Welcome The Trauma Audit & Research Network (TARN)

TARN  Largest European Trauma registry >550,0000 injured patients with >46,000 injured children  Review and monitor processes of care & outcomes  Report to Trusts & Commissioners  Inform changes in practice: Improve Trauma Care

TARN  Academic: University’s of Manchester, Sheffield and Leicester  Non Profit making  100% membership in England, Wales  Members in Southern Ireland, Denmark and Switzerland  Clinically led  BOARD and Executive Committees  Research and Audit Committees

TARN Research Committee Director: Professor Fiona Lecky Clinical Professor & Honorary Consultant in Emergency Medicine at ScHARR & Salford Royal NHS Foundation Trust 11 members including: Executive Director, Medical Statistician, Registry Manager, 3 Data Analysts, Clinical Research Advisor, Research Fellows, Pre-hospital. Meet Monthly:  Ongoing Research projects  New Research proposals

Have you got a Research idea? Complete Request form or

TARN Audit Committee Director: Dr Dhushy Kumar Consultant in Critical Care, Pre-hospital Care & Anaesthesia at University Hospital Coventry. 15 members: National representation Clinicians, TNCs, Data Coordinators, Rehabilitation, TARN Executive Director, TARN Registry & Training Managers Meet 6 times per year:  Ensuring high quality feedback is provided & maintained by TARN Have you got an Audit request?

The beginning  1988: Report by RCS: The Management of patients with Major Injuries “Serious deficiencies in the management of severely injured patients”  Enhancing pre-hospital care, ensuring appropriate medical intervention  Rapid transfer to the best local facility  Assessing the use of helicopters  Adopting ATLS principles  Integrating trauma services within and between hospitals  Investing in rehabilitation services  System of Auditing & Research  TARN Established in 1989: Based Salford Royal Hospital

Major Trauma Network development Public Accounts Committees March 2010 Chief Executive of NHS on public record as  Committing to development of Major Trauma Networks across England by end of 2011/12  Mandating TARN membership  Most Major Trauma Networks “live” April 2012

What has changed On scene patient triage: Positive Direct to MTC (< 45 mins travel) Indirect Transfer (>45 mins, time critical intervention) MAJOR TRAUMA CENTRE Consultant led trauma team Immediate operating theatre All specialties: neurosciences Immediate CT scan Interventional radiology Specialist critical care Trauma Unit Trauma team Immediate CT Resuscitate, Assess & ? Transfer TARN

Major Trauma Centre: Best Practice Tariff Year 3 (15-16)  Additional payment made to Major Trauma Centres only  Based on Injury Severity  Moderate Trauma (ISS>8): £1,500  Major Trauma (ISS>15): £3,000  Payment conditional on ‘Best Practice’ targets being met

Major Trauma Centre: Best Practice Tariff Year 3 (15-16) Level 1 (Moderate Trauma): Injury Severity Score >8  TARN data is completed and dispatched within 25 days of discharge/death.  Rehabilitation prescription completed for each patient & recorded on TARN.  Tranexamic acid (TXA) administered within 3 hours of injury for any patient receiving blood: Exclusions: Isolated Serious (Severity 3+) Head injuries  Non-emergency transfers: Patient must be admitted to MTC within 2 calendar days of referral from Trauma Unit

Major Trauma Centre: Best Practice Tariff Year 3 (15-16) Level 2: (Major Trauma) Injury Severity Score >15 Level 1 criteria and following additional criteria met:  Direct admissions or emergency (<12 hour) transfers: Patient must be seen by Consultant within 5 minutes of arrival  Direct admissions: Head CT performed within 1 hour of arrival for patients with SeeAIS1+ Head injury & GCS <13 in ED (or intubated pre-hospital)  Exclusions: patients requiring emergency surgery or interventional radiology within 1 hour of admission Additional BPT fields added to TARN database

Web-based Trauma Data Collection  Electronic data collection & reporting system  Secure on-line system through patient pathway  Data Collection AND Reporting

TARN Reports  Clinical Reports: Published March, July, November. notification to all users  Dashboards: Published Quarterly for MTC and Trauma Units, half yearly for CMTCs  Performance Comparisons: Updated March, July, November. Available to all.  Online Reports: Self produced reports  Ad Hoc analysis: Available any time Separate Reporting Training session

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