WEST SUFFOLK TRAUMA AUDIT September 2013 Numbers Network
. WEST SUFFOLK TRAUMA AUDIT September 2013
. Numbers Network 03003303999 Lee Van Rensburg lee. van-rensburg@addenbrookes. nhs. uk NHS sec 01223 216103 Rod Mckenzie Trauma Director MTC
. Outline Why MTC and networks Network - East of England MTC – Cambridge University Hospitals NHS Foundation Trust OTU – Orthopaedic trauma unit Repatriation Boast 4 Adrian Boyle Rod Mackenzie Simon Lewis
. Why change Networks and pathways established over time
Why change 60% of ISS > 15 patients received less than optimal care Trauma: Who cares? You must read this report! A report of the National Confidential Enquiry into Patient Outcome and Death (2007) 5
Reasons? Disorganised pre-hospital care Low frequency (< one per week per hospital) Inadequate trauma team response Lack of seniority in immediate hospital care Ø Lack of appreciation of seriousness Ø Lack of urgency Ø Incorrect decision making 6
Recommendations • Importance of: – – – Tempo Seniority Resources Systems Philosophy
Political engagement "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
Our Network 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. www. excellence. eastmidlands. nhs. uk
East of England … past • 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
Primary transfer zone? Eo. E Hospital Type 1 ED Eo. E Major Trauma Centre Primary (peak and off –peak 45 minute) transfer zone Drive-time isochrones on this map were generated using averaged GPSbased 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: 0009: 00 and 16: 00 -19: 00 were averaged. For off-peak speeds, ITIS vehicle (car) speeds excluding the hours 07: 0009: 00 and 16: 00 -19: 00 were averaged.
. Why change paths
East of England Integrated Trauma System Trauma Network Office Ambulance Service Network Co -ordination Service Trauma Units Network Transfer Services Major Trauma Centre Rehabilitation Services Eo. E Hospital Type 1 ED Eo. E 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). 03003303999
Major Trauma Centre Addenbrooke’s and the Rosie Hospitals Innovation and Excellence in Health and Care
Burden of disease Burden of Disease (Count of patients, 95% CI) Pre-hospital System Survive to hospital Admitted with significant injury (meeting UK TARN entry criteria) 1 Age-standardised population rate per 100, 000 (95% CI) 2 999 Call Serious injury Survival to hospital Serious Injury 2623 3 55 (53 -57) 46 (42 -48) 34 (32 -36) Severe Injury (ISS >8) Major Trauma (ISS > 15) 22 (20 -23) 12 (11 -13) (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)
MTC Activity?
Implementation
Major Trauma Centre www. tarn. ac. uk 19
Major Trauma Centre
DH Peer Review Feedback Overview “The strengths of the Eo. E 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.
. MTC - 22
. OTU Orthopaedic Trauma Unit 5 Consultants special interest in trauma Subspeciality interest Mr Lee Van Rensburg – Upper limb Mr Alan Norrish – Lower limb/ frames/ infection Mr Peter Hull – Pelvic and Acetabular/ lower limb Mr Matija Krkovic – Frames / lower limb Mr Andrew Carrothers – Pelvic and acetabular/ lower limb
. East of England school of surgery visit
East Midlands Major Trauma Network Trauma & Orthopaedics: over-triaged patients No significant injury Home Patient given: Copy relevant notes CD of x-rays Over-triaged patient at QMC Outpatient fracture e. g. wrist ED to ED call: patient given local new-patient Fracture clinic appointment Local Trauma Unit Inpatient fracture e. g. closed tibia shaft What is best for patient? What does the patient want? What is the surgical capacity? Definitive care Trauma coordinators Remain at QMC Definitive care
East Midlands Major Trauma Network Trauma & Orthopaedics: Patients with multiple trauma Identify named T&O consultant Trauma Unit Trauma Coordinator Trauma Unit ED Secondary triage at Trauma Unit Trauma Coordinator T&O consultant Identify ward and bed ED consultant Rehabilitation lead Major Trauma Admission record e-mail EMAS triage 48 hours notice QMC Rehabilitation Team Queens’s Medical Centre Trauma Conference Definitive care Fit for transfer Fit for home Transfer with: - Rehab prescription - Copy notes - E-transfer x-rays - Fracture clinic follow-up
Questions and Comments? Addenbrooke’s and the Rosie Hospitals Innovation and Excellence in Health and Care
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