Present: BETSI CADWALADR UNIVERSITY HEALTH BOARD TRAUMA BOARD Wednesday 31st January 2018 14:00-16:00hrs VC Venues: Seminar Room, ED, WM Seminar Room, ICU, YGG & Room 3, H Seminar Room, ICU, YG VC Number: BCU: 512126 Non BCU: 01633461995 (when prompted enter pin 2126 and then #) MINUTES Ash Basu, Consultant ED & Trauma Lead, Wrexham Maelor Hospital Rob Perry, Consultant ED and Trauma Lead, Ysbyty Gwynedd John Glen, Consultant Intensivist & Deputy Trauma Lead, YGC Sue O Keeffe, Wales Critical Care & Trauma Network Manager (North) Duncan Robertson, Consultant Paramedic, WAST In Attendance: Rachael Thistleton, Wales Critical Care & Trauma Network Administrator Minute taker 1. Welcome and apologies welcomed all to the meeting and noted the following apologies: Mr Ben Sassi, Nia Sparkes and Dr Mark Knights 2. Minutes of the last meeting The minutes from the BCU Trauma Board Meeting held 23 rd November 2017 were accepted as true and accurate. 3. Matters Arising 1 No. 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Actions from the minutes of the 23 rd November 2017 / to email to define reverse IEP process. to add TRID feedback for YGC to next agenda will email MW regarding Level 2 rehabilitation to email MW re: relay difficulties with TARN backlog to feedback re: TARN comparison/conversion at next meeting to email MW for populated template for Major Incident Emergency Planning to arrange further ED charts meeting By Whom / Update Incomplete: reiterated the process requirements for images being available for repatriated patients from RSUH to BCU. It was commented that for patients with polytrauma then there needs to be a template to use for requesting images from RSUH. Action 3.1: to discover who IEP requests are sent to at RSUH Action 3.2: / to compile template for IEP process Incomplete carried forward Action 3.3: will email MW regarding Level 2 rehabilitation Incomplete carried forward Action 3.4: to email MW re: relay difficulties with TARN backlog however will feedback revised report from SL once received. Action 3.5: to feedback re: TARN comparison/conversion from Steve Littleson once received Not required: JG advised that he has been in contact recently with MW who has stated that she is agreeable with the numbers previously stated. Action 3.6: JG to forward P1/P2 numbers to - complete Incomplete: Dates sent however difficulties with engagement due to winter pressures Action 3.7: to arrange ED trauma charts meeting
3.8 3.9 4.1 5.1 6.1 6.2 6.3 7.1 8.1 12.1 to add Trauma Calls to next agenda to add Duncan Robertson to distribution list NS to provide update re: referral data from Steve Parsonage at next meeting to contact Sue Owen regarding low submission cases to TARN for 2016 to complete TRID regarding difficulties with acceptance of isolated HI AC to complete TRID re: communication difficulties with RSUH to contact crash call investigators re: TXA vs Admission to email RSUH re: Refer a Patient in other specialities, as new Chair, to email Gareth Evans, Director of Therapies inviting him to the January Trauma Board meeting to add Trauma Charts to next meeting NS AC Incomplete: advised that she has not received this from NS. It was commented that NS has advised that she will send a report for inclusion in the minutes, will request that the report also includes an update on referral data. Action 3.8: to request update re: referral data : commented that currently there is a shortage of admin staff resulting in difficulties with TARN. It was agreed that this is currently problematic for all BCU. Incomplete carried forward Action 3.9: to contact crash call investigators re: TXA vs Admission : Already rolled out to Neuro and a plan to roll out to other specialities : It was further noted that Stuart Harmes has been contacted but was unable to attend this meeting. requested to speak to Stuart Harmes regarding attending future TB meetings Action 3.10: to speak to Stuart Harmes re: attending future meetings Action 3.11: to add Stuart Harmes and Gareth Evans to distribution list 14.1 to send email re: day for Trauma Board 2018 commented that meeting days are now alternated between Weds/Thurs to ensure attendance. 16.1 to organise dates for 2018 and circulated 4. TARN update updated the group on the recent TARN report run by from the TARN website. It was noted that for the calendar year of 2017: WM submitted 47 cases which totals 47% expected submissions with accreditation of 95.4% YGC submitted 45 cases which totals 21-26% expected submissions with accreditation of 90.9%. YG submitted 39 cases which totals 15% expected submissions with accreditation 98.3% Difficulties: It was commented that there is currently no TARN being completed at YGC as the TARN coordinator post is a split role with the medical rota and currently she does not have capacity to undertake TARN. There was an agency TARN administrator employed but agency staff were removed due to financial pressures. is concerned that data, as a whole, is not considered a priority in BCU and it was agreed that this issue requires escalation to Hospital Directors and also Executives. It was further commented that for peer review, the TARN issue at YGC has been escalated as a serious concern. noted that the difficulties are concurrent across the three sites. Action 4.1: to send WG document mandating TARN and the letter sent to YGC Action 4.2: to draft letter to hospital directors and secondary care director (David Donegan) 2
Successes: commented that the WM TARN coordinator is due back from sickness shortly. noted discussions regarding the recording of arrival times at ED. The ambulance wait times are having a negative impact on LOS pre-hospital. Steve Littleson has commented that the time of arrival should be recorded when the patient arrives in ED therefore pre-hospital care will be lengthened. 5. Finance/Contracts NS was not present at the meeting however, it was noted that NS has advised that a report will be sent to to go out with the minutes. Finance Report Not discussed to be circulated from NS with the minutes Contract Review Update advised the group that she is not aware of where the contact is up to. Action 5.1: to ask NS for contract status report 6. Governance Issues Compassionate o highlighted a recent difficult EMS case. There were two fatalities, one being an infant. The mother of the baby is doing well in RSUH, she is out of critical care despite having a DAI and an ISS score ~ 70. She is currently however in PTA. o JG commented on a recent patient with a crush injury resulting in a traumatic cardiac arrest; the patient passed away however she became an organ donor on YGC ICU. Three people have benefited. The father has written a very moving letter commending the care received in YG. DR requested feedback given to WAST. Action 6.1: JG to forward feedback via to DR o noted a WM patient who attended and spoke at the recent NW Trauma Conference. Alex Ball, rehab lead RSUH has contacted the family to use their story to highlight the rehab work agenda at Westminster. further advised that a follow up idea of meet and greet with staff who were involved with patient JW has been proposed. commented that she will contact the family on behalf, as he is unable to cold call trauma patients. Action 6.2: to contact family of JW re: meet & greet for the family CaseNote Reviews None reported TRIDs o Feedback YGC: TO D not in attendance to comment. The group agreed if the YGC TRID is not presented at next meeting, then the item is to be removed. o RSUH possible TRID: commented on a male patient transferred to RSUH from YGC ED as open leg # but arrived in severe pain. will forward the TRID to JG and MA (copying in DR) for them to look into. Action 6.3: to forward the TRID to JG and MA (copying in DR) for casenote review. o commented that the response to TRIDs from Simon Shaw is not satisfactory. commented the issue was discussed at the Network Board Meeting recently. The group agreed to keep under review. TTL/Specialty referrals? o noted that it was agreed at the recent NWM&NW Trauma Network meeting that if there is no response from the TTL in 30 mins then the referring team would make an executive decision whether the patient should be transferred. advised a caveat is required that seniors are to make the decision. will look at the minutes to ensure accuracy of details. 3
requested to be kept up to date with developments. o commented on discussions with Rich Hall regarding issues with TTL getting more calls than anticipated which is causing difficulties for RSUH ED staff. advised that he is organising a meeting to discuss the issue further. advised to continue creating TRIDs if problems are occurring. commented that it has been discussed in RSUH to introduce an overall trauma consultant, separate to a TTL. commented that this would not necessarily be an ED Consultant. 7. Refer a patient Generic user access The group discussed various RAP issues including Nadex login instead of generic on the website. JG commented that there has been email dialogue to combat some of the issues. advised that Dylan Williams is the Director for IM&T in BCU and suggested that contacts him directly. Action 7.1: to contact Dylan Williams re: issues with RAP 8. Workplans commented that for peer review to show progress and/or difficulties the methodology of knowing the compliance status is also required. advised that for the next meeting feedback and RAG status is required. queried highlighting to local governance teams, advised if there are reds this will be required. commented that it requires a team approach. advised that a standing agenda item is required; the Network will circulate the work plans two weeks before the next meeting for changes in status to be recorded and for follow up discussions at the trauma board meeting. Action 8.1: will convert to excel document then send work plans out two weeks before the next meeting for populating Action 8.2: to add Workplans as a standing agenda item 9. Issues of Significance from: North West Midlands and North Wales PAQ meeting commented that she hasn t attended recently. North West Midlands and North Wales Trauma Network meeting fed back to the group: o Shane Roberts mentioned silver trauma triage tool used in RSUH to ensure patients are highlighted, has requested it to potentially amend for use in North Wales. o RAP Neuro on board, plan to roll out further to other specialities in due course. Paediatric Network Trauma Board Meeting advised he was unable to attend recently, however there is a paediatric trauma event shortly. Action 9.1: to forward paediatric trauma event details to to distribute 10. NW Trauma Training Course update Evaluation advised the inaugural Trauma Training Course in North Wales held its first skills course on the 15.12.17 and SIM course 18.12.17. There was also pre-course reading and mandatory MCQ. Evaluation was overall excellent with only a few issues to tweak, however there has been a meeting to discuss any potential changes. There are currently four dates for BCU in 2018. April YGC, July WM, October YG, December YGC. 11. Trauma Charts Review fed back to the group that at the recent Trauma Training Course there was a request for a unilateral trauma chart; there has been a meeting previously but unfortunately there was no representation from YG. will make contact for a further date to meet. Action 11.1: to add Trauma Charts to next meeting 4
12. Pre-hospital Trauma Calls updated DR on the issue that BCU hospitals were getting inconsistent pre-hospital trauma calls. advised she had previously met with Gill Pleming who put in touch with Phil Jones, Clinical Operations Manager at WAST, who met with. Phil advised that the priority was on the CAD system. DR noted that the new CAD system is now up and running. commented that there is already a SOP in place for pre-hospital trauma calls for the rest of Wales. Action 12.1: to forward Phil Jones, Operations Manager at WAST contact to DR for discussion 13. Adult Critical Care and Adult Trauma Ward competencies (for information) commented that the competencies are now developed on National basis. 14. Thoracotomy Guidelines commented that he has agreed to write guidance for thoracotomy guidelines, however as this is not routinely undertaken it will not require too much detail. advised Network assistance if required. 15. AOB None reported 16. Date and Time of Next Meeting Thursday 29 th March 2018 5
Action Card from Trauma Board Meeting 31 st January 2018 3.1 3.2 3.3 3.4 to discover who IEP requests are sent to at RSUH / to compile template for IEP process will email MW regarding Level 2 rehabilitation to email MW re: relay difficulties with TARN backlog / 3.5 to feedback re: TARN comparison/conversion from Steve Littleson once received 3.6 JG to forward P1/P2 numbers to - complete JG 3.7 to arrange ED trauma charts meeting 3.8 to request update re: referral data 3.9 to contact crash call investigators re: TXA vs Admission 3.10 to speak to Stuart Harmes re: attending future meetings 3.11 4.1 4.2 to add Stuart Harmes and Gareth Evans to distribution list to send WG document mandating TARN and the letter sent to YGC to draft letter to hospital directors and secondary care director (David Donegan) 5.1 to ask NS for contract status report 6.1 6.2 6.3 JG to forward feedback via to DR to contact family of JW re: meet & greet for the family to forward the TRID to JG and MA (copying in DR) for casenote review. 7.1 to contact Dylan Williams re: issues with RAP 8.1 8.2 will convert to excel document then send work plans out two weeks before the next meeting for populating to add Workplans as a standing agenda item 9.1 to forward paediatric trauma event details to to distribute 11.1 to add Trauma Charts to next meeting 12.1 to forward Phil Jones, Operations Manager at WAST contact to DR for discussion JG 6