Data analysis, Audit and Service Improvement in Greater Manchester

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How Does the Network use Data to Influence Care Delivery in Greater Manchester?

There are a number of ways that the Greater Manchester Major Trauma Network uses data to ensure consistent and improving performance across the conurbation.

Individual hospital sites are responsible for collating data around the specific services delivered at each site. It is every Trust’s responsibility to evidence practice and develop a robust system of analysis and feedback to those involved in the delivery of care. Once evidence is collated, it is interpreted and reported to stakeholders and interested parties.

The collected data is measured against agreed standards (from both internal and external sources) and performance can be analysed and compared to previous years.

The GM Major Trauma Network holds an audit calendar that outlines individual data sets required from sites and services to ensure that standards set are consistently met. In examining data any opportunities for improvement can be identified and interventions for improvement are actioned accordingly.

Audits are regularly presented through the Clinical Effectiveness Committee (CEC) meetings and the Network visits a different hospital site every 8 weeks to examine morbidity and mortality data. Themes can be identified and the Network’s work plan adjusted to meet demand as required.

About the Trauma Audit and Research Network (TARN)

The Trauma Audit and Research Network is the independent monitor of trauma care in England and Wales.

TARN is a collaboration of hospitals from all over England, Wales, Ireland and other parts of Europe which supports a group of staff on a non-profit making basis; based at the University of Manchester, Salford Royal Hospital.

The aim of TARN is to collect and analyse clinical and epidemiological data to provide a statistical base to support clinical audit. This aids the development of trauma services and informs the research agenda.

TARN holds a database of information that is the largest in Europe and membership to TARN is mandatory for every hospital. Hospitals calculate the Injury Severity Score (ISS) of each patient that attends their hospital with traumatic injuries. A score is calculated, and if the score is >9 then information is submitted to TARN about the cause, actual injuries, treatment and outcome of the patient.

It is impossible to list every potential combination of injuries, so for this reason injuries are calculated retrospectively; that is after diagnosis, treatment and discharge from the hospital has occurred. This information is collated, and used to help Doctors, Nurses and Managers improve their service.

The data provided is crucial evidence to ensure what hospitals do for patients is safe and effective. It achieves this by:

Supporting multidisciplinary clinical audit by analysis of individual case management
Provides comparative statistics to clinicians about institutional performance
Provides summative information to local health commissioners about the trauma workload and it’s management
Provides population based statistics on the epidemiology of trauma
Identifies areas of potential research interest
Refines methods of measuring injury severity, particularly those concerned with disability

The data includes specific standards of care recommended by professional bodies and supports researched based evidence for best practice. The overall aim of TARN is to collect and analyse clinical and epidemiological data what provides a statistical base to support clinical audit, to aid the development of trauma services and to inform the research agenda.

In doing so TARN:

Support multi-disciplinary clinical audit by the analysis of individual case management
Provide comparative statistics to clinician about institutional performance
Provide summative information to the local health commissioners about the major trauma workload and it’s management
Provide population based statistics on the epidemiology of trauma
Identify potential areas of research interest

TARN produces reports for member hospitals three times a year. Each report contains a core section containing measures such as time to CT scan and a themed section focusing on a particular type of injury:

March – Thoracic and Abdominal Injuries

July – Orthopaedic Injuries

November – Head and Spinal Injuries

They also produce annual reports for all sites and quarterly performance dashboards. Individual hospital teams use this information to compare their performance against specific outcome measures. The Network team uses this data to compare performance of different sites, ensure compliance with standards and develops a work programme around supporting sites to achieve excellence.

Data completeness in Greater Manchester is generally good. The case ascertainment and accreditation for the MTC sites is consistently 100% and greater than 95% respectively. A number of the TU/LEH sites also score highly against these measures; however in general, data quality in non-MTC sites requires some improvement. This has become more apparent following TARN’s introduction of a data reliability index in 2018/19. This index has highlighted the need for all sites to undertake further work on the reliability of its data. Improvement of data quality has been added to the Network’s work programme for 2019/20.

Find out more from the TARN website here https://www.tarn.ac.uk/

What are the benefits of a Major Trauma Network?

Improved patient outcomes

The National Audit Office estimated that between 400 and 600 lives could be saved per year across England. Since the establishment of major trauma networks in 2012 we have seen a 9% increase in survival outcomes
Major trauma patients receive world class care from specialist teams providing 24/7 emergency access to consultant-delivered care
Long term disability is reduced by improving outcomes for adults and children involved in major trauma
Centralising services that include specialist rehabilitation services means major trauma patients have access to what they need in one place, minimising delay. As a consequence these patients require less long-term NHS care
Through the provision of specialist care and rehabilitation, patients will have an improved ability to return to work and undertake recreational activities
The NHS is able to better plan for and respond to major incidents, thus improving the care major trauma patients will receive
To ensure best outcomes for major trauma patients, hospitals specialising in major trauma have specialist doctors and clinical support staff available at all times
Having major trauma centres and units specialising in major trauma is a more cost effective way of caring for patients as they ensure the best use of resources, making the major trauma centres and trauma units more sustainable

Changing the System – Major trauma patients and their outcomes in the NHS (2018)

Link to TARN website

TARN