The Scottish Trauma Audit Group

STAG priorities (2022)

1. The National Planning Forum report on major trauma provision made a series of recommendations for the future of trauma data collection provided by STAG:

  • All hospitals with an Emergency Department should contribute to STAG (N=30)
    29 hospitals now participate in STAG.
  • The audit should expand to include paediatric trauma
    From November 2017, all hospitals participating in STAG collect data on all patients, regardless of age.
  • National Key Performance Indicators (KPIs) should be agreed and measured to help monitor the success of the STN and drive improvements
    KPIs for the Scottish Trauma Network Download the Key Performance Indicators for the Scottish Trauma Network - Version 7.7 in PDF format [365 Kb] have been agreed by the STN Steering Group following a long consultation process and literature reviews for supporting evidence. A subset of KPIs are now being measured in eSTAG and reported on within eSTAG and Tableau™.  CT head KPIs were reviewed and updated in 2021 to ensure they were clinically relevant and better aligned to NICE guidelines – 2.4.3-2.4.6 were ratified in April 2021. New KPIs are available for: time to repatriation, time to specialist care; time to neurosurgery is still in development.
  • STAG should be extended to include data collection on the full patient journey including rehabilitation and Patient Reported Outcome Measures (PROMs)
    STAG started to collect PROMS data in June 2018 in order to gather data on functional outcome and quality of life. Visit the PROMs section on this website for more information. Paediatric PROMs started in April 2022 and is currently using PedsQL methodology.
    Two of the KPIs relate to rehabilitation, with the introduction of formal planned care using a National Rehabilitation Plan for major trauma patients. The Rehabilitation Plan is now being used in all four regional trauma networks.
  • STAG and the Scottish Ambulance Service data should be linked
     SAS data are now imported directly into eSTAG.
  • STAG and hospital in-patient data (ISD SMR01 data) linkage should be progressed
    This allows valuable information to be explored in relation to outcomes and survival - STAG now have routine linkage with SMR01 data.

    • 2. Additional work agreed by STAG Steering Group:

  • Develop electronic data collection (eSTAG)
    The development of an electronic data collection system (eSTAG) to facilitate collection of STAG data from the 30 hospitals in Scotland treating patients who have suffered trauma was completed in late 2017. eSTAG is a web-based system developed in-house by the National Services Scotland IT team in collaboration with the STAG project team and accessed by colleagues in NHS Boards via the N3 network. The system allows the collection and storage of data pertaining to patients who meet the inclusion criteria for the STAG audit.
  • Develop electronic reports using Tableau™
    Reports via Tableau™ use data from eSTAG, to show performance against the KPIs and management information. There are four different types of reports:
    1. Hospital reports for clinicians and managers working within a named hospital;
    2. Network reports for staff involved in network activities e.g. planning, management and operational aspects of the network;
    3. National Reports for Scottish Trauma Network and Scottish Government staff;
    4. Scottish Ambulance Service reports for staff that are involved in the pre-hospital care and inter-hospital transfer of patients.
  • Develop a real time mortality tracker using CUSUM methodology
    This is now sent to hospitals and regional trauma networks every quarter.
  • Develop a method for assuring data completeness by using Scottish in-patient data (SMR01) for comparison.
    This is now a monthly process and has allowed STAG to include patients who are admitted to a medical specialty. Patients who are admitted to the traditional surgical pathway or critical care are tracked prospectively using local hospital systems.
  • Recalibrate the Probability of Survival model using Scottish data (currently based on English data).
    STAG have now recalibrated the Ps 12 model using Scottish data from 2013-2018 and removed patients with hanging and drowning injuries.
  • Governance
    In 2016 STAG piloted a governance process that is triggered when hospital mortality is statistically lower than the Scottish mean. This pilot was successful and is now standard procedure within STAG. This process ensures that outcome data are reported, investigated and actions for improvement agreed when necessary. Scottish National Audit Progamme (SNAP) Governance now encompasses this and expands the governance to include KPIs.
  • Frailty data
    After a pilot in NHS Lanarkshire and discussions with colleagues in care of elderly, health improvement Scotland and the Scottish trauma network; STAG have commenced the collection of frailty data. We understand from review of outcome data that a proportion of patients who die following trauma are frail. Highlighting this has led to improved links with emergency medicine, trauma and care of the elderly specialties. Collection of the data will allow us to better understand the full extent of frailty in the trauma population and the added risk to mortality.