use?

Tracy: We all use the same software in Georgia. There are tabs you fill out for every trauma patient, for example if they have VTE prophylaxis and what kind, Heparin, Thrombin inhibitors. When I get a report, it’ll say something like, “Of all hospitals, 65% of their trauma patients have VTE prophylaxis. Your hospital….”

I just did a report. At our hospital quality meeting I said, “This is our average hospital length of stay, ICU length of stay, time on vent, percentage of patients that go to ICU….” Just some basics, and I compare it.

ImaCor: Do you track acute kidney injury (AKI)?

Tracy: Yes. NSQIP, the National Surgical Quality Initiative, is working with TQIP in Georgia because AKI is high in the NSQIP and the trauma population. I actually have to review all my AKI patients for the last year: Were they on CRRT (continuous renal replacement therapy); if so, how many days, when did they start it. They want to know how many scans did they have with contrast, how much, antibiotic use, what was their first blood pressure when they came in. A lot of this is already in the registry. I’ll have to collate the rest.

ImaCor: What happens if you’re not meeting the standard metrics?

Tracy: They want to see we’re addressing it in an organized manner. Our head of the mortality committee and our chief medical officer attend that meeting. Georgia is trying to be more consistent on how we treat. The state is doing a paper on it for AKI.

ImaCor: It sounds as though Georgia is ahead of most state collaboratives.

Tracy: Yes. I’d say we’re just ahead of a growing trend. Funding may be involved when you participate in TQIP, so there’s motivation. We have become a little more sophisticated in trying to move centers toward, number one, complying with the standards, and then number two now, we’re trying to move the needle on performance improvement. So we’re looking at that and looking at results because it’s just like with core measures: eventually they may start looking at them and deciding on payment related to those metrics.

ImaCor: What do you think is the next trend for the American College of Surgeons?

Tracy: I really believe it’s ‘preventing complications.’ We’re all using the same definitions and we’re all putting in the same stuff, so why are some centers so much better than others? So that’s what they’re looking at: best practice. And so they’re going to say, “Well, what do you do in your practice to prevent AKI?” Part of the definition for AKI in TQIP is related to dialysis. Some of our trauma surgeons will tell you that they has a much lower threshold for starting dialysis than they did in the past. 90% of the patients I’ve looked at recently have diabetes. Half of them are hypotensive. So these are high-risk people. They’ve already got two strikes against the kidneys when they come in, before you start giving them antibiotics or need to use contrast.

ImaCor: How do you harmonize your efforts when you have team members collecting data, your role administrating, coordinating, and developing standards, and then clinicians at the bedside treating patients. There could be a lot of clinical variation there. So how does that work?

Tracy: The whole thing about quality and performance improvement is to reduce variation in care. So to reduce variation in care of somebody who’s at risk for VAP, you’re saying, “Okay, what are clinical signs of pneumonia?” So you have those listed up there, the temp or the white count or purulent sputum or whatever. So what are risks for AKI? And so you would list these. And if you have more than two or three of these factors, then you’re going to renally dose all your antibiotics, etc. And so you would make up an algorithm like that. We’ve got 15 or 20 of these.