60% of ISS > 15 patients received less than optimal care 5 Trauma: Who cares? A report of the National Confidential Enquiry into Patient Outcome and Death (2007) Why change You must read this report!
Disorganised pre-hospital care Low frequency (< one per week per hospital) Inadequate trauma team response Lack of seniority in immediate hospital care Lack of appreciation of seriousness Lack of urgency Incorrect decision making 6 Reasons?
"Current services for people who suffer major trauma are not good enough. There is unacceptable variation, which means that if you are unlucky enough to have an accident at night or at the weekend, in many areas you are likely to receive worse quality of care and are more likely to die. The Department of Health and the NHS must get a grip on coordinating services …." Amyas Morse, head of the National Audit Office, 5 February 2010 Political engagement
Our Network www.excellence.eastmidlands.nhs.uk This document refers to all severely injured patients, meaning those who have suffered potentially life-threatening or life-changing physical injuries, i.e. all those who could benefit from regional networks.
18 Acute Hospitals One regional Ambulance Service (EEAST) Range of charity sector pre-hospital enhanced care providers (e.g. Air Ambulance Charities) Range of specialist acute, reconstruction and rehabilitation services Range of specialist and general community rehabilitation services East of England … past
EoE Hospital Type 1 ED EoE Major Trauma Centre Primary (peak and off –peak 45 minute) transfer zone Drive-time isochrones on this map were generated using averaged GPS- based road segment speeds from ITIS GPS Floating Vehicle Data against the Navteq Premium Streets database. For normal peak speeds, ITIS vehicle (car) speeds between the hours 07:00- 09:00 and 16:00-19:00 were averaged. For off-peak speeds, ITIS vehicle (car) speeds excluding the hours 07:00- 09:00 and 16:00-19:00 were averaged. Primary transfer zone?
Ambulance Service Network Co- ordination Service Trauma Units Network Transfer Services Major Trauma Centre Re- habilitation Services Trauma Network Office East of England Integrated Trauma System EoE Hospital Type 1 ED EoE Major Trauma Centre Primary (peak and off –peak 45 minute) transfer zone* Burns Centre secondary transfer pathways Brain injury secondary transfer pathways
Network Co-ordination provides three key functions: (1)co-ordination of components of the trauma system (from acute care through to rehabilitation); (2) a dedicated 24/7 single point of telephone contact for healthcare professionals seeking access to immediate clinical advice, bed bureau functions related to critical care / specialist beds and access to a directory of services for complex injury and rehabilitation services; (3) a means for monitoring patient flow and system performance (for professionals, patients and families). Network Co-ordination 03003303999
Addenbrookes and the Rosie Hospitals Innovation and Excellence in Health and Care Major Trauma Centre
Major Trauma (ISS > 15) 12 (11-13) Major Trauma (ISS > 15) 12 (11-13) Severe Injury (ISS >8) 22 (20-23) Severe Injury (ISS >8) 22 (20-23) Serious Injury 34 (32-36) Serious Injury 34 (32-36) Survival to hospital 46 (42-48) Survival to hospital 46 (42-48) Serious injury 55 (53-57) Serious injury 55 (53-57) Admitted with significant injury (meeting UK TARN entry criteria) 1 Admitted with significant injury (meeting UK TARN entry criteria) 1 Survive to hospital Pre-hospital System 999 Call 2623 3 999 Call 2623 3 Age-standardised population rate per 100,000 (95% CI) 2 Burden of Disease (Count of patients, 95% CI) (1)See www.tarn.ac.uk (2)Directly age-standardised rate per 100,000 resident population with 95% confidence interval (3)Based on estimate from Ambulance Service related to 999 call burden for trauma related AMPDS codes (150000/year) Burden of disease
DH Peer Review Feedback Overview The strengths of the EoE trauma network are multiple. It has from the outset planned to be a true trauma network. The panel noted from the visit as well as the supporting documentation that the network is well developed and benefits from excellent engagement and clinical leadership. The network has focused on an inclusive design with evidence of strong commitment and clinical consensus achieved through appropriate boards and other trauma groups, which are held regularly and have clear governance in place. The patient pathway is well defined and there are good facilities throughout the ED and supporting departments.
DH Peer Review Feedback Commended True attempts at whole network engagement The TEMPO resource The outreach service (NCS and facilitated transfer) The well-developed and defined Trauma service delivery pathway Trauma team processes (activation, composition, leadership) Radiology provision The flexibility and commitment shown by the ITU team The work undertaken to improve the provision of rehabilitation
DH Peer Review Feedback Commended Rehabilitation is an undoubted success and is one of the strong points within the Network. The service is well developed compared to a number of other Trauma Networks and this is as a result of good clinical leadership and investment in a complete new unit. The appointment of rehab consultants to lead this has been an undoubted success The [RAAR] has a good multi-disciplinary team, who appear to have the necessary skills, to deliver effective rehabilitation to trauma patients. The unit is very well equipped.
East Midlands Major Trauma Network Trauma & Orthopaedics: over-triaged patients Over-triaged patient at QMC No significant injury Home Outpatient fracture e.g. wrist ED to ED call: patient given local new-patient Fracture clinic appointment Patient given: Copy relevant notes CD of x-rays Inpatient fracture e.g. closed tibia shaft What is best for patient? What does the patient want? What is the surgical capacity? Local Trauma Unit Remain at QMC Definitive care Trauma coordinators
East Midlands Major Trauma Network Trauma & Orthopaedics: Patients with multiple trauma Major Trauma Trauma Unit ED Trauma Unit Trauma Coordinator Queenss Medical Centre Trauma Conference Definitive careFit for transfer EMAS triage Secondary triage at Trauma Unit Admission record e-mail T&O consultant ED consultant Rehabilitation lead Fit for home QMC Rehabilitation Team Trauma Unit Trauma Coordinator 48 hours notice Identify named T&O consultant Identify ward and bed Transfer with: - Rehab prescription - Copy notes - E-transfer x-rays - Fracture clinic follow-up
Addenbrookes and the Rosie Hospitals Innovation and Excellence in Health and Care Questions and Comments?