Frequently asked questions
TORQUE is a redesign and quality improvement project being conducted by the NSW Institute of Trauma and Injury Management (ITIM), a network within the Agency for Clinical Innovation (ACI). It is funded by the NSW State Insurance Regulatory Authority (SIRA).
TORQUE consists of two main components:
- A re-design of the current NSW Trauma Registry including linkage to the eMR.
- A new Trauma Patient Reported Measures (PRM) program to be linked to the NSW Trauma Registry.
The existing NSW Trauma Registry (Collector) has been in use since 2008 and relies entirely on manual data entry. New technologies and data linkages developed over the past five years allow more efficient and integrated data collection methods, freeing up trauma service time and resources for more focused quality improvement work.
There is also a need to develop a more patient centred approach to the NSW trauma system, one that aligns with NSW Health strategic priorities, to ensure that patient needs are being met across the NSW Trauma system.
The pilot for the Trauma PRM program will take approximately 12 months to complete (late 2021). An interim report will be made available to all trauma services. The virtual registry build is expected to be complete by the end of 2022.
The Trauma PRM program is a standardised state-wide process using surveys for the collection and monitoring of patient reported outcomes, experience and health care utilisation and return to work or study information in severely injured patients across NSW.
The pilot will assist ITIM to identify issues prior to its broader implementation across all the NSW trauma centres. Focus areas will include:
- Provision of patient information prior to discharge
- PRM survey content and processes
- Data collection
- Data reporting
- Data and process governance
The Trauma PRM program development will occur in a phased approach:
- The first phase will be a pilot beginning in October 2020. The first phase will include two major trauma services and one regional trauma service. The identified phase one sites are Royal Prince Alfred Hospital, Liverpool Hospital and Wagga Wagga Hospital.
- The trauma services who partake in first phase will be asked to participate in an evaluation process. This is to assist in making improvements and changes prior to the second phase commencing in 2021.
- The second phase will add additional trauma services to the program. This phased approach will continue until all trauma services are included in the PRM outcomes registry.
- The trauma service will be required to work closely with the ITIM team and identify suitable patients who will be willing to participate in the Trauma PRM program.
- Trauma services will be required to inform identified patients about the Trauma PRM program including providing information, brochures and answering any additional questions the patients may have. ITIM will provide the relevant training and information to pilot sites prior to the rollout commencing.
- The pilot sites will be required to enter patient contact details for the selected patients into Collector. This is anticipated to be five to ten patients per month.
- Pilot sites will be required to liaise with ITIM and the TORQUE Registry Support Nurse on a weekly basis for half an hour. This is to facilitate the early identification of any issues arising during the pilot and to seek early resolution of the identified issues to support pilot sites.
- All pilot sites will be required to participate in an evaluation process for the Trauma PRM program. This is to assist with the streamlining and improvements of processes prior to further development and rollout of the program.
The pilot is being conducted in a phased approach, so as the project progresses, we will continue to add sites throughout 2021-22 until all trauma services are included.
Initial phases will commence with the designated trauma services in NSW. It is anticipated that as the program becomes more established, consideration will be given to expanding to cross-border services.
The contact details for patients or the authorised representative is necessary for two main reasons.
- To facilitate the contacting of patients by the TORQUE Registry Support Nurse undertaking the trauma PRM surveys at the appropriate timepoints following discharge from hospital.
- As part of the follow up calls, the Trauma PRM program staff are required to conduct a patient verification process for each call. That is to ensure the correct patient or authorised representative is contacted for the follow up calls and ensure confidentiality and legal requirements are upheld.
The evaluation is an important part of the pilot process to ensure that aims and objectives of the pilot are being fulfilled and lessons learnt are captured. Trauma services partaking in the pilot will be requested to participate in an evaluation process. This includes surveys and/or interviews with pilot trauma sites which will be undertaken by ITIM.
No. NSW Trauma PRMs program is part of an ongoing quality improvement and system monitoring program. PRMs will form part of the NSW Trauma Registry minimum dataset. Analysis and reporting of aggregate data will continue through ITIM annual reports. Research requests to analyse Trauma PRM data will still need to be coordinated by the ITIM Research Committee and approved by relevant ethics committees. As is presently the case, any data pertaining to patients managed within a given trauma service(s) will be accessible by those trauma services as part of the minimum dataset.
Inclusion criteria
Patients will be eligible for Trauma PRM surveys at 1, 6 and 12 months post discharge from hospital if:
- They meet the NSW Trauma Registry minimum data set criteria
- Their contact details are available and documented in the NSW Trauma Registry
Exclusion criteria
- Opted out of registry for any reason
- Discharged from ED or within 24 hours of arrival to hospital
- Pre-existing cognitive impairment (such as dementia based on ICD codes)
- Significant pre-existing mental health diagnoses (based on ICD codes)
- Death in-hospital
- Severe brain injury resulting in persistent vegetative state
- Discharged to a nursing home or other long-term care facility
- Residing overseas
- Age < 16 and no parent available to provide follow up outcomes
- Incarcerated
Exclusion criteria during pilot only
- Age < 16 (no proxy capability during early phases or pilot)
- Non-English speaking background (surveys only in English during pilot)
Note:
- All patients are included in Trauma PRMs unless meeting the exclusion criteria. This is an opt -out approach.
- All patients and/or their relative(s) should be made aware that they have the right to opt-out of participating in the Trauma PRMs surveys at any time.
The collection of patients reported measures for TORQUE has been approved by the NSW Population Health Services Research Ethics Committee on an opt-out basis (protocol reference: HREC/17/CIPHS/18). Consent for the conduct of the surveys will be obtained at the time of contact by ITIM. Trauma services will only need to provide appropriate patients or their carer with a Trauma PRM patient information brochure and enter their contact details into the existing fields in Collector.
The patient will be requested to sign an opt-out consent form to exclude them from receiving the PRM surveys post discharge from hospital. Trauma services are required to document any opt-out patients in Collector to ensure they are not contacted post discharge from hospital. Opting out will not affect their care. See the 'Decline to participate protocol' and associated form for more information.
The decline to participate form is a state form and is ordered through Stream Solutions. Most Hospitals administrative staff who have stream solutions access can order these forms as required.
The product number for ordering is: NH700435.
Yes, consumers have been involved in this process such as brochures and information sheets. We also have consumer representation on our TORQUE Steering Committee.
Yes, ACI held ‘Privileging the Voices of Aboriginal Patients in the development of the NSW Patient Reported Outcome Measures (PROMs) Program’ workshop. Work on this aspect will continue in the background. Resource content has also been reviewed by the ACI Aboriginal and Cultural Diversity Engagement Officer.