Real-life Trauma: Inside the Registry

Vol. 18 •Issue 19 • Page 32
Real-life Trauma: Inside the Registry

Take a peek into the fast-paced world of trauma registries.

Oh, the stories they could tell. Some are heart-wrenching—the little girl who lost her life to a lawnmower as she ran out to greet her daddy. Others are a bit off, a bit humorous, like the man who arrived in the trauma department after a jet skiing accident. He was with his girlfriend at the time É the girlfriend his wife didn’t know about. Other stories are uplifting, like the person who recovered against the odds. Still, it’s the sorrowful tales that tend to stick in the mind. With all of the stories, and millions more like those, it’s a trauma registrar’s job to put the pieces together.

We’ll introduce you to four working trauma registrars, all with different levels of experience, from 20 plus years to less than 2 in the field. Being a trauma registrar is a rewarding profession that makes a difference, and one that these women are happy and proud to be in.

Bringing an HIM Background

Mardi Davis, BS, RHIT, CSTR, CAISS, knew coding wasn’t for her. After garnering her registered health information technician (RHIT) credential and graduating from an associate degree program, she couldn’t figure out what she wanted to be, and she began to peek around at registries at a large health care system. Davis discovered that St. Vincent Mercy Medical Center/St. Vincent Mercy Children’s Hospital, Toledo, OH, a Level I trauma center, had a trauma registry and sent an e-mail to the director, explaining her coursework and when she was graduating. “She told me to check back in a month, and then I saw the ad in the paper and I knew it was for me,” Davis said. “So I applied, and she called me before I even got back home.”

Once she started working in the registry, the data systems specialist in trauma administration had no one to train her. Nobody knew what her job consisted of. She poked around and tried to find others with HIM credentials in the field of trauma registry, and she was surprised that so few HIM professionals were involved in trauma registries. Mostly, Davis noted, emergency room clerks, paramedics and nurses filled the positions in the registries. She made it her “secret agenda” to work with anyone who could upgrade the educational experience to ensure HIM professionals filled the roles, but found roadblocks. She began mentoring local college students in HIM programs, and hired two former HIM students to work in the registry with her. “I think an HIM background should be mandatory for any registry job, but that’s just my personal opinion,” Davis said.

Her boss noticed that her data management background came in handy, but didn’t touch on any database information, so Davis tapped into the knowledge of her husband, a “computer geek,” to help her learn how to administer the software in the trauma registry. “I did not know how to download, export, install updates or keep it running and I could not believe the amount of information I’ve learned on the job,” Davis said.

Now, there’s no typical day for Davis. In the morning, she’ll abstract data right from the patients’ bedsides. She then gathers information on the patients that came in the previous night and that morning, and she enters the information on her laptop. In the meantime, she also works with researchers and generates reports for them ad hoc. She works with education, research, injury prevention, does administrative reports and attends a monthly meeting with the coroner to review all deaths. She also serves as the president of the Alliance of Ohio Trauma Registrars (AOTR). “That’s why I didn’t want to go into coding, because I am such a multi-tasker,” Davis noted.

Davis also likes that the data she collects makes a difference. She can use statistics to show the number of gunshot wounds in an area, and she can even help keep drivers safe. Because she can pinpoint where most of the automobile crashes happen in the city, the police department can use the data to see where a red light is often run, and city council can then use that information to make changes to an intersection. And she doesn’t hesitate to go right up to patients to ask questions and get the full story so she can get the most complete information. “A lot of it is, I was just walking down the street minding my own business,” Davis said. “Um, and then you got shot, right? That’s a popular story. I’m not afraid to ask a patient [about injuries].”

A Full Plate

Like Davis, Jane Riebe, BA, CSTR, director of regional trauma registries, project assistant for regional disaster planning, The Hospital Council of Northwestern Ohio, Toledo, can never seem to have a typical day. She’s been in trauma registry longer than anyone else in her state, and she now manages the trauma registries of two regions in Ohio. She started out with a computer programming background, and got her start at a large, inner-city hospital in Toledo. She and her supervisor were tasked with developing a trauma program so the facility could become a verified Level I trauma center. She stayed at that hospital until 2000, when she took over her current position. “Working with a region is really different from working in a hospital, because when you’re with one hospital, everything pertains to that one hospital,” Riebe explained. “I’m doing a juggling act, and keeping all my hospitals on track as well as keeping the regions together.”

A juggling act, indeed. She gets the trauma data from the hospitals in her regions and sends it to the state. Riebe also composes an annual report for her regions every year, and that report is customized for each individual hospital—that’s 35 hospitals now, down from 48 that she was doing when she managed three regions last year. She sits on several committees, travels throughout the state very often and even took on a disaster planning role in her “spare time.” Riebe works on research projects, serves on the regional physician advisory board and acts as a resource to others working in trauma registry. She sets up training courses for trauma registrars and helps put together an annual trauma symposium. Yes, it can get a bit overwhelming. “Bored is not in my vocabulary,” Riebe joked. “I’m very content, even though I’m stressed out a lot.”

In her role, she gets to see the registrars she trained throughout the state. She also gets to hear their complaints, and like Davis, she’s a member of the close-knit AOTR, which meets every other month in the state capital. Riebe hears—and sympathizes with—trauma registrars who stress about the numerous deadlines that must be met. And like many health care professions, trauma registry finds itself a non-revenue generating entity, meaning that hospitals are cutting costs in registries and causing some registrars to be underpaid. “[The facilities] don’t know what we do, so they don’t think we do anything,” Riebe explained. “And you hear that a lot. And because they don’t know what the registrars do, a lot of them are underpaid, and it’s very hard to convey to someone why your job is not just data entry.”

Technically part of the trauma department, trauma registrars, like HIM professionals, must have a keen eye for detail and must be able to hone in on discrepancies in charts. They also must work with technology in the form of often complicated databases. Despite the sometimes harried nature of her job, Riebe has blossomed in the field. When she started out, she was terrified to give presentations—now she’s an old pro. And she gets personal satisfaction out of her work even though she’s so busy at times she feels like screaming. “You do stay very, very busy on the job,” Riebe said. “You know, people say, oh, winter goes so slow. Every single day goes too fast for me. I don’t care if it’s in January or July. They all go too fast.”

A Different Take

Roberta Smith, LPN, trauma registrar, Delray Medical Center, Delray Beach, FL, finds her days settled into more of a set routine than Davis or Riebe. She works with the Trauma One registry system, putting in data and requesting reports for her Level II trauma center. If she finds a glitch in the documentation, she lets the quality assurance nurse know, and she attends data committee meetings at the health care district. She compiles monthly statistics for the hospital’s financial and administrative departments, as well. She works with four others in the registry and enjoys the small office feel. Her office is in a different building than the trauma center, and she has no interactions with patients. “For me, it’s a perfect job, because basically I am in an office,” Smith said. “It’s autonomous and what I do as far as reviewing charts, running reports, printing out statistics and communicating with EMS and the health care district suits me well. I also run special reports as requested for research by our physicians and program manager, and I supply the quality assurance nurse with the reports she needs for her data.”

Like all trauma registrars, Smith must comply with the minimum data sets that are determined by the county and the state, and her program will soon participate in the National Trauma Data Registry, sending data to the national level. The job is a big change for Smith, who worked as a nurse for 34 years, and that’s where she picked up coding as a case manager and utilization review nurse. Now, she aims to get her certifications in trauma registry as well as abbreviated injury scoring (AIS) coding. Like the others, she received a lot of on-the-job training. Her facility didn’t have a registrar for a while before she came, and she worked with a former registrar to learn the database. “It was kind of crazy when I got there,” Smith recalled.

Like HIM professionals, Smith is sometimes frustrated by documentation that isn’t complete or detailed enough. She also deals with numerous deadlines, and she has to have all of the patient demographics and the initial data in the system within 3 days of admission, and within 20 days of the patient’s discharge, the record has to be completely finished. Her registry has a caseload of approximately 1,500 patients per year, which adds to the challenge of having complete and accurate data. “It doesn’t matter if I get 20 patients on the weekend or I get eight, I’ve got to have it all done within that time,” Smith said.

Finding Her Little Niche

Ellen Fitzenrider, BA, RHIT, trauma data management coordinator, University Hospitals of Cleveland, knows all about deadlines. She ran the gamut of HIM professions: she worked as an MT, a cancer registrar and then in an HIM department. She then found herself in trauma registry, which she’s been doing for 20 years. “I call myself a crack filler. All through my life I’ve seen where there’s a little niche and I’ve tried to fill it,” Fitzenrider noted.

She just naturally clicked with the coordinator of a local trauma registry after interviewing for the job, and when the coordinator moved, she moved too, to her current position at Level I trauma center Rainbow Babies and Children’s Hospital. Like Davis, she strongly advocates for an HIM background for trauma registrars. “The hospitals think they can pull anybody off the street to do the job, and that doesn’t work well,” Fitzenrider said. “You really need a coding background. You need to be able to do ICD-9 coding. We do AIS coding so you need a background in coding, and anatomy and physiology, to be able to do the job and to understand the charts.”

In her role, Fitzenrider does quality management, works with two other Level III trauma center facilities and works a lot with statistics and pulling reports. Like the others, Fitzenrider identifies trauma patients by their ICD-9 code—it has to be between 800 and 959. “Inclusion criteria varies from facility to facility and also from state to state,” Fitzenrider pointed out.

Fitzenrider and the other trauma registrars don’t have to do follow-up on patients—a difference from cancer registrars. And she often has to deal with physicians. Like HIM professionals, Fitzenrider often struggles with getting physicians to understand the role of the registrars. She has to confront physicians about issues with the way they cared for patients, according to trauma center guidelines. “Some of the resi-

dents I think are really, really good, and then we get some that just are very busy and don’t have time,” Fitzenrider said. “And it’s dealing with the ones who don’t have time, because you know within the next 3 years, you’re going to be reviewed for the [trauma center] verification process.”

Fitzenrider also has to deal with some horrifying stories in the charts that she reviews, and these stories are even more striking because children are involved. In the past, she explained that she had to go to the floor to collect data, and the charts were right at the bottom of the patients’ beds. She’d be struck by cases of abuse. “You’re going, what is wrong with the world and what is wrong with people that this child was treated this way, or you feel so bad because accidents happen, and some of the pictures with impalings or dog bites, it’s like, oh my goodness. It’s a little tough sometimes,” Fitzenrider noted. “But then when [the patients] get well, bounce back and go home the next day, there’s a positive side, too.”

Lynn Jusinski is an associate editor with ADVANCE.

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