Northern Trauma Network

Transcription

1 Northern Trauma Network Meeting: Northern Trauma Network Clinical Advisory Group (CAG) Date: 20 April 2015 Time: 09:30-11:30 Venue: Mill A, Waterfront 4, NE15 8NY Present: Abi Redpath, County Durham and Darlington FT Bas Sen, Consultant, Newcastle upon Tyne Hospitals NHS FT Caroline Davies, Senior Trauma Paramedic, NEAS Cat Lane, Consultant, North Tees & Hartlepool NHS FT Craig Ord, Trauma Coordinator, Newcastle upon Tyne Hospitals FT Dave Bramley, City Hospitals Sunderland NHS FT Dominic Inman, Consultant, Northumbria Jackie Gregson, Consultant, Northumbria Healthcare (Chair) Jason Urron, Paed Trauma Consultant - RVI Julie Carter, Lead Trauma Nurse, South Tyneside Julie O hara, Trauma Lead, STees Laura Graham, Rehab Medicine Consultant, Northern Trauma Network Leigh Simmonds, Consultant, Darlington Memorial Lesley Durham, North of England Critical Care Network Paul Fell, Consultant Paramedic, NEAS Phil Godfrey, Trauma Lead consultant, James cook Reuben Saharia, Consultant, RVI Seema Srihari, Northern Trauma Networks (Notes) Vicci McGurk, Acting Network Manager, Northern Trauma Network Apologies: Lee Thompson, Paramedic, NEAS Nicola Lipscombe, Trauma Co-ordinator, STees Paul Dixon, City Hospitals Sunderland NHS FT Jim McVie, Consultant, James Cook James Taylor, Gateshead Health NHS FT Andy Port, Clinical lead- Trauma, JCUH Paul Fearon, Consultant, RVI Jonathan Forty, Consultant, RVI In Attendance: POLICIES/G UIDELINES APPROVED IN THIS MEETING MINUTES AR BS CD CL CO DB DI JG JU JC JO LG LS LD PG RS SS VM LT NL PD JM JT AP JF 1. INTRODUCTION Action 1.1 Welcome & Apologies JG welcomed everyone, especially JU and JC to the meeting and introductions were made around the table. 1.2 Previous Minutes These were agreed to be an accurate reflection of the meeting with the following amendments: Page 1 Attendees Leigh Simmonds added as attendee. Page 1 Apologies Dominic Inman noted as from Northumbria NHT FT, not RVI. 1.3 Action Points from Previous Minutes As below 2. AGENDA ITEMS 2.1 Peer Review Feedback and Action Planning The PR review is complete now and all the participating Trusts, Ambulance 1

2 Service as well as the Network have received the letters from national PR team with findings, who are in varying stages of responding to the letter and formulating the action plans. VM tabled the PR findings for the whole patch; DB requested to keep the document under cover till formally released by Trusts. A discussion ensued on the IR and SC raised for the Network. DB had formally responded to the PR team on the IRs and SCs raised; VM informed that the Network had received a formal response from the National PR team. Regarding the IR raised by the PR team on not having separate paed guidelines, DB informed that the PR team had been reassured that we have one of the safest triage tools in the country. The Network has now formally appointed two paediatric trauma consultants (Jason Urron and Raj Khanna) to the CAG to represent paediatrics. JU agreed to develop paediatric trauma guidelines for the Network. JU There was a discussion on the pros and cons of adding child physiology to the Trauma Triage Tool. It was agreed that our triage tool was very safe and that any alterations to the tool might result in under triage. DB informed that regarding the second IR, monitoring arrangements are now in place with consent from WCH. The PR panel is happy with the action. Funding for the Network is now agreed and finalising the resources are in progress, this SC is now resolved. An action plan has been agreed on to work on serious head injury pathways. While it is acknowledged that most cases turned down by the neuro surgeons are elderly Trauma which triggers AIS 8+ mechanism, it was agreed that we need a rigorous data collection process to ensure that no young major trauma is left out. BS suggested that we need to look at national collaboration for data collection and sharing as current data was insufficient to draw any conclusions. The Network will look at national guidelines for abdominal injuries and adopt for the Network. LG had led on responding to the rehab questions, and work is in progress to redesign the pathway. The group felt that it was very important to have commissioner engagement at this point, as the network would need funding to progress the rehabilitation work stream. LG agreed to lead on commissioner engagement, VM to identify the named contact and forward to LG. It was felt that the ATNC training was expensive and the group discussed ways to provide equivalent, cost effective and local training. It was agreed that the network could look to provide a common curriculum to the region, however this would need to be accredited by a University. PG and BS agreed to write to the Network formally with the MTC point of view and DB would take it forward from there, and write to the CRG with a proposal. 2.2 Network Update Funding Agreed. Staffing JG/VM LG/VM BS/PG /DB 2

3 Advert for Network Manager is out, shortlisting in progress. Work Plan VM will pull together the common themes from PR and update the work plan. 2.3 Locality Updates JCUH No issues to report. RVI The repatriation of elderly patients is not streamlined and it was felt that the MTC beds were kept on hold due to the issues with pathways. Repatriation figures are sent to the CEOs every month, however it was felt that a regional pathway should be written to streamline the repatriation of patients, with identified named contacts at each TU. CO to lead. CDDFT the trauma lead had stood down. AR will be stepping down on 15 th June to join the Northumbria Trust. This has led to some staffing pressure with consultants. JG to inquire to CDDFT on behalf of the Network for a named Trauma lead. CO VM Agend a item for next meetin g JG Darlington Currently do not have a TARN Co-ordinator. Northumberland NESCH will start functioning in June, which will effectively see all Trauma cases from Wansbeck and North Tyneside automatically directed to the new hospital. North Cumbria Ruth Reed stepped down as Trauma lead at North Cumbria following Peer Review. Emma Farrow is the new lead for Trauma. NEAS The 60 minute transfer time is officially adopted by NEAS, and the proposal has gone to the national group to formalise the procedure. It is not clear yet if YAS has adopted the same procedure, agreed to take up with YAS and report to CAG. would also make the minor changes to the triage tool to include the new parameters. GNAAS started carrying blood from January 2015 and Ultrasound from April MERIT/Enhanced Care Team MERIT operational from April DB clarified that the MERIT and HEMS services are predominantly for trauma, though it was expected that they will also respond to post cardiac calls and any other life threatening conditions. It was clarified that the Trusts do not have to operate mobile medical teams. DB would write formally to all the Trusts. 2.5 NEAS hotspots Report Data is being collected by NEAS on Major Trauma. 2.6 Paediatric Trauma LD informed that NECTAR has now agreed on premises for standalone PICK retrieval services (Old Newcastle General Hospital on Westgate Road). The team is equipped with two vehicles; this is expected to rise to 4 eventually. 2.7 Rehabilitation A meeting to discuss Rehab prescription and to address the PR findings is organised on The group suggested that data collection is an important step forward to establish baselines and to identify gaps. LG informed that she intended to visit the TUs within the network to discuss rehab pathways and prescription. DB LG The group discussed involvement of private providers for rehab care. LG 3

4 informed that the Rehab meeting would discuss this in detail on (update from the meeting on : The trauma rehab group were approached by a private care provider providing complex care to explore whether links could be established. The group unanimously thought this would not be appropriate as the number of patients with such needs in the trauma pathway is so small. LG has since contacted the care provider and suggested possible further discussion with specialist rehab services.) 2.8 Format of CAG Membership Patient Representation It was felt that EG would be better suited to include a lay member. Please can any suggestions on a suitable lay member for this group be ed to Vicci McGurk on vicci.mcgurk@nhs.net? Task and Finish Groups The group agreed that it was a good idea to form Task and Finish groups so work could go on outside this meeting. 3. STANDING ITEMS 3.1 TARN March TARN report for the Network has been distributed to the group earlier. It was felt that the TUs were struggling with data completeness; and DB pointed that the Network now is at third from the bottom for WS score. The group suggested that the TARN Co-ordinators should look at unexpected deaths across the region to establish the cause of death. It was suggested that the period for this data collection should be April 2014 till December 2014 to form a report containing basic parameters such as Age, LOS, Patient ID, Location etc. Clinical leads to disseminate to the TARN co-ordinators. Page 42 of the TARN Network report shows patients receiving Tranx Acid this shows only TU data, not MTC. The TUs felt that the numbers were too high SS to query with Laura White (TARN). SS will also ask for MTC data for Pre- hospital care. 3.2 Network Clinical Governance Incident Reporting and MDT Proforma clinical leads are requested to forward MDT proformas within 2 weeks SS clinical leads Trauma MDT Proforma DRAFT June of MDT meetings. (Proforma attached in this document) 3.3 Trauma Management Guidelines BS suggested that national guidelines for Direct oral anti coagulant and Paed Ortho Management are in progress and that this could be adopted by the Network. Transfusion Protocol for Tranex Acid Regional variations on administration of Tranex Acid exists this has been addressed and resolved. 3.4 Education and Training The RVI Trauma Conference on was attended well it was felt that the presentations were relevant and useful. The conference suggested national collaboration for MTCs as it was felt in the conference that the MTCs work on isolation at the moment. VM planning to attend the Network Manager meeting for North. It was suggested that the Network should keep a register for those trained in damage control. Please can the clinical leads forward the information to To be b/f to the next meetin g clinical leads 4

5 3.5 Any Other Business It was clarified that the Trauma Website is still in use, this will move on to be a standalone website once the Trauma Network is fully functional. DB proposed that the Network should look to produce a paper Trauma, who dies?. The current data includes elderly patients who trigger the PS mechanism due to various other factors not related to major trauma, which is not reflective of the real picture. It was felt that this exercise would be useful for the region to dig specifically into trauma deaths and to establish that we have a safe system in place. 3.6 Date of Next Meeting am on in Millennium A, Waterfront 4; 4. MEETING CLOSE 5