In my last post, I wrote about how the electronic trauma flow sheet (eTFS) practically assures a garbage in situation. Today, I’ll dig into what happens on the back end, and how it also creates a garbage out situation.

There are two ways to view the eTFS on the back end (abstraction phase): read a paper report (timeline), or view it live in the electronic health record (EHR). Let’s look at each:

• Paper report. Anyone who has actually generated one of these can tell you that it’s a disaster! Reams of paper, typically 20-30 pages. Hundreds of “chronological” entries. Inclusion of extraneous information from later in the hospital stay. Ebola screens. Sepsis score. Many things that have nothing to do with trauam. They are difficult to understand, and it is very difficult to pick out the true “signal” due to all the “noise!” And it doesn’t matter how customized the report is, it will nearly always fail on these issues.
• Live EHR. Your abstractor (registrar, PI coordinator, trauma program manager) logs in and pulls up the screen(s) containing the eTFS. Once again, they need to mouse and keyboard around, looking for the specific things they are interested in. Piece by piece, they try to assemble a human-understandable picture of what happened. But since it’s not chronological across all activities in this view, it can be very challenging.
• Both. And then there’s the issue of Garbage In I discussed yesterday. Conflicting patient arrival times. Lack of accurate team arrival documentation. Vital signs and IV infusions are recorded after patient expiration or discharge. No massive transfusion start time. Inaccurate data from the scribe’s “cheat sheet.”

The final result of all of the shortcomings listed above is this: it increases trauma flow sheet abstraction time by three-fold or more! If you are a trauma center with a two-tier trauma activation system, you probably have a lot of TTAs. Therefore, it takes a lot of time to abstract all those flow sheets. Which ultimately means that you (this really means your hospital) will have to pay for more registrars / PI coordinators / nurses!

Hopefully, I’ve convinced you that the eTFS is not a great way to go. In the next post, I’ll discuss strategies to use if your hospital is “considering” moving to an eTFS. And next week, I’ll wrap up with what to do if you’ve already been burdened with it.