Severn & Peninsula Major Trauma Networks Paediatric Major Trauma Centre Acceptance Policy May 2014, V3
REVIEW DISTRIBUTION APPROVAL/ADOPTED 6 months after formal approval and then annually Severn major trauma network committee Severn MTC Steering Committee Peninsula Network Advisory Group Peninsula Major Trauma Centre Management Committee To be agreed by the Severn and Peninsula Trauma Networks, the MTC s at Plymouth Hospitals NHS Trust and North Bristol NHS Trust, the PMTC at University Hospitals Bristol NHS Trust and all Trauma Units in both Networks AMENDMENTS DATE V1 Paediatric Stakeholder Group, 02/04/2014 V2 15 th April 2014 V3 1 st May 2014 RELATED POLICIES AUTHOR/FURTHER INFORMATION Amber Young, Paediatric Lead STN & PTN Victoria Legrys Severn Trauma Network Julian Shafee Peninsula Trauma Network THIS DOCUMENT WAS CREATED May 2014 THIS DOCUMENT REPLACES New policy
1. INTRODUCTION AND PURPOSE OF THE POLICY 1.1 Following the introduction of Regional Major Trauma Networks, Major Trauma Centres are required to have automatic acceptance of patients requiring treatment for major trauma injuries 1.2 The purpose of this policy is to provide direction and guidance for actions from key individuals and organisations within The Severn & Peninsula Major Trauma Networks to reduce the challenge and improve the patient pathway and quality of care. To do this it will: 1.2.1 Ensure the automatic acceptance of trauma patients within the Severn & Peninsula Major Trauma Network from Trauma Units and Acute Trusts to the Paediatric Major Trauma Centre. 1.2.2 Ensure that all relevant parties are aware of their specific roles and responsibilities, and prevent the acceptance and transfer of patients being delayed. 1.2.3 Describe the procedure where capacity to accept severely injured patients is exceeded. 2. APPLICATION: TO WHOM THIS POLICY APPLIES 2.1 This policy will relate to patients from Peninsula MTC, Trauma Units and Acute Trusts within The Severn & Peninsula Major Trauma Network areas following major trauma. 2.2 This policy applies to referring Acute Trusts, Ambulance Trusts, local air ambulance services and the Search and Rescue service It is the responsibility of Bristol Children s Hospital staff to ensure that that this policy is followed from first contact by an outside agency. 2.3 The policy will be implemented by all personnel in major trauma, the Clinical Site team, A&E, Intensive Care, High Dependency Units and General Wards. 2.4 The final responsibility for the implementation of this policy lies with the Paediatric Trauma Team Leader who accepts the patient. Departure from the policy would have to be justified to the Executive On-call with clear and compelling reasons. Any departure from the policy must be documented in the patient notes or failing that, in a letter to the Director of Operations. 3. PRINCIPLES 3.1 This policy applies 7 days a week, 24 hours per day. 3.2 All emergency and urgent contacts, including referrals to Neurosurgery, to the Paediatric MTC are to be via the Paediatric Trauma Team Leader. The one exception to this is for children with burns. All burns contacts must go via the following dedicated contact: SWUK Children s Burn Centre Tel: (0117) 923 0000 Bleep 6780 The Trauma Team Leader must be informed of all children being admitted with burns particularly those who may have sustained traumatic injuries other than their burns.
3.3 All relevant clinical information is to be given to the receiving Trust 3.4 Time critical transfers are to be organised by the referring hospital who are also responsible for providing the appropriate level of escort, together with all necessary documentation. This must include the Severn Major Trauma Network trauma patient record or the Peninsula Trauma Booklet along with any necessary Imaging and Damage Control Surgery information. 3.5 All non time-critical transfers are to be retrieved by the BRCH PICU Retrieval Team, as per national guidance. If the Retrieval Team is unable to collect the patient within 24hours of decision to transfer then the referring hospital will organise the transfer as per 3.4. 3.6 This policy should be read in conjunction with: The Severn & Peninsula Major Trauma Network repatriation/ongoing care policy SWAST Triage Tool 4. CLASSIFICATIONS 4.1 Primary Transfer: A transfer from scene to the Paediatric MTC. 4.2 Emergency Secondary transfer: A transfer from a non-paediatric MTC, TU or LEH, within the trauma networks, to the Paediatric MTC of a patient identified or suspected to have major trauma. Defined as immediate and urgent transfer in network secondary transfer protocol. 4.3 Non Emergency Secondary Transfer: A delayed secondary transfer is a patient who has been identified as major trauma or trauma who requires treatment at the MTC/TU but has not been transferred urgently. These patients are expected to arrive at the Paediatric MTC within 2 calendar days of injury. 5. Automatic Acceptance Process for Primary Transfers and Emergency Secondary Transfers 5.1 The referring hospital must contact the Paediatric Trauma Team Leader with details of the patient. A rapid assessment of the patient at a TU should have already taken place and any critical inventions be taking place. 5.2 The referring hospital must also inform the appropriate Ambulance Service Coordination desk of the transfer, for all time critical transfers and details of the patient. Consideration should always be given as to whether an aero-medical transfer is the most appropriate course of action. 5.3 The transfer procedure must be carried out at Trauma Team Leader level. 5.4 The Paediatric Trauma Team Leader will carry a dedicated trauma phone. All calls must be made to this number. Bristol Royal Children s Hospital, Trauma Team Leader - 0117 3420906
5.5 Full patient details including name of referring Trauma Team Leader to be recorded in the trauma booklet which is located within the Trauma Team Leader Folder which will be carried by the duty trauma consultant at the Paediatric MTC. 5.6 On arrival, the patient will either be taken to the resuscitation room and trauma call procedures initiated or transferred directly to specialty. Where a patient is transferred direct to specialty the Paediatric Trauma Team Leader must attend and complete the relevant sections of the trauma booklet. 6. Acceptance of Non Emergency Secondary Transfers 6.1 Stable patients who require treatment at The Paediatric MTC and have not been transferred as an emergency will be referred to the relevant speciality at BCH. The referring hospital must contact the relevant consultant. The accepting consultant must the call the Major Trauma Nurse Practitioner within the site team to inform them of the patient s details and time of referral. The clinical site team are responsible for holding a full list of all major trauma patients coming into the Major Trauma Centre and ensuring a bed will be available. 6.2 The patient must then be transferred within 2 calendar days from referral. The Clinical Site team will then ensure a suitable bed is made available. The Major Trauma Nurse Practitioner will support the transfer in, with the support of the receiving consultant as necessary. 6.3 If a bed has not been identified at 24 hours the Major Trauma Nurse Practitioners will escalate to the Network Manager and Clinical Lead for Major Trauma at the Paediatric MTC. 7. Capacity & Overflow Management 7.1 The Bristol Royal Children s Hospital Major Trauma Centre has a duty of care to the population covered by The Severn and Peninsula Major Trauma Networks and must accept all severely injured patients in a timely manner. Timely is defined as the degree of urgency of transfer as defined by the Paediatric Trauma Team Leader only. 7.2 The Paediatric Trauma Team Leader has responsibility for decisions regarding capacity and the ability to accept patients from the Severn & Peninsular Major Trauma Network and from outside the network. 7.3 Where there are problems with capacity in specific areas of BRCH (such as PICU) to accept patients from the Severn & Peninsular Major Trauma Networks, it is the responsibility of the affected unit/department to inform the Duty Major Trauma Consultant or STR in a timely manner and to work together to resolve the situation expediently. Capacity constraints cannot be used over clinical priority to turn-down or delay patients. 7.4 It is expected that regardless of capacity at Bristol Royal Hospital for Children, all timecritical major trauma patients will be accepted by them for life saving treatments. Should capacity issues necessitate transfer of any patient to another paediatric hospital, it is anticipated that a stable patient will be moved to allow trauma victims to be admitted to BRCH. Under exceptional circumstances where it is identified in discussion with the Trauma Team Leader that
a patient may more expediently be transferred from a TU to another Paediatric Trauma Centre, it is the responsibility of the TTL to make appropriate arrangements. 7.5 The decision of whether a patient requires immediate Paediatric Major Trauma Centre care and therefore must be accepted, must be made by the Paediatric Trauma Team Leader. 7.6 If no other Paediatric Major Trauma Centre within a reasonable travel time can accept the patient in a timely manner the Bristol Royal Children s Hospital must accept the patient.
Appendix A Paediatric Single Point of Call Access Number: BRCH Trauma Team Leader: 0117 3420906 SWUK Children s Burn Centre Tel: 0117 923 0000 Bleep 6780 Appendix B Hospital Major Trauma Centres Bristol Royal Children s Hospital (Paediatric) Town Switchboard number Bristol 0117 923 0000 Derriford Hospital (Adult) Plymouth 01752 202082 Frenchay Hospital (Adult) Bristol 0117 970 1212 Trauma Units Bristol Royal Infirmary Bristol 0117 923 0000 Gloucestershire Royal Hospital Gloucester 0300 422 2222 Great Western Hospital Swindon 01793 604020 Musgrove Park Hospital Taunton 01823 333444 North Devon District Hospital Barnstaple 01271 322577 Royal Cornwall Hospital Truro 01872 250000 Royal Devon & Exeter Hospital Exeter 01392 411611 Royal United Hospital Bath 01225 428331 Torbay Hospital Torquay 01803 614567 Yeovil District Hospital Yeovil 01935 475122 Local Emergency Hospitals Weston General Hospital Weston-Super- Mare 01934 636363