Present: BETSI CADWALADR UNIVERSITY HEALTH BOARD TRAUMA BOARD Thursday 23 rd March 2017 14:00-16:00hrs VC Venues: Seminar Room, ED, WM Seminar Room, ICU, YGG & Room 3, ABH Seminar Room, ICU, YG VC Number: BCU: 512127 Non BCU: 01633461995 (when prompted enter pin 2118 and then #) MINUTES Sue O Keeffe, Wales Critical Care & Trauma Network Manager Aeneas O Kelly, Consultant Orthopaedic Surgeon, YGC Tom O Driscoll, ED Consultant, YGC Keith Williams, Head of Joint Resiliance Unit, WAST Ellie Fairhead, Service Manager, RSUH Simon Davies, Major Trauma Coordinator, RSUH Meinir Williams, Hospital Director, YG Ash Basu, ED Consultant and Trauma Lead, WM Mark Knights, Consultant Anaesthetist, YG Gill Milne, Head of Contracts, Preswylfa (part meeting) In Attendance: Rachael Thistleton, Wales Critical Care & Trauma Network PA, Minute Taker 1. Welcome and apologies chaired on RP s behalf due to sickness. welcomed all to the meeting and noted apologies from the following: Rob Perry, ED Consultant, YG Andy Campbell, Consultant in Critical Care & Anaesthesia, WM 2. Minutes of the last meeting confirmed that future meetings will be held bi-monthly. The minutes from the BCU Trauma Board Meeting held on the 23 rd February 2017 were accepted as true and accurate. 1
3. Matters Arising No. Actions from the minutes of the 23 rd February 2017 4.1 to ask SL to discuss the TARN figures at the next Network Board meeting 5.1 RP to speak to Meinir Williams regarding re-tender 5.2 Trauma leads to contact speciality leads and collate comments regarding quality of service from RSUH to feedback to MW. 5.3 to ask Val Attwood for progress on re-tender 6.1 RP to take difficulties with discrepancies between transfer advice and TTL to the next Network Board meeting to be discussed 6.2 to request feedback on referrals from Ortho teams. 6.3 to advise EF of spinal referral issues 7.1 to resend information out on Midlands Network Emergency Planning spreadsheet to leads for review 9.1 to send out feedback on National Trauma Peer Review Conference to group 11.1 to feedback the Rehab Prescription trial progress at the next Trauma Board Meeting By Whom RP MA/AB/ RP RP Update Carried forward not done due to annual leave. No update from RSUH. Complete. MW and are to meet to discuss as a matter of urgency to consider service improvement and delivery. MW commented that the Contract department has been approached by Liverpool. Action 3.1: RT to liaise with Val Harris to organise meeting between and MW regarding re-tender Complete. AB has received a response from Anaesthetics & ITU staff that confirmed the service arrangement with RSUH is beneficial and commented that they had also asked to continue. There has been no response from Surgical/Orthopaedic staff. AOK commented that he had not been approached for a response from YGC. MK confirmed he has been contacted in YG. Action 3.2: to contact MA regarding comments from YGC regarding quality of service from RSUH. MW happy to manage discussions with Val Attwood. MW commented that Morag Olsen, Chief Operating Officer has been supportive and advised Val to go through MW with regards to commissioning. AB attended the recent NWM&NW Trauma Network Board Meeting, where it was commented that the majority of TRID s are around communication, SD and EF agreed. AB informed the group that it is hoped a BCUHB executive will attend the next Trauma Network Meeting. There was a group discussion about the cost element of Refer a Patient. EF commented that the cost is to be 6,000 per speciality however that there had been a free trial for Spine/Neurosurgery negotiated. and EF agreed that having the NW TRIDs would be beneficial Action 3.4: RT to forward NW TRID with communication issues to EF Complete Complete Complete No replies received, requested AB/TO D to re-look at e-mail. Mindful of YGC new build and whether the document is still accurate and fit for purpose. KW commented on recent discussions held with the Welsh Government. advised the document is based on physical infrastructure regarding P2 capacity that each TU could receive. The group agreed that a local version is required. The group agreed further discussion is required and therefore to include as an agenda item at the next meeting. Action 3.5: RT to add Midlands Network Emergency Planning spreadsheet onto agenda Action 3.6: to circulate document to the Trauma Board group commented that feedback was requested from the National Trauma Peer Review Conference and that she had forwarded National Peer Review documents and presentations to the group. recently met with the Physiotherapists and OT s from YGC and it had been reported that there are difficulties with the rehab prescription trial. The action that came from the prescription meeting is for staff to attend Leighton Hospital, whose compliance is at 97%. It was further agreed to have a MDT meeting between the physiotherapists, OT s, nurses and lead clinicians. AB advised the Rehab Prescription was discussed at the NWM&NW Trauma Network Board Meeting and the feedback was positive. AB commented he is meeting with Leighton to discuss. 2
4 TARN update WM AB informed the group that KS recently attended the Trauma Care Conference held in Stone, Staffordshire. AB further commented that he has liaised with David Rawlinson, EMRTS with regards to KS being provided with PRF sheets as there was previous difficulties noted. There are monthly meetings planned for AB and KS to discuss any problems. AB advised KS has reported difficulties with staff recording incident number instead of PCR number. YGC TO D advised that they are pleased to announce the appointment of Beverely Rice who is the new TARN coordinator/ Rota Coordinator. She has a background in medical staffing at YG and will be learning the ED rota processes initially before commencing TARN. YG MK advised of no problems in YG and that SO is currently submitting 2015 data. commented that Mark O Leary, TARN Coordinator at RSUH has advised that the current PCR sheets don t have the time of departure recorded. The reason it was removed is because it was poorly completed, however there is an electronic system in the ambulance to record time. advised TARN coordinators can have access to the electronic records so she will arrange for this to be done. also commented that she is willing to access the records and distribute accordingly on behalf of RSUH to ultimately solve the issue. ACTION 4.1: to arrange for access to the electronic ambulance records for TARN coordinators 5 Finance/Contracts Contract Review Update : No financial details currently available. MDT OPD clinics in North Wales GM commented that the last discussions with EF were in November 2016. It was discussed about moving to a local MDT OPD clinic and for this to be held bi-monthly. It was agreed that more details were required about what was required and the charging mechanism. The group discussed the site for the clinic and AOK questioned a capacity issue at the TU s and therefore Holywell or Llandudno was proposed. agreed and advised siting the clinic further East would be a better location for the North West and Central Wales patients. AB queried whether having more than one site involved would be possible. GM commented that hospital transport could pose a possible problem with siting clinics in one location. MW queried whether patients had been contacted regarding feedback and questioned the efficiency of the current service. EF advised that based on the high DNA rate it was assumed that location was the factor. advised that a patient satisfaction survey is about to go live and is happy to add further questions to capture the information. ACTION 5.1: to Add further questions to the patient satisfaction survey to capture feedback. 6 Governance Issues CaseNote Reviews : Not required to be discussed TRIDs o WM AB informed the Board of a TRID that has been escalated to a SIR locally. The TRID was with regards to an elderly patient who had fallen downstairs. Following CT scan which showed large haemothorax and rib #s, the patient was transferred to theatre. EMRTS declined transfer initially as the patient was not intubated, further complicated by the Helicopter being offline. AB commented that there is a further meeting tomorrow (24.03.17) and formal SIR. EMRTS are also documenting a SIR. requested SIR presentation at Network Board and locally. MW to request EMRTS (Dindi) to present their SIR as well at Network Board. MK commented the case will also be discussed at the WM M&M meeting. Action 6.1: to request presentation of SIR a the next NW&NWTN Board Meeting o WM AB informed the Board of a TRID discussed at last meeting which has now been closed (TRID 1497). SD commented that he believed that it was breakdown in communication. o YGC TO D informed the Board of an issue that Mr Hanna, Orthopaedic surgeon had raised regarding the delay in transfer of a patient with a SDH. SD commented that the neurosurgeons had advised YGC that the patient required transferring after seven days clear of Clopidogrel and 3
o o o therefore he was destined to come over after that time, he has now arrived. AOK questioned when Refer A Patient goes live, EF advised sign off is on 10 th April. MW commented on possible governance issues that would have impact on patient safety and queried whether a follow up email including non patient identifiable data should be used. advised that several processes have already been looked at faxes, secure generic emails, etc. recommended implementing a deadline, and it was agreed that if the scheme is not live by 31.05.17, then Justine from Information Governance will be invited to suggest an alternate. YG MW presented to the group a TRID regarding 15 year old. MW gave the background as the patient fell from a horse, atypical presentation at 7pm, deteriorated and CT requested. CT showed splenic injury and the patient was referral to AlderHey. There is an internal issue with inhouse surgical team regarding delay who weren t called until 3.45 am and the patient was peri-arrest at that point. RSUH No TRIDs to be discussed AB queried the TRID concerning Mr Tzerakis patient transferred with thoracic spine injury to Mold Community Hospital. advised that it is being dealt with by complaints. 7 Issues of significance from North West Midlands and North Wales PAQ meeting: The last meeting held on the 22 nd February was fedback at the last Trauma Board meeting. North West Midlands and North Wales Trauma Network meeting: o MA has officially taken up post of Chair of the Network. o discussed the devastating head injuries document and informed the group that the Wales document is to sit along the FICM document. to send to Board Members, but has previously sent them to Walton and Simon Shaw at RSUH. o AB commented on the discussion regarding thoracotomy guidelines, which is planned to be amended into making more TU specific. o Friday 13 th October Networks major trauma sharing event o Post peer review meeting report discussion May Action 7.1: to send devastating head injuries document (Wales) to Trauma Board o AB informed the group that the paediatric spleen case was discussed. o The phone number of the TTL in Alder Hey has changed (without notification to stakeholders). noted that the Operation protocol will need to be amended o AB informed the group that a nurse from COCH gave an update on Jump Nation. The Trauma Coordinator in Chester has evaluated the data which has shown the majority of injuries were not severe and that the number of patients has reduced since the section was closed. o AB commented on a case from Wigan that was discussed regarding a 15 year old hit by car culminating in cardiac arrest, and unsurvivable injuries. There were discussions on support for TU staff and family. There is a Working group to be set up regarding children with devastating head injuries to involve NEWTS, palliative care etc. Action 7.2: to amend the Operation protocol accordingly and re-circulate 8 NW Trauma Training Course update Minutes from the Trauma Training Course on the 14 th March were distributed before the meeting. A trauma course for NW is being developed but it is not to replace ATLS. The group are working towards precourse reading to ensure the baseline knowledge. MK to send out new list by email. The trauma simulation course faculty is to be decided at the next meeting. MK commented that RSUH may send a representative for each course, and that it is recommended for to run three to four courses per year. Pre-course reading is to be completed for the next meeting to initiate the first course by the end of the year. 9 AOB A North Wales Major Trauma Conference is being held 12.05.17 advised the Board that there are to be three patient stories presented and presentations from RSUH staff. Peter Oakley is to chair the day, and further commented on an earlybird offer if booked by the end of March ( 10) SD queried regarding a presentation by Stuart (Neurosurgeon) to discuss head management in TU. commented that sensitivity required as several patients/family members are to be in attendance. AOK advised Welsh Orthopaedic Society is to be held on the same day so Orthopaedic s are unlikely to attend. 4
Network Meeting in May It was discussed whether a BCUHB executive would be available to attend. commented she will ensure MW is aware of date and time. MW advised important to create a link with the executives and is happy to be the link. AB advised the post peer review plan is to be discussed. KW Dr Evan Moore (MD) has requested KW to complete work around mass casualty akin to a workshop. KW requested ideas on what to capture from the Board. requested KW to email questions that she will relay to the group. MW informed the group that she chairs the NW implementation group. MW further commented that the new EMRTS helicopter will arrive in Caernarforn in May and that there are infrastructure changes. The last Q&S report presented has seen a 50% increase in EMRTS activity by having local Consultants involved as it has increased their presence. Action 9.1: RT to send Val and Meinir Network Board Meeting dates Action 9.2: KW to send questions pertaining to mass casualty to to send to the Trauma Board group 10 Date and Time of Next Meeting Thursday 18 th May 2017 14:00-16:00hrs 5
Action Card from Trauma Board Meeting 23 rd March 2017 No. Actions from the Minutes of the 23 rd February 2017 By Whom RT to liaise with Val Harris to organise meeting between and MW 3.1 RT regarding re-tender to contact MA regarding comments from YGC regarding quality of 3.2 service from RSUH 3.4 RT to forward NW TRID with communication issues to EF RT 3.5 RT to add Midlands Network Emergency Planning spreadsheet onto agenda RT 3.6 to circulate document to the TB group 4.1 to arrange for access to the electronic ambulance records for TARN coordinators 5.1 to add further questions to the patient satisfaction survey to capture feedback. 6.1 to request presentation of SIR a the next NW&NWTN Board Meeting 7.1 to send devastating head injuries document (Wales) to Trauma Board, Walton and Simon Shaw at RSUH. 9.1 RT to send Val and Meinir Network Board Meeting dates RT 9.2 KW to send questions to to send to the TB group KW 6