Proposal for ROCR Approval
1. Record
Type?
New
2. Unique
Number
R00432
3. Title
The Trauma Audit & Research Network
4. Collection
Type
National
5. Other
Reference
6. Description
The Trauma Audit & Research Network (TARN) is an
established national clinical audit for trauma care
across England, Wales and the Republic of Ireland and
has been supporting trauma receiving trusts for over
twenty years by providing each NHS trust with
analysis of process, case mix adjusted outcome
analysis and comparisons of trauma care. The data
collected follows the patient pathway from incident
through to discharge from hospital and focuses on key
observations, interventions, investigations and
attendants treating the injured patient.
7. State
Submitted to ROCR
8. ROCR
Reference No
9. Start Date
01/04/2014
10. End Date
31/03/2015
11. FT
Collection
Type
MANDATORY
Proposal for ROCR Approval
12. Collection
Type
PART MANDATORY
13. Owning
Organisation
Academia - Manchester University
14. Owning
Department
The Trauma Audit & Research Network
15. Owner
Name and
Contact
Details
Name: Antoinette Edwards
16. Senior
Supporting
Official Name
Chris Moran
17. Senior
Supporting
Official
Contact
Details
Title: National Clinical Director for Trauma
18. Data
Provider Burden Days
7540
18. Data
Provider Burden £
£ 1535671.8
18. Frequency
Weekly
18. Source
Organisations
(Number of
orgs)
Acute Foundation Trust (100) , Acute Non Foundation
Trust (45)
Email: antoinette.edwards@manchester.ac.uk
Tel No: 0161 206 4397
Email: chris.moran1@me.com
Location: Nottingham University Hospital
Proposal for ROCR Approval
19. Set Up
Costs
£ 4000.0
20. Other
Costs
£ 473279
21. Total
Costs
£ 2012950.8
22. Please
explain the
reason for any
increase or
decrease in
burden and
provide
details of the
any other
costs figure
provided in
Q20
All trauma receiving trusts in England are required to
submit their trauma cases, therefore an increase in
burden would have occurred 2010-2011. Unless there
is significant change in healthcare policy, no additional
increase or decrease in burden is expected.
23. Benefits to
Patients and
the NHS
Traumatic injury is a global burden and contributes
largely to death and disability across the UK. For every
trauma death at least 2 people are left with severe
and permanent disability and the effects of traumatic
injury have considerable long term implications upon
the quality of life of its survivors. As a result of
traumatic injury, there is also a significant impact
upon the associated costs to the NHS. As a national
clinical audit, TARN’s key role is to deliver a high
quality service that supports clinicians in driving
improvements in trauma care. The national clinical
audit is relied upon by Trusts, Commissioners,
regulatory bodies (such as NICE), NHS England and
the Department of Health to provide the means to
monitor care and outcome by providing a robust data
collection system that can adapt to reflect changes in
service delivery and providing case mixed adjusted
analysis and reporting of key standards and
Proposal for ROCR Approval
recommendations to support improvements in care
and the commissioning trauma care services. The
evidence available from TARN can support
improvements within the system resulting in cost
savings to the NHS through delivering a more effective
service to patients.
24. Financial
benefits to
running this
collection
By centralising the national audit, TARN is able to
provide a number of services which would otherwise
add significant cost if they were to be administered at
trust level such as uniform Injury Severity Coding by
experienced, trained and independent injury coders,
ad hoc analyses and reporting performed by an
experienced analyst and statistical team and a web
based system to support data collection. TARN are
able to provide regular training on data collection and
provide a dedciated support service to manage
analysis requests and queries in regard to data input
and patient inclusion. In addition to this, TARN
provides individual cases reviews where unexpected
outcomes occur and follow an outlier review process.
As a national clinical audit it provides three National
Reports focusing on specialist areas of trauma
management which provides a benchmarking tool for
Trusts against the TARN Registry.
25.
Publication
methods
Yes. The publication methods are in the form of
regular updates of the TARN website, emails and
newsletters to trusts.
26.
Publication
Links
Trusts receive reports relating to their own standards
of care and outcome in the format of Dashboards and
Clinical reports. However, rates of survival and
performance comparisons of trauma receiving trusts
are publicly accessible on the TARN website. In
addition, TARN has recently produced the first national
Children’s Report which is publicly available. In 201415 TARN plan to publish additional reports relating to
the elderly and head injured patients. These reports
will also be publicly available.
Proposal for ROCR Approval
27.
Requesting
Organisation
Academia - Manchester University
28. Collection
Method
Web based collection
29. NHS
Mandate
Commitment
In 2010 The National Audit Office published its report
on ‘Major Trauma Care in England’ which focuses on a
number of deficiencies in the management of major
trauma patients. Some of the overall findings
suggested an unacceptable variation in the standards
of trauma care across England and that little had been
done to improve trauma care despite numerous
reports since 1988 outlining poor practice. The report
also highlighted that ‘data collection was an important
tool to improve service delivery and patient outcome,
yet only 60% of trauma receiving trusts submitted
data to TARN’. In response, the restructuring of
trauma services has evolved in the form of Major
Trauma Networks that are to effectively manage the
care of major trauma patients across England. In
2010, Sir David Nicholson, in a letter to Chief
Executives of Strategic Health Authorities in England
stated that all hospitals that are part of a Regional
Network will be required to submit data to TARN and
be signed up by the end of 2010/11. Similar
restructuring is taking place across Wales. Agreed by
ministers, the scope of prescribed services was
directly commissioned by the NHS CB 1st April 2013.
Following on from this and on behalf of the NHS
Commissioning Board, a letter from the Chair of the
Major Trauma Clinical Reference Group was sent to all
Major Trauma Centre Chief Executives. This stated
that from April 2013, all Major Trauma Centres are
required to submit their trauma cases to TARN within
25 days of patient discharge for inclusion within the
Commissioning Dataset for PBR purposes. To support
this, TARN provides a validated and approved
submission (including the ISS) by 10 working days
Proposal for ROCR Approval
following submission – approximately day 37 post
discharge. In addition, TARN is central to providing a
service to trusts that supports the allocation of the
Best Practice Tariff for Major Trauma. Patient eligibility
and tariff level criteria are measured by TARN and
validated at trust level.
30. Changes
since last
assessment
31. Data in
operational
systems
Yes
32. Plans for
collecting this
data from
operational
systems
33. If the data
was not
collected,
what would
the
consequences
be
TARN has become the key provider for delivering
evidence of quality trauma care for both clinical and
commissioning purposes. TARN's key aim is to
encourage best practice within the emergency care
setting and support this by monitoring standards
recommended by NICE, the Royal College of Surgeons
& British Orthopaedic Association. As well as delivering
national clinical reports to support all trusts in their
governance of trauma care, the organisation is central
in providing the facility to support allocation of the
Best Practice Tariff for Major Trauma, and responsible
for the production of national CQUIN reports and the
Major Trauma Dashboard. Data collection to TARN can
provide valuable evidence of improvements in care
over time and is highlighted in a recent press release
from NHS England. From the data collected by TARN,
results already show an increase in survival rates
since the launch of the Major Trauma Networks and
that ‘1 in 5 patients who would have died before the
Proposal for ROCR Approval
launch of the Trauma Networks are now surviving
severe injuries’. Professor Sir Bruce Keogh, Medical
Director for NHS England stated that ‘these figures
show how getting the right patient to the right hospital
at the right time can save lives and improve recovery
from serious trauma.’ The organisation is also key in
the development of the first national Major Trauma
PROMs (Patient Reported Outcomes Measures). This
will provide clinicians, commissioners and politicians
with a greater understanding of the long term impact
of major trauma as well as informing rehabilitation
services to help guide improvements. Without the
facility to provide quality evidence of good clinical
practice across England, there would be no means to
assist clinicians, comissioners and governmental
organisations in driving improvements in care. In
parallel to this, any health gain achieved from better
care can reduce the financial burden of trauma such
as reduced bed stays, and improve the long term
effects of injury in regard to return to work.
34. Is there an
impact
assessment or
business case
for this
collection? If
so please
attach
No
35. Process
required for
others to go
through to
obtain the
data
There are three examples of where data is reused by
others: 1. Trusts can request their own data and can
be delivered in any format requested. 2. ISS to the IC
- details. 3. Research The data collected is also used
for research purposes. For the majority of research
projects the data is analysed by TARN and is
presented in an aggregated format. However,
exceptions are made for individuals that require data
to gain professional qualifications where demonstrable
skills in analysing data are required. Data is also
Proposal for ROCR Approval
requested by other organisations with the intention to
merge with other datasets. Under both of these
circumstances, a Data Sharing Agreement is in place
between both TARN and the organisation requesting
the data to ensure that the data is held securely. No
patient or trust identifiers are provided in any dataset.
36. Keywords
Audit, Injury, Trauma
37. National /
Official
statistic
National
38. Method
used to store
the data
The system (eDCR) is a web based data collection
system that is used by participating NHS Trusts. The
system comprises of a database server and web
server which are hosted and maintained by the
University of Manchester. The Database tier is SQL
Server 2008 x64 running on the Operating system
Windows 2008 x64 R2. The web tier is running IIS 7.5
that is hosted on the Operating System Windows 2008
x64 R2. The web server has a small footprint of CPU,
Memory, Disk and Network that is virtualised.
Virtualisation is a technology that enables the sharing
of a large single server by many different applications
that all reside in their own secure and segmented
space. The advantages of virtualisation are that it is
not only a cost effective (reduction of required
servers) but it is also a much greener technology.
Automatic encryption of identifiable information is
conducted within the system using a proprietary
algorithm. This algorithm to comply with the
recommendations set out by the Department of Health
(3DES/AES 256). Indentifiable information that is not
covered by s251 approval remains encrypted on the
system to TARN personnel designated with password
protected system access.
39. Why
sampling is
TARN supports Trusts and Commissioners in improving
services and patient outcomes. The data collected also
Proposal for ROCR Approval
not used
supports some tariff based measures. As TARN is an
established national Clinical Audit, a sampling of
organisations is not possible.
40. Details of
any pilots
The UK Major Trauma Outcomes Study (MTOS)
originated in 1989 in Salford with a small group of
collaborators who began collecting data from some
trusts to provide an evidence base to support a drive
in trauma care standards. The group utilised an
American methodology for outcome prediction
modelling and by 1992, 33 trauma receiving hospitals
in the UK submitted data. By the late 1990’s
approximately half of all trauma receiving hospitals
submitted data to the group, now re-named as The
Trauma Audit & Research Network. The organisation
has steadily grown to become the national audit for
trauma care. Since 2010, there has been a significant
change to the delivery of trauma care across England
with the establishment of Trauma Networks. To
support the recommendations set out by the National
Audit Office, Sir David Nicholson, in a letter to Chief
Executives of Strategic Health Authorities in England
stated that all hospitals that are part of a Regional
Network will be required to submit data to TARN and
be signed up by the end of 2010/11. 100% of all
trauma receiving trusts across England submit data to
TARN.
41. Equalities
dimensions
used in the
collection
Age/Date of Birth, Gender
42. Policy that
the collection
supports
With the national restructuring of trauma care across
England, trauma is now part of Domain 3 of the NHS
Outcomes Framework and Data submission to TARN is
now part of the NHS Standard Contract. Agreed by
ministers, the scope of prescribed services was
directly commissioned by the NHS CB 1st April 2013.
Following on from this and on behalf of the NHS
Proposal for ROCR Approval
Commissioning Board, a letter from the Chair of the
Major Trauma Clinical Reference Group was sent to all
Major Trauma Centre Chief Executives. This stated
that from April 2013, all Major Trauma Centres are
required to submit their trauma cases to TARN within
25 days of patient discharge for inclusion within the
Commissioning Dataset for PBR purposes. To support
this, TARN provides a validated and approved
submission (including the ISS) by 10 working days
following submission – approximately day 37 post
discharge.
43. IG Data
type
Anonymised