Toward an all-inclusive trauma system in Central South Ontario: development of the Trauma- System Performance Improvement and Knowledge Exchange (T-SPIKE) project

Toward an all-inclusive trauma system in Central South Ontario: development of the Trauma- System Performance Improvement and Knowledge Exchange (T-SPIKE) project

Can J Surg 2021;64(2):E162-E172 | PDF

Paul T. Engels, MD; Angela Coates, MEd; Russell D. MacDonald, MD, MPH; Mahvareh Ahghari, MEng; Michelle Welsford, MD; Tim Dodd, ACP; Katie Turcotte; Jeffrey D. Doyle, MD; Arthur M. Eugenio, MD; Jason P. Green, MD; J. Eric Irvine, MD; Paul J. Lysecki, MD; Simerpreet K. Sandhanwalia, MD; Sunjay V. Sharma, MD, MSc

Abstract

Background: There is currently no integrated data system to capture the true burden of injury and its management within Ontario’s regional trauma networks (RTNs), largely owing to difficulties in identifying these patients across the multiple health care provider records. Our project represents an iterative effort to create the ability to chart the course of care for all injured patients within the Central South RTN.

Methods: Through broad stakeholder engagement of major health care provider organizations within the Central South RTN, we obtained research ethics board approval and established data-sharing agreements with multiple agencies. We tested identification of trauma cases from Jan. 1 to Dec. 31, 2017, and methods to link patient records between the various echelons of care to identify barriers to linkage and opportunities for administrative solutions.

Results: During 2017, potential trauma cases were identified within ground paramedic services (23 107 records), air medical transport services (196 records), referring hospitals (7194 records) and the lead trauma hospital trauma registry (1134 records). Linkage rates for medical records between services ranged from 49% to 92%.

Conclusion: We successfully conceptualized and provided a preliminary demonstration of an initiative to collect, collate and accurately link primary data from acute trauma care providers for certain patients injured within the Central South RTN. Administration-level changes to the capture and management of trauma data represent the greatest opportunity for improvement.

Résumé

Contexte : On ne dispose actuellement d’aucun système intégré de gestion des données pour évaluer le fardeau réel des traumatismes et de leur gestion dans les réseaux régionaux de traumatologie (RRT) en Ontario, en bonne partie en raison de la difficulté d’identifier les cas parmi la multiplicité des dossiers d’intervenants médicaux. Notre projet représente un effort itératif pour créer la capacité de cartographier le parcours de soin de tous les polytraumatisés du RRT de la région Centre-Sud.

Méthodes : Grâce à l’engagement général des intervenants des grandes organisations de santé du RRT de la région Centre-Sud, nous avons obtenu l’approbation d’un comité d’éthique de la recherche et conclu des accords de partage des données avec plusieurs agences. Nous avons testé l’identification des cas de traumatologie du 1er janvier au 31 décembre 2017 et les méthodes de liaison des dossiers de patients entre les divers échelons de soin pour identifier les obstacles à la liaison et leurs solutions administratives possibles.

Résultats : Au cours de 2017, les cas de traumatologie potentiels ont été identifiés auprès des services ambulanciers terrestres (23 107 dossiers), des services de transport médical aérien (196 dossiers), des hôpitaux référents (7194 dossiers) et du registre hospitalier principal de traumatologie (1134 dossiers). Les taux de liaison entre les différents services pour les dossiers médicaux variaient de 49 % à 92 %.

Conclusion : Nous avons conceptualisé et présenté avec succès la démonstration préliminaire d’un projet visant à recueillir, colliger et relier avec justesse les données primaires des intervenants en traumatologie aiguë pour certains patients blessés du RRT du Centre-Sud. Des changements administratifs centrés sur la saisie et la gestion des données de traumatologie représentent la meilleure voie vers une amélioration.


Accepted Mar. 30, 2020

Presented at the Trauma Association of Canada virtual annual scientific meeting and conference, Nov. 16–20, 2020

Affiliations: From the Department of Surgery, McMaster University, Hamilton, Ont. (Engels, Coates, Doyle, Sharma); the Trauma Program, Hamilton Health Sciences, Hamilton, Ont. (Engels, Coates, Sharma); Ornge, Mississauga, Ont. (MacDonald); the Department of Medicine, University of Toronto, Toronto, Ont. (MacDonald, Ahghari); the Centre for Paramedic Education and Research, Stoney Creek, Ont. (Welsford, Dodd, Turcotte); the Division of Emergency Medicine, McMaster University, Hamilton, Ont. (Welsford); Niagara Health, St. Catharines, Ont. (Doyle); Cambridge Memorial Hospital, Cambridge, Ont. (Eugenio); Grand River Hospital, Kitchener-Waterloo, Ont. (Green); Brantford General Hospital, Brantford, Ont. (Irvine); Joseph Brant Hospital, Burlington, Ont. (Lysecki); and Oakville Trafalgar Memorial Hospital, Oakville, Ont. (Sandhanwalia).

Competing interests: None declared.

Contributors: A. Coates, P.T. Engels, S.V. Sharma, R.D. MacDonald and M. Welsford designed the study. A. Coates, S.K. Sandhanwalia and T. Dodd acquired the data, which A. Coates and P.T. Engels analyzed. A. Coates, P.T. Engels and S.V. Sharma wrote the manuscript, which all authors critically revised. All authors gave final approval of the article to be published.

Funding: This project was supported by an Education Research Grant (2015) and an Innovation Grant (2017) from McMaster Surgical Associates.

Content licence: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

DOI: 10.1503/cjs.000820

Correspondence to: P. Engels, Hamilton General Hospital, 6 North Wing, Room 617, 237 Barton St E, Hamilton ON L8L 2X2, engelsp@mcmaster.ca