North West Midlands & North Wales Trauma Network Board Meeting 11 May 2017, Boardroom 2, Wrexham Maelor Hospital Approved Minutes

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1 North West Midlands & North Wales Trauma Network Board Meeting 11 May 2017, Boardroom 2, Wrexham Maelor Hospital Approved Minutes Attendees: Mark Anderton - Chair MA Consultant Emergency Medicine Glan Clwyd Paul Knowles PK Consultant - Emergency Medicine (chair) MCHT Sarah Graham - minutes SG Services Improvement Facilitator MCC&TN Adrian Vreede AV Operations Manager SATH Sue O Keeffe SOK Network Manager All Wales Simon Davies SD Major Trauma Coordinator UHNM Graham Mayers GM Consultant Anaesthetist Wales Ash Basu AB Consultant Emergency Medicine Wrexham Alison Lamb AL Consultant Nurse in Spinal Injuries RJAH Shane Roberts SR Head of Clinical Practice WMAS Ellie Fairhead EF Service Manager, Major Trauma UHNM Simon Shaw SS Consultant Neurosurgeon UHNM Nigel Lee NL Director of Secondary Care BCUHB John O Brien JO Director of Operations Leighton Verity Lockett VL Service Manager Emergency Care Leighton Apologies: Clive Bezzina CB Consultant Rehabilitation Medicine Haywood Hosp Richard Hall RH Consultant Emergency Medicine UHNM Rob Perry RP Consultant Emergency Medicine Ysbyty Gwynedd Jane Wood JW TARN Audit Clerk SATH Alex Ball AKB Consultant Rehab Medicine/ Network Lead UHNM David Rawlinson DR Clinical informatics Manager EMRTS Mark Brown MB Consultant Orthopaedic Surgeon UHNM Amanda Walshaw AW Therapy Centre Manager SATH Tina Newton TN Consultant Emergency Medicine BCH Dr Ram RAM Consultant Emergency Medicine SATH Steve Littleson SL Data Analyst (Minute Taker) MCC&TN Kay Newport KN MTC Coordinator BCH Dianne Lloyd DL Therapy Clinical Lead SATH Amanda Walshaw AW Therapy Centre Manager SATH No Item 1 Welcome and Introductions 2 Apologies: Apologies noted above 3 Speaker: Refer a Patient (RAP) - Suresh Pushpananthan Background Patient Safety Issues communication breakdown, Audit of reality around what generally happens at the moment when trying to refer a patient. RAP is a Cloud based system to transfer information securely via Referapatient.org

2 Specialty specific forms are available should never take more than 5minutes to complete. Digital ASIA chart provided, space for referring consultant details, SMS alert when the consultant gets a referral. Referring doctor will make the decision about the urgency of the referral. Confirmation alerts throughout the process. Can be done on mobile phones or via bleeps. No patient identifiable info on the alerts. Generic login s are not allowed it has to be individual people, but some hospitals have found ways around this. You don t have to create an account to make a referral. Referrals list to departments is available which include contact details and therefore no need for paper notes. Messages can be added to the referral. [REC]ALL system allows referrals to be made digitally instead. Early warning system that informs people that referrals are being made. Bed Management Panel with a digital board list of patients. Diary scheduling available. There is the ability to capture statistics and data. Assisting with entire patient flow MTC Rapid Referral Form is being implemented, this can be used in place of the red phone. Communication is documented. Huddle MDT meeting application select who you want to speak to, it dials them and records the discussions, useful for polytrauma patients etc. Repatriations Outgoing patient s system that creates a transfer letter. This system would not change current policy, it should enhance the system like better communication and information being recorded. Re: Governance issues between Wales and England, how could organisations be reassured? IG approval is complete. No patient data is crossing the system it is saved to servers in each country and is completely secure and covered by all legal aspects. Data is owned by the Trust and is saved in its entirety every 12 months. If this is the system that will be put into place, there needs to be discussions across the network to inform all relevant specialties. Training video s and webinars are available. UHNM Update Some departments have gone live like Spinal. The MTC would own/host the system the TU s would not need to pay anything. EF said there are concerns that the Business Case for neuro will not be accepted. MA to write to the CEO at UHNM on behalf of the Network, that they fully support this going ahead. BCU are about to renew the contract with UHNM and potentially it could be a way of pushing things forward, around better governance, reducing delays etc. Mark Anderton 4 Trauma Unit Peer Review Updates from 2016 Visits All reports are available from the Network Office. Leighton Dr Paul Knowles provided verbal feedback. Shrewsbury No report submitted, AV will get and update from Dr Ram. Glan Clwyd feedback presented by Dr Mark Anderton. Wrexham feedback presented by Dr Ash Basu. Ysbyty Gwynedd presented by Sarah Graham on behalf of Rob Perry Essentially all very similar issues for North Wales Units, but essentially all the units are working to improve their current systems. 5 Approval of minutes from previous meeting Approved as an accurate record. 6 Outstanding Actions from Previous Minutes including updates from today s meeting) 2

3 6b) AL to circulate Spinal Injury Report Doug Mobley still working on this, close from minutes until final report is ready. CLOSED 6c) AL to discuss Retrieval Service with RJAH AL is still waiting for the new manager to arrive so she can speak about the business case. Close until further notice. CLOSED. 6d. SD to set up meeting with Powys to develop exit strategy Powys claim that there are no problems, therefore we need to produce evidence to support our claims. SD to provide evidence. Simon Davies 6g vi) UHNM wants to use the refer-a-patient web-based referral system, but is struggling to secure the 24k SL produced communication TRID report for the Board. Mr Suresh Pushpananthan invited to today s meeting. See notes above. 5.i) NWAA update SS has offered them support whilst they embed their new systems. We will continue to TRID any issues but close on minutes until further notice. CLOSED 5.ii) SOK mentioned a case involving a walker near Wrexham. They sustained a chest injury, and AB referred them to Aintree, as they were a Wirral patient. Aintree refused, and now the patient is out-of-area. Clearly not in the patients best interests. PK to liaise with their trauma lead. PK has spoken with the TU Lead who agreed to raise this with the individual in question and take to their Board. CLOSED 5.iii) SOK also mentioned a case where a spinal patient at Glan Clwyd had been visited by AL on day 2, and part of the transfer plan was for a size 6 uncuffed tracheostomy tube to be in situ. This was done, and patient was stable for 10 days and ready for transfer, when Oswestry said they were unable to take them with that tracheostomy. Need standardised information, and can this be challenged in the future Resolved. CLOSED. 7.diii) AB informed the Board that there is now a locum consultant at Stoke, so she can start discussions with SaTH around what rehabilitation sessions they would like. Plan to pilot the rehab medic as part of the trauma team. Deferred until next meeting. CB did update on the ARTU. CLOSED. 8.ii) Reverse PACS imaging for when patients are repatriated back from the MTC. UHNM to investigate a process internally. SS still no update. However, RH mentioned that scans from Leighton are very slow and often the patient arrives at the MTC before their scan. PK will look into this KP assured the Board that Leighton Hospital have checked the system and all is working fine, as discussed this could be person specific. CLOSED 8.iv) Glan Clwyd will shortly be trialling completion of rehab prescriptions SOK said the trial had been stopped, they are now looking at the process Leighton Hospital use. SOK is asking national colleagues for JD s for 3

4 these posts. CLOSED. 7 Positive news (Compassionate Governance) - Due to time constraints it was agreed that SOK would bring this back to the next meeting. 8 Governance: 1. Review Open TRIDs Due to time constraint s it was agreed to deferred the review of TRIDs until the next meeting. Sue O Keeffe 2. New case presentations Dr Ash Basu Wrexham Hospital. Discussions around WAS pre-alerts, Patient had a fall down stairs. Very busy shift, SAPhTE scored exceptionally high. Initial Assessment and observations brought straight to ED. ED timeline shown. Consultant was aware of the patient. Consultant involvement and theatre management provided. PM Report feedback provided. Patient died. Issues presented. SD suggested linking with their haematologist Jane Graham as she is working closely with the Trauma Service and may be able to help with their queries. AB acknowledged that there is still a lot of work to be done. EMRTS have also addressed their communications errors and have revised their SOP. 9 Data Activity: Deferred until next meeting as SL is on leave. 10 Business Updates: Paediatrics Deferred as no representation at the meeting. Spinal Centre Nothing to report. WMAS i) updated about new medical dispatch system ii) TRID system is now fully linked to the internal WMAS reporting system so it will speed up the reporting from now on. iii) Major Incident planning, the first hour capability concept is being taken forward for national consideration. SS said capability numbers at Stafford Hospital need reviewing as their ED is only open until 8pm. SR To review. Shane Roberts Rehabilitation nil to report Networks MCCTN: i) Update from National MT Managers meeting in London regarding MTC Peer Review, the new QSIS database that requires completion by Information has been sent to CEO s of the MTC s and an old contact list was used, therefore need to go back and check if they received the information required as it contains logon/registration details for QSIS. ii) TU Peer Review will be a process of self declaration and the Network Team with the Regional Trauma Lead assessing against last year s information and report. None of the TU s in this Network will be visited this year. TQUINS is no longer being used but the Network office have a system in place, and will notify the organisations accordingly. 11 AOB 1. ED Resuscitative Thoracotomy Guideline (written by Dr Caroline Leech, UHCW). PK said that it doesn t cover what the TU s need to do. Royal College of Surgeons have written a statement about local decision making. PK feels it would be difficult to have network guideline and 4

5 therefore just needs a message within the current version to reflect local decision making. SS will take it to the Council Meeting next week, then inform SG if it can be put on the website. 2. Referrals to TTL at UHNM EF confirmed the process. 3. AV mentioned that some WMAS crews are not using the triage tool & potential trauma patients are going to PRH. AV has asked consultants to TRID so that SR can investigate. 4. Burton Trauma Pathway SG to organise a meeting with Burton, UHNM and the Mid Trent Network. Paul Knowles Simon Shaw Sarah Graham 12 Date of next meeting: 6 th July, Room DTCIM156, Lower Ground, UHNM 5