One of the most overused terms in trauma performance improvement is “track and trend.” It implies that the event in question will be closely monitored, with the promise of potential future action.

But the reality is that, much of the time, these events are largely ignored, and a running tally is either kept somewhere or will be calculated at some undefined time in the future. The ultimate result is that these events tend to get “swept under the rug” and ignored.

All is not lost! If done correctly, “track and trend” can be very valuable.  Here are the key components of an effective “track and trend” process:

• A definition of the problem event. Be very specific. For example, the occurrence of VTE interruption in patients with orthopedic injuries requiring surgery.
• Occasionally optional: An intervention that has been implemented to address the event and make it “better.” If you have experienced what you believe is a truly one-off event and want to confirm its rarity, an intervention is not necessary. However, this is not a common occurrence. Most events will require some type of intervention, especially if they are serious or seem to be recurring.
• A length of time for monitoring. Again, be specific. The length of time must be based on the specific event being tracked. Sometimes the time frame may be brief, e.g., three months. But in this VTE example, a longer time may be required, such as a year.
• A threshold goal. This is the new minimum acceptable performance standard. It will be dependent on the event being tracked.  Sometimes, guidance can be found in the literature. But most of the time, the current incidence will need to be calculated, and then reduced by an arbitrary amount to arrive at the new threshold. In this example, if the current incidence is 20%, the program may want to drop it to 10%.

In this example, the full “track and trend” text reads like this:

We will track the occurrence of interruption of VTE chemoprophylaxis in patients undergoing operative repair of orthopedic injuries after implementing a new VTE practice guideline. This will be monitored for 12 months, with a goal of an incidence of less than or equal to 10%.

Here is another example. A trauma surgeon took a hypotensive patient to CT scan during a trauma activation, where the patient suffered a cardiac arrest due to inadequate resuscitation. The PI process captured this, and the TMD counseled the surgeon.

Here’s the track and trend text in this case:

After counseling by the TMD, we will track the occurrence of hypotensive patients being taken to CT during trauma activations by Surgeon X for six months, with a goal of no occurrences during that period.

The final part of the track and trend process is to see if the goal was met. If so, create solid documentation for loop closure, and your job is done! If not, it’s time to put on your thinking cap, change the intervention, and start again. Repeat until the final goal is reached.

By implementing this process, the track and trend process can actually be a meaningful part of the PI program.