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September 2013
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Network 03003303999
Lee Van Rensburg [email protected] NHS sec 01223 216103
Rod Mckenzie Trauma Director MTC
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Why MTC and networks Network - East of England MTC – Cambridge University Hospitals NHS
Foundation Trust OTU – Orthopaedic trauma unit
Repatriation Boast 4
Adrian BoyleRod MackenzieSimon Lewis
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Networks and pathways established over time
60% of ISS > 15 patients received less than optimal care
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Trauma: Who cares?
A report of the National Confidential Enquiryinto Patient Outcome and Death (2007)
Why change
You must readthis 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
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Reasons?
• Importance of:– Tempo– Seniority– Resources– Systems– Philosophy
Recommendations
"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 –peak45 minute) transfer zone
Drive-time isochrones on this map were generated using averaged GPS-
based road segment speeds fromITIS 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?
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Ambulance Service
Ambulance Service
Network Co-
ordination Service
Network Co-
ordination Service
Trauma Units
Trauma Units
Network Transfer Services
Network Transfer Services
Major Trauma Centre
Major Trauma Centre
Re-habilitation Services
Re-habilitation Services
Trauma Network OfficeTrauma Network Office
East of EnglandIntegrated Trauma System
EoE Hospital Type 1 EDEoE Major Trauma Centre
Primary (peak and off –peak45 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
Addenbrooke’s 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)
SeriousInjury
34(32-36)
SeriousInjury
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
Survive to hospital
Pre-hospital System
Pre-hospital System
999Call
2623 3
999Call
2623 3
Age-standardised population rate per 100,000 (95% CI) 2
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
MTC Activity?
Implementation
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Major Trauma Centre
www.tarn.ac.uk
Major Trauma Centre
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.
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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
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East Midlands Major Trauma NetworkTrauma & Orthopaedics: over-triaged patients
Over-triaged patientat QMC
No significantinjury
Home
Outpatient fracturee.g. wrist
ED to ED call: patient given local new-patient Fracture clinic appointment
Patient given:Copy relevant notesCD of x-rays
Inpatient fracturee.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
Definitive care
Trauma coordinators
East Midlands Major Trauma NetworkTrauma & Orthopaedics: Patients with multiple trauma
Major Trauma
Trauma Unit EDTrauma Unit
Trauma Coordinator
Queens’s Medical CentreTrauma
ConferenceDefinitive care Fit for transfer
EMAS triage
Secondary triageat Trauma Unit
Admissionrecorde-mail
T&O consultant
ED consultant
Rehabilitation lead
Fit for home
QMC Rehabilitation Team
Trauma UnitTrauma Coordinator
48 hoursnotice
Identify namedT&O consultant
Identify ward and bed
Transfer with:- Rehab prescription- Copy notes- E-transfer x-rays- Fracture clinic follow-up
Addenbrooke’s and the Rosie Hospitals
Innovation and Excellence in Health and Care
Questions and
Comments?
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