TARN Audit Coordinator of the Year –
Highly Commended
The Judging Committee would like to recognise the following coordinators as
‘Highly Commended’, and thank all who entered the 2017 competition.
Ian Barlow
Sharon Ryan
Samantha Jones
With his wealth of knowledge and experience over 20 years,
Ian has been pivotal in ensuring TARN data is collected as
completely and accurately as possible . He has contributed to
the development of the team by articulating the requirements
and challenges to colleagues at all levels within the Trust.
Sharon Ryan commenced her role at Northampton
General Hospital (NGH) in September 2014, and
since then has progressively improved Northampton’s
TARN data with regards both the number, and quality,
of cases submitted. It’s not just the complete and
accurate dataset now being submitted that is
impressive either, but also the timeliness that the
cases are being submitted.
Sam Jones has been the Major Trauma Coordinator at Royal
Manchester Children's Hospital since 2012, when the North West
Children’s Major Trauma Network was implemented.
Ian has a close working relationship with the various clinical
teams which is as a result of his presence on the wards and
in ED - he is an integral part of the service.
With meticulous attention to detail, conscientious
collection and data contribution to TARN, Sharon has
helped to raise the morale of the trauma teams and
ED staff at a time when the NHS is widely reported as
having low morale!
Ian recognises that early identification of eligible TARN cases
means better capture of data, hence frequent visits to the
wards. This also allows staff to ask him questions; Ian’s
clinical understanding of TARN information (he is known
locally as ‘Mr TARN’) means he is the ‘go-to’ person for any
consultant, registrar or junior doctor undertaking audit work
on trauma cases.
Sharon’s hard work is helping to raise the profile of
trauma care within NGH, the profile of NGH within the
Central England Trauma Network (CETN) and the
profile of CETN across the Midlands Critical Care &
Trauma Networks (MCC&TN).
Data is at the heart of clinical audit and the positive difference
that Ian has made to data improvement is demonstrated in
the following chart, showing the proportion of eligible cases
submitted within 25 days:
At Central England Trauma Network Board Meetings,
Sharon is held as a beacon of efficiency and a
reference for other hospitals within the network. The
network Data Analyst is planning to meet with Sharon
to see if her approach can be replicated to any
degree within other units.
% of eligible cases submitted <25 days - LTHT (MTC02b)
% of approved eligible cases
90
80
70
60
50
40
No HES data
for Q1
30
20
10
0
Q2
Q3
Q4
Q1
Q2
2013/14
Q3
Q4
Q1
Q2
2014/15
Q3
Q4
Q1
2015/16
Q2
2016/17
Source: Major Trauma Dashboard
Sharon has markedly improved the quality,
completeness and timeliness of NGH’s TARN data, it
is now consistently amongst the best in the country
and across the Midlands Trauma Networks:
In terms of the actual number of cases submitted compared
to the expected number of cases, these figures are shown in
the chart below. It is clear that the gap between ‘expected’
and ‘submitted’ is narrowing:
No. of approved eligible cases
No. of eligible cases submitted <40 days - LTHT (MTC02a)
Expected HES Data
450
400
350
300
250
200
150
100
50
0
No HES data
for Q1
Q1
Q2
Q3
Q4
Q1
2012/13
Q2
Q3
Q4
Q1
2013/14
Q2
Q3
Q4
Q1
2014/15
Q2
Q3
Q4
2015/16
Q1
Q2
2016/17
The graph shows 100% of cases being submitted
within 40 days of discharge, which places NGH within
the top few hospitals in the country (red dot on the
caterpillar chart below). The run chart on the right
shows NGH’s performance (blue line) consistently
performing way above the national average (purple
flat line) for the previous 7 quarters as well:
Source: Major Trauma Dashboard
Sam acts as a key resource of knowledge in TARN data across the
hospital, facilitating its use for research and ensuring the meticulous
inputting of data. She combines this with a vision of how it can be
utilised and expanded to change pathways and practice in the
future, working collaboratively with the team on development of
children’s rehabilitation outcome measures, which will make up part
of her PhD. Sam has also begun to use the data to inform accident
prevention, working with charities and using the TARN data to
inform on prevention from known mechanism of injuries.
Sam is responsible
for the review and
validation of the
TARN dashboard and
feedback to the
Major Trauma &
speciality leads. Data
quality improvement
extends beyond the
formal TARN data
and includes the
support of an internal
database on
candidate trauma,
based on the TARN
model, which has
facilitated monthly
data on candidate
major trauma which
is shared with the
clinical team.
Examples can be
seen to the right:
Day of the week Dec 2016
6
6
5
4
3
3
2
2
3
2
3
2
Number
1
0
Sam has developed ‘Transfer – in guidelines’ to facilitate timely
transfer of patients from outside hospitals, a local manual for Major
Trauma data input, and also the Trauma Documentation Sheet for
children when they first arrive in the ED department. This has
improved data collection and is now used as the standard across
Regarding data quality, again improvements have been
made:
Quality of Patient Data Submitted to TARN - LTHT (MTC01)
100
% of key fields completed
Her role in setting up the systems at RMCH to manage our data has
been invaluable, being a key-facilitator in setting up the Trust’s
database ‘MajorTAM’ for the management of all data on Major
Trauma Patients, which feeds into the TARN database. She also
developed the Major Trauma monthly spreadsheet for tracking of,
not just TARN eligible patients, but candidate patients as well. This
has allowed constant scrutiny of the data, including reasons for
over-triage and changes in length of stay.
80
60
40
20
0
Q1
Q2
Q3
2012/13
Q4
Q1
Q2
Q3
2013/14
Q4
Q1
Q2
Q3
2014/15
Q4
Q1
Q2
Q3
2015/16
Q4
Q1
Q2
2016/17
Source: Major Trauma Dashboard
With his detailed understanding of TARN, Ian was pivotal in
the implementation of our new processes, working with the
Business Intelligence team, senior nurse specialists and
consultants to develop more robust systems, and conducting
TARN awareness exercises to identify ‘TARN champions’ on
wards where it has historically been challenging to capture
patient data. Processes have also been put into place to aid
dispatch flow of case notes and verify TARN data.
As one of the largest Teaching Hospitals in the country, there
are always audits taking place and Ian is the key TARN
contact, undertaking audit work alongside the consultants and
extracting data from our local systems or from the TARN PRI
report and articulating what the data shows, offering advice
on the nuances of the information.
Our understanding of the trauma service delivered to our
patients in Leeds is much better now, and Ian has had a
significant impact in improving our knowledge of the service.
Within the CETN Sharon works well with the Data
Coordinator to provide information for governance
and business meetings. Sharon also assists another
local TU with queries around TARN submissions.
The TARN data Sharon collects is used to update the
teams with NGH progress at Multidisciplinary Trauma
Reviews. It also provides the opportunity to identify
areas that need improving upon or where
recommended practise may have changed.
With Sharon bringing NGH’s data up to such a good
standard, all the units within CETN can now boast
submitting the right number of expected cases with
excellent data quality, as shown below:
the North West Children’s Major
Trauma Network. Sam also takes a
lead role in training personnel
responsible for data input, and has
had a key role in the development
and implementation of the Trauma &
Orthopaedic Forward Plan for audit.
Sam has been assiduous in the development of our governance
system, ensuring any patient pathway issues are raised through our
incident reporting system and fed back to the relevant sources. She
compiles themed reports for pathway problems and feeds back
when there is evidence of improvement. She has also had
opportunity to ‘excellence report’, always ensuring that good
practice is applauded.
Sam has not only networked widely
in the UK, but has won an award
which allowed her to visit a Major
Trauma Centre in the United States.
Whilst presenting her work she
made connections that have allowed
ongoing collaboration as to the setup
of both the acute and rehabilitation
services.
Sam’s overall impact has been wide and profound within the
network. Her commitment to data, its acquisition, management and
assessment has been paramount in the development of the clinical
service and the engagement of the network. Through her work, we
understand the pathways of almost every patient TARN eligible or
candidate, which informs the future of care within the service.
Template produced at the Graphics Support Workshop, Media Services
Ian and his team attend a weekly multi-disciplinary clinical
meeting, for which they prepare key data on mortality, care of
the most severely injured patients, TARN cases and the MTC
dashboards.
Sharon proactively scours the ED electronic and
paper record systems and collates all the information
for patients who are TARN eligible, the details of
which are then presented at the NGH Major Trauma
Management Group, which enhances the process of
patient review immeasurably.