Trauma Care Network News Issue 3 Inside Issue 3 Implementation of trauma care system Monitoring patient outcomes International Trauma Care Conference 23rd - 26th April West Midlands Major Trauma Clinical Lead appointed Peter Oakley, Consultant in Anaesthesia and Trauma at University Hospital of North Staffordshire, has been appointed as the Clinical Lead for Major Trauma in the West Midlands. Peter who works in the hospital s emergency department as a Trauma Team Leader also specialises in Intensive Care and Neuro-Anaesthesia. As the clinical lead for Major Trauma Peter will oversee the development and implementation of the Trauma Networks. He will work with colleague doctors and other specialist staff within the region, building on the specialist expertise already available to provide the best care possible for severely injured patients. Talking about his appointment Peter says: Two of the hallmarks of the new major trauma system in the West Midlands are timing and coordination this means prompt, prioritised care in the field, rapid transport to the most appropriate facility, and well-organised, fully-briefed, multi-disciplinary, specialist care, ready and waiting at the front door of the hospital. Successful major trauma care isn t just about the first hour of treatment. It s about planned, co-ordinated care involving all the necessary disciplines from the moment the injuries are sustained, through resuscitation and intensive care, surgical repair and reconstruction, to recovery and rehabilitation. The new major trauma system also emphasises the importance of early rehabilitation, to assist injured patients to realise their full recovery potential. Rehabilitation Medicine has so much to offer the major trauma patient, not just in the later stages of care, but from the outset. In the West Midlands referral will be made to the Rehabilitation Service on day 1. Patients and families will come to see the Rehabilitation Coordinator as the friendly, familiar face guiding them through the pathway of care. The Ambulance Service is also pivotal in saving lives and optimising outcome after major trauma. Not only will their Paramedics and Immediate Care Doctors be delivering critical care in the field, but a Specialist Paramedic at the Trauma Desk in Ambulance Control will be coordinating care behind the scenes to ensure that the right things are put in place along the evolving care pathway. The introduction of a Trauma Care system is a mandated national requirement in the NHS Operating Framework in England 2011/12
West Midlands Trauma Implementation Workshop a success Over 100 people from organisations including hospital trusts, specialist rehabilitation units, Headway, Rehab UK, Local Involvement Networks (LINks) members and councillors attended the West Midlands Trauma System Implementation Workshop on 19th December 2011 in Birmingham. Dr Matthew Wyse, Consultant Anaesthetist and Clinical lead for the Major Trauma Service at University Hospital in Coventry said: "I would like to thank everyone for taking time to attend this event. We know that having a trauma care system in place will not only save more lives and reduce disability but will improve our patients' long term outcomes and it is gratifying to see that we are making significant progress towards achieving this aim." "We have a challenging programme of work ahead and this workshop has given us an ideal opportunity to look at the proposed systems and processes required that will benefit our patients by increasing survival rates, shortening recovery times and reducing disability from injury." Sue Best, Headway Acute Trauma Support (HATS) Nurse, said: "It is encouraging to see that patients' and relatives' interests and overall satisfaction with the service is high on the agenda and will be monitored regularly in the future. Doing so will ensure people in the West Midlands have access to a trauma service that will improve patients' outcomes." The implementation of the three trauma networks begins on 26th March 2012. Each network will have an adult major trauma centre at its heart. The adult major trauma centres are: Queen Elizabeth Hospital, Birmingham University Hospital of North Staffordshire in Stoke University Hospital Coventry The Birmingham Children's Hospital will be the children's major trauma centre. The MTCs will be supported by Trauma Units and Local Emergency Hospitals, Rehabilitation Centres and ambulance and air ambulance services, commissioners and patients to ensure a smooth pathway for trauma patients from when the 999 emergency call is first received by the ambulance service through to being discharged from rehabilitation services. Midlands and East Specialised Commissioning Group (West Midlands office) 3rd Floor, King s House, 127 Hagley Road, B ham B16 8LD Telephone: 0121 695 2369 Email: info@wmsc.nhs.uk Website: www.wmsc.nhs.uk 2
Introducing a regional trauma system to improve patient care Here in the West Midlands we have been working with specialist clinicians in trauma care to develop a regional trauma care system. This system will give people considered access to specialist medical teams, with all the necessary specialist services needed to treat major trauma patients available on one hospital site. The new regional trauma care system will have three trauma care networks. Each network will have a major trauma centre at its heart. How the trauma care system will be implemented Work has already started on setting up three trauma networks: North West Midlands Network will cover North and South Staffordshire, Shropshire. The network may extend into parts of Wales and further north west however this is still to be decided. Central England s Network covers Coventry and Warwickshire and parts of Northamptonshire Birmingham, Black Country and Herefordshire and Worcestershire extends across Birmingham, Sandwell, Solihull, Dudley, Wolverhampton and Herefordshire and Worcestershire The Trauma Networks will go live on 26th March 2012. What do we mean by network Clinical networks are organisations used to deliver locally integrated services that are of consistently high quality. They are made up of clinicians including doctors and nurses and ensure that there is greater collaboration between services regionally whilst retaining strong local clinical and public engagement. They are committed to developing effective networks that support the patient s journey from the scene of the incident right through to rehabilitation. The Trauma Care Networks will monitor the quality and performance, making sure that there are policies and procedures in place so that the patient receives the specialist care that they need no matter where they are. If Major Trauma Centre is within 45 minutes journey time Injured Patient Major Trauma Centre Transferred to Major Trauma Centre if required Transferred closer to home for rehabilitation Trauma Unit If Major Trauma Centre is more than 45 minutes journey time the patient may be taken to nearest trauma unit for stabilisation 3
How will the trauma system work? There are a number of partner organisations working together to care for trauma patients from when the 999 call is received through to the patient making a full recovery. The ambulance and air ambulance services The Trauma Desk situated in the Emergency Operations Centre at Ambulance Service headquarters will coordinate communications between all the relevant NHS organisations. The Trauma Desk will be staffed by paramedics with specialist trauma expertise. They will work on a rota between the trauma desk, air ambulance and as part of the extended skills trauma teams, provide a rapid response, making an initial assessment of the patient s injuries using a triage tool. They will then assess the patient at the incident and with the use of the triage tool will decide where the patient needs to be taken to - depending on how severely injured the patient is. Major Trauma Centre ECT/MERIT Crew on Scene WMAS Trauma Desk TU MTC There is one adult major trauma centre at the heart of each network. The Birmingham Children s Hospital will be the children s major trauma centre and will work with the three networks across the region. On arrival at the department in the major trauma centre the patient will have access to a full range of specialist services and equipment including scanners and trauma specialists. Patients will be scanned within 30 minutes and will receive surgery, where necessary, within the hour. Trauma Units and Local Emergency Hospitals support the major trauma centres. Specialist Rehabilitation Services Major Trauma centres will have rehabilitation teams in place with an acute care co-ordinator and rehabilitation coordinator whose roles will be to support the patient from when they are admitted through to discharge. Specialist rehabilitation providers networking with MTCs will be involved in the rehabilitation care plans for patients with the aim of accepting patients from an MTC or TU within 24 hours of the referral. Trauma Units will provide some specialist care for patients who do not have multiple injuries, for example a patient who may have broken an arm or leg. If a patient is severely injured and having problems breathing the patient may be taken to a trauma unit if it is closer than the major trauma centre where they will be stabilized before transferring them on to the MTC. Local Emergency Hospitals (LEH) will offer full accident and emergency services however patients with severe life threatening threatening injuries will not go to the LEH. They will be taken directly to the appropriate specialist centre for treatment. However the number of patients that this affects is very small, about 1 2 patients a week. 4
How will we monitor outcomes of the new system? Introducing a trauma care system across the West Midlands means that patients with severe life threatening injuries will receive co-ordinated care starting as soon as the first 999 emergency telephone call is made. To measure the improvements in the standard of care that our patients receive we will be monitoring the outcomes of the new system in a number of ways including setting service standards; key performance indicators; continuous performance monitoring; the collection of TARN data; and a formal peer review in 2013. These measures will look at improvements in patient care and survival rates, quality and safety standards. West Midlands Trauma Care System on track to deliver high quality care The National Clinical Director for Trauma Care, Professor Keith Willett praised the four West Midlands major trauma centres during a visit in January 2012, saying he was pleased that the NHS in the West Midlands is gearing up in preparation for the introduction of the trauma care system across the West Midlands that will see that the quality of trauma care provided will be the best possible for major trauma patients. Each major trauma centre is working towards a set of specification standards which have been developed and funded by PCTs locally. Input from clinicians, NHS managers, patient advocacy groups and other key stakeholders, will ensure that patients will receive the same high standard of care wherever they go, providing equity of service across the region. The standards include: Trauma/emergency consultant available to provide advice and guidance to the pre-hospital team during the pre-hospital stage eg ambulance/air ambulance and BASICs doctors Trauma team alerted and on standby to receive patient Trauma team to include doctors from: emergency medicine; anaesthetics; intensive care; general surgery and trauma and orthopaedic surgery Patient to have scans within 30 minutes of arrival at hospital unless requiring other more urgent treatment Patient to have, where necessary, surgery within one hour of arrival Neurosurgery treatment (brain) to be available within one hour of patient s arrival at the centre TARN Data In addition, a national Trauma Audit and Research Network (TARN) collects data from all hospital trusts that receive severely injured patients. TARN data is used to assist hospitals in the development, improvement and monitoring of the quality of care that they provide for severely injured patients, highlighting any variations in the regions across England. 3 5
Trauma Care 13th International Conference Monday 23 rd April Paramedic Programme TARN Symposium: Regional Trauma Networks Rescue Day Wednesday 25 th April Trauma Critical Care Association of Surgeons in Training Advances in Military Trauma Tuesday 24 th April Nursing Programme Sports Injury Trauma Science The Cutting Edge Thursday 26 th April Olympics Games Paediatric Trauma Spinal Cord Injury On behalf of the educational charity Trauma Care and Queen Elizabeth Hospital Birmingham charities I am writing to invite you to send health care professionals to the conference in Telford. The conference this year has substantial sponsorship in recognition of the newly established Trauma Networks in the region. The conference is designed to provide education and therefore CPD for staff within Major Trauma Centres, Trauma Units and Local Emergency Hospitals. The programme will be attractive to the Emergency Departments, staff in Imaging, Theatre staff, Critical Care, Rehabilitation, Paediatric trauma and should embrace all disciplines. There is no charge for places. I would wish to raise an invoice for a 25 non-attendance fee to cover catering costs if your delegates do not attend. Application forms are available from Ashleigh Knights at Ashleigh.Knights@uhb.nhs.uk to enable us to manage places. I am happy to take single day delegates and delegates that may come for several days or the whole conference. I would be grateful if you could forward completed forms to Ashleigh on a regular basis. Yours sincerely Professor Sir Keith Porter Chairman of Trauma Care & Clinical Lead for Birmingham, Black Country, Hereford and Worcestershire Network. For further details and application forms visit trauma care website or contact Ashleigh Knights. Email: ashleigh.knights@uhb.nhs.uk 6 To find out more visit: www.traumacare-uk.com
Farmer says thank you for saving his life One person who is alive today, thanks to major trauma services, is farmer Alan Hinch. He is lucky to be alive after his van was hit by a car on a rural road in Market Harborough in September last year. He was left fighting for his life with injuries including a broken back, shattered pelvis, fractured hips and a collapsed lung. The 75-year-old was cut out of his van before being airlifted to the nearest major hospital able to deal with life threatening injuries. This was the first link in a complex chain of life saving treatments which has meant Alan is here today. University Hospital in Coventry is one of three hospitals in the West Midlands designated as an adult Major Trauma Centre. These specially designated trauma centres will receive the vast majority of severely injured patients, providing immediate access to consultant delivered care 24 hours a day, 365 days a year, as well as advanced diagnostic scans and technology. This means patients like Alan get definitive trauma care from the moment they arrive at hospital. On arrival at the University Hospital in Coventry Alan had a CT scan from his head to his knees, which immediately diagnosed all his injuries and allowing the trauma team to prioritise his care. He was nursed in the critical care unit where their initial concern was that he might not survive. The following day he had emergency surgery to put a metal plate in his thigh bone to fix the fracture. He was in a coma for three days and stayed on the critical care unit for another 12 days. Alan said: "The last thing I remember is the sound of the helicopter, the next thing was waking up in the critical care unit three days later." Dr Matthew Wyse, Consultant Anaesthetist and Clinical Lead for Major Trauma Service said: "At University Hospital we see about 300 major traumas each year. Patients brought here do not need to be transferred anywhere else because we have all the lifesaving services on one site. Patients get faster access to scans and treatment which save lives. Patients like Alan are in safer hands. Every second counts when you have a patient with life threatening injuries." Alan says: "If I had gone to the nearest hospital, valuable time would have been lost and I am not sure whether I would have been here today to tell the tale. At University Hospital there are the people and the equipment all in the one place to do everything at once." Getting Involved If you have any questions queries or comments, please contact: Your local primary care trust Email us at info@wmsc.nhs.uk Telephone 0121 695 2369 Write to us at King s House, 127 Hagley Road Birmingham B16 8LD Midlands & East Specialised Commissioning Group The East and West Midlands and the East of England Specialised Commissioning Groups have clustered together to work as one specialised commissioning group and will now be known as the Midlands and East Specialised Commissioning Group (M&ESCG). This newsletter is produced by the West Midlands Office. 7