Minimizing NFS code use to impact mortality outcomes in TQIP reports

Authored by:
Theresa Radeker, MHA, BSN, RN, TCRN
Vice President and Managing Partner

The trauma registry serves as the backbone for data collection and analysis within trauma centers, guiding performance improvement efforts and facilitating compliance with national benchmarking initiatives like the Trauma Quality Improvement Program (TQIP). One of the critical components of accurate trauma data reporting is the appropriate use of Not Further Specified (NFS) coding. While NFS codes offer a solution for documenting cases where granular data is unavailable, over-reliance on these codes can significantly impact the quality of data analysis and subsequent mortality outcomes reported in TQIP.

NFS codes are used when detailed clinical or procedural information isn’t available at the time data is entered into the registry. While these codes allow data to be submitted on time, over-reliance on them can mask critical details about injuries, patient conditions, and treatments. This lack of detail makes it harder for trauma centers to identify problems and implement improvements. In TQIP, where accurate data is needed to compare outcomes between hospitals, overusing NFS codes can lead to unreliable results, especially when looking at mortality rates.

Studies show that trauma centers that use NFS codes frequently have trouble identifying preventable deaths and areas where they can improve. For example, without enough detail about the severity of injuries, it’s harder to see patterns or areas that need attention, like delays in care or undertriage.1 This can cause trauma centers to miss opportunities to fix problems and improve patient outcomes.

To reduce the negative effects of NFS coding, trauma centers should provide thorough training for registry staff and use standardized processes to check data accuracy. Working together with trauma registrars, clinicians, and data analysts can also help ensure more detailed and accurate data entries. By using NFS codes less often and improving data quality, trauma centers can make better use of TQIP’s tools to improve care and reduce mortality rates. Accurate data isn’t just a technical goal—it’s a vital step toward better results for trauma patients.

In summary, minimizing the use of NFS codes and ensuring high-quality data capture are essential for achieving superior outcomes for trauma patients. Accurate data collection and coding not only facilitates compliance with national benchmarking initiatives like TQIP but also drives continuous improvements in trauma care.

  1. Oliphant, Bryant W. et al.  Not Further Specified: Unclassified Orthopedic Injuries in Trauma Registries, Cause for Concern?  Journal of Surgical Research, Volume 244, 521 – 527