Improving Trauma Care in West Suffolk: Network Strategies and Recommendations

1. West Suffolk trauma audit September 2013

2. Numbers • Network • 03003303999 • Lee Van Rensburg • lee.van-rensburg@addenbrookes.nhs.uk • NHS sec 01223 216103 • Rod Mckenzie • Trauma Director MTC

3. 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

4. Why change • Networks and pathways established over time

5. 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

6. Reasons? • 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

7. Recommendations • Importance of: • Tempo • Seniority • Resources • Systems • Philosophy

8. 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

9. 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

10. 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

11. Primary transfer zone? 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.

12. Why change paths

13. East of England Integrated Trauma System Trauma Network Office Ambulance Service Network Co-ordination Service Trauma Units Network Transfer Services Major Trauma Centre Re-habilitation Services 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

14. Network Co-ordination Network Co-ordination provides three key functions:  • 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

15. Major Trauma Centre

16. 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 2623 3 Serious injury 55 (53-57) Survival to hospital 46 (42-48) Serious Injury 34 (32-36) Severe Injury (ISS >8) 22 (20-23) Major Trauma (ISS > 15) 12 (11-13) • See www.tarn.ac.uk • Directly age-standardised rate per 100,000 resident population with 95% confidence interval • Based on estimate from Ambulance Service related to 999 call burden for trauma related AMPDS codes (150000/year)

17. MTC Activity?

18. Implementation

19. Major Trauma Centre www.tarn.ac.uk 19

20. Major Trauma Centre

21. 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.”

22. 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

23. 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.

24. MTC - 22

25. OTUOrthopaedic 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

28. East of England school of surgery visit

30. No significant injury Home Patient given: Copy relevant notes CD of x-rays ED to ED call: patient given local new-patient Fracture clinic appointment Over-triaged patient at QMC Outpatient fracture e.g. wrist Local Trauma Unit Definitive care What is best for patient? What does the patient want? What is the surgical capacity? Inpatient fracture e.g. closed tibia shaft Trauma coordinators Remain at QMC Definitive care East Midlands Major Trauma Network Trauma & Orthopaedics: over-triaged patients

31. Identify named T&O consultant Trauma Unit Trauma Coordinator Trauma Unit Trauma Coordinator Trauma Unit ED Secondary triage at Trauma Unit T&O consultant Identify ward and bed ED consultant Rehabilitation lead Admission record e-mail Major Trauma EMAS triage 48 hours notice Transfer with: - Rehab prescription - Copy notes - E-transfer x-rays - Fracture clinic follow-up QMC Rehabilitation Team Trauma Conference Definitive care Fit for transfer Queens’s Medical Centre Fit for home East Midlands Major Trauma Network Trauma & Orthopaedics: Patients with multiple trauma

32. Questions and Comments?