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Form of workJob Description
Job Description:
The Clinical Trauma Registrar is responsible to maintain and assure the quality and accuracy of the trauma registry database, the foundation of the trauma PIPS process. This role contributes to the development of standard work and during the process of trauma registry data entry, reliably identifies cases that warrant review, fully completes data abstraction into the trauma registry database according to Trauma Service standards, trauma leadership needs, existing regulatory requirements and to meet data entry deadlines for the County, NTDB and TQIP. The Registrar collects, analyzes and reports trauma data for quality improvement tracking as assigned, as well as targeting injury research and prevention. This role implements processes to assure accuracy and confidentiality in the handling of all trauma registry related matters. In addition, as the Performance Improvement (PI) Specialist, the Registrar is actively engaged in PI evaluation, review, and solution generation/implementation to improve the optimal care of the trauma patient. The Clinical Registrar & PI Specialist is skilled in writing reports and presenting data graphically, both internally and externally, to promote process improvements, improved outcomes and optimal patient care.
Duties and Responsibilities:
" Database Management
" Maintains and updates the trauma registry database.
" Evaluates all documentation for accuracy and completeness prior to data entry.
" Abstracts and enters data elements on all trauma patients concurrently.
" Maintains data accuracy using a validation process.
" Ensures data is entered in a timely manner; concurrent for admitted patients and within 1 month of discharge for patients sent home from the Emergency Department.
" Implements changes in database in coordination with Alameda County EMS-A, the National Trauma Data Bank (NTDB), and TQIP (Trauma Quality Improvement Program) and Trauma Services leadership.
" Retrieves demographic and financial information through the electronic health record.
" Adheres to inclusion criteria set forth by Alameda County, State of California (CEMSIS) and American College of Surgeons (Client) NTDB.
" Assures confidentiality of data and abides by HIPPA regulations.
" Complies with standard work instruction for trauma patient identification, data abstraction and entry.
" Participates in validation of data reliability, accuracy, and completeness of database, including PI data
Knowledge, Skills, and Abilities:
" Demonstrates breadth and/or depth of knowledge and skills required for position including proficient understanding of pathophysiology and medical terminology.
" Maintains current knowledge with national and regional trauma registry requirements and practices; shares technical knowledge. This includes required clinical and database knowledge and skills, as applicable.
" Basic knowledge of ICD-9/10 coding.
" Demonstrated ability with databases including data entry, data abstraction, and data validation.
" Ability to utilize data from computer-based sources and paper-based sources to generate reports.
" Demonstrated knowledge of Alameda County EMS-A trauma center designation criteria.
" Demonstrated knowledge of Client verification requirements.
" Demonstrated knowledge to report data based on requested queries.
" Ability to abstract and review data for clinical compliance with unit and organizational standards.
" Knowledge guest relations and hospital and unit resources. Applies this knowledge to contribute to the smooth transfer of information.
" Knowledge of Structure Standards, Procedures, Protocols, Guidelines as needed to perform job functions
" Ability to organize and prioritize tasks
Technical Knowledge: Ability to use a PC running Windows 7 Professional, EPIC, Microsoft Office Suite (Word, Excel, Powerpoint), Trauma Registry Database, and Web-based data warehouse programs.
The Clinical Trauma Registrar is responsible to maintain and assure the quality and accuracy of the trauma registry database, the foundation of the trauma PIPS process. This role contributes to the development of standard work and during the process of trauma registry data entry, reliably identifies cases that warrant review, fully completes data abstraction into the trauma registry database according to Trauma Service standards, trauma leadership needs, existing regulatory requirements and to meet data entry deadlines for the County, NTDB and TQIP. The Registrar collects, analyzes and reports trauma data for quality improvement tracking as assigned, as well as targeting injury research and prevention. This role implements processes to assure accuracy and confidentiality in the handling of all trauma registry related matters. In addition, as the Performance Improvement (PI) Specialist, the Registrar is actively engaged in PI evaluation, review, and solution generation/implementation to improve the optimal care of the trauma patient. The Clinical Registrar & PI Specialist is skilled in writing reports and presenting data graphically, both internally and externally, to promote process improvements, improved outcomes and optimal patient care.
Duties and Responsibilities:
" Database Management
" Maintains and updates the trauma registry database.
" Evaluates all documentation for accuracy and completeness prior to data entry.
" Abstracts and enters data elements on all trauma patients concurrently.
" Maintains data accuracy using a validation process.
" Ensures data is entered in a timely manner; concurrent for admitted patients and within 1 month of discharge for patients sent home from the Emergency Department.
" Implements changes in database in coordination with Alameda County EMS-A, the National Trauma Data Bank (NTDB), and TQIP (Trauma Quality Improvement Program) and Trauma Services leadership.
" Retrieves demographic and financial information through the electronic health record.
" Adheres to inclusion criteria set forth by Alameda County, State of California (CEMSIS) and American College of Surgeons (Client) NTDB.
" Assures confidentiality of data and abides by HIPPA regulations.
" Complies with standard work instruction for trauma patient identification, data abstraction and entry.
" Participates in validation of data reliability, accuracy, and completeness of database, including PI data
Knowledge, Skills, and Abilities:
" Demonstrates breadth and/or depth of knowledge and skills required for position including proficient understanding of pathophysiology and medical terminology.
" Maintains current knowledge with national and regional trauma registry requirements and practices; shares technical knowledge. This includes required clinical and database knowledge and skills, as applicable.
" Basic knowledge of ICD-9/10 coding.
" Demonstrated ability with databases including data entry, data abstraction, and data validation.
" Ability to utilize data from computer-based sources and paper-based sources to generate reports.
" Demonstrated knowledge of Alameda County EMS-A trauma center designation criteria.
" Demonstrated knowledge of Client verification requirements.
" Demonstrated knowledge to report data based on requested queries.
" Ability to abstract and review data for clinical compliance with unit and organizational standards.
" Knowledge guest relations and hospital and unit resources. Applies this knowledge to contribute to the smooth transfer of information.
" Knowledge of Structure Standards, Procedures, Protocols, Guidelines as needed to perform job functions
" Ability to organize and prioritize tasks
Technical Knowledge: Ability to use a PC running Windows 7 Professional, EPIC, Microsoft Office Suite (Word, Excel, Powerpoint), Trauma Registry Database, and Web-based data warehouse programs.
