NCEPOD: Trauma - Who Cares? - London Health Programmes

More documents

Recommendations

Info

CHAPTER 10 - TransfersArrangement of transfersA consultant arranged the transfer in only 49 of 137 (35.8%)cases reported by clinicians on the A&E questionnaire.From the casenotes provided to <strong>NCEPOD</strong>, the grade ofthe clinician arranging the transfer could only be identifi edin 87/194 (44.8%) cases. A consultant was responsible forarranging 39/87 (44.8%) of these transfers (Figure 50).Figure 50. Grade of clinician organising transfer60Number of patients50403020100CON NCCG SpR3 SpR 1/2 SpR unknown SHO Other NotrecordedTable 93. Grade of clinician receiving the transferNumber of patients %Consultant 14 18.4NCCG 2 2.6SpR 3 2 2.6SpR 1/2 1 1.3SpR undefi ned 46 60.5SHO 10 13.2Other 1 1.3Subtotal 76Not documented 118Total 194The documentation of the grade of clinician receiving thepatient was equally poorly documented. In 118/194 cases(60.8%) it could not be determined who received the patient.Only 14 cases were documented as being received byconsultants (Table 93).The standards and guidelines for the Transport of theCritically Ill Patient 9 recommends that “each hospital shouldhave a designated consultant available 24 hours a day toorganise, supervise and where necessary undertake allinter-hospital transfers” and that the decision to transfera patient “must be made by a consultant in intensivecare in discussion with consultant colleagues”. This is not120
10Transfershappening. The lack of documented consultant input is aconcern. Either local guidelines exist which obviate the needfor consultant involvement or the process of care, includingtransfers, is being managed and delivered by staff in training.Accompanying staffRecommendations state that a minimum of two attendantsshould be present for the transfer 9 .Of the 194 transfers only 35 (18.0%) had a documentedsecond attendant and 3 (1.5%) a third attendant.In 155/194 cases notifi ed to <strong>NCEPOD</strong>, the grade of theaccompanying person was not documented. In the 39/194cases where specialty was documented, an anaesthetistor critical care specialist accompanied 36 of the cases.The published recommendations mandate that one of theattendants should be competent in intensive care medicine,anaesthesia or another acute specialty in order to be able tomanage any signifi cant airway complication.Reason for transferThe reasons for transfer were mainly for specialistmanagement of injuries (172/194; 88.7%). Six patients weretransferred due to lack of critical care facilities at the initialhospital. Other reasons cited for transfers were because oflack of local facilities (primarily lack of imaging facilities).The transfers for specialist care are detailed in Figure 51.Of the 172 cases transferred for specialist treatment, themajority were transferred for neurosurgical care – 106/172(61.6%). Six (3.5%) patients were transferred to paediatricunits. Eighteen (10.5%) patients were transferred for burns/plastic surgery input and 7 (4.1%) for the management ofcardiothoracic injuries.While it is essential to transfer patients if the appropriatecare is not available at the initial receiving hospital, it mustbe remembered that this will inevitably incur delays in thetime to defi nitive management. In cases where there is atime critical injury e.g. neurosurgical operation for expandingintracranial haematoma, this type of care may not allowFigure 51. Specialty to which the patients were transferred120Number of patients100806040200NeurosurgeryBurns/plasticsPaediatricsSpinal/neurologyCardiothoracics/thoracicsurgerySpecialtyOrthopaedicsLiverOtherNot recorded121
Page 1:
Trauma: Who cares?A report of the N
Page 4 and 5:
ContentsAcknowledgements 4Foreword
Page 6 and 7:
AcknowledgementsThis is the twenty
Page 8 and 9:
AcknowledgementsThe organisations t
Page 10 and 11:
ForewordSevere injury - a car crash
Page 12 and 13:
Summary of fi ndingsThis study show
Page 14 and 15:
Principal recommendationsOrganisati
Page 16 and 17:
IntroductionTrauma remains the four
Page 18 and 19:
IntroductionReferences1. Chaira 0,
Page 20 and 21:
MethodQuestionnaires and casenotesT
Page 22 and 23:
MethodQuality and confidentialityA
Page 24 and 25:
CHAPTER 1 - Data overviewFigure 2.
Page 26 and 27:
CHAPTER 1 - Data overviewMode of ar
Page 28 and 29:
CHAPTER 2 - Organisational dataTabl
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
CHAPTER 3 - Overall assessmentAll c
Page 38 and 39:
CHAPTER 3 - Overall assessmentKey f
Page 40 and 41:
CHAPTER 4 - Prehospital careRespons
Page 42 and 43:
CHAPTER 4 - Prehospital careFigure
Page 44 and 45:
CHAPTER 4 - Prehospital careTranspo
Page 46 and 47:
CHAPTER 4 - Prehospital careAdequac
Page 48 and 49:
CHAPTER 4 - Prehospital careIn 40/5
Page 50 and 51:
CHAPTER 4 - Prehospital carecaused
Page 52 and 53:
CHAPTER 5 - Hospital receptionIntro
Page 54 and 55:
CHAPTER 5 - Hospital receptionTable
Page 56 and 57:
CHAPTER 5 - Hospital receptionTraum
Page 58 and 59:
CHAPTER 5 - Hospital receptionTable
Page 60 and 61:
CHAPTER 5 - Hospital receptionThese
Page 62 and 63:
CHAPTER 5 - Hospital receptionOvera
Page 64 and 65:
CHAPTER 6 - Airway and breathingInt
Page 66 and 67:
CHAPTER 6 - Airway and breathingFig
Page 68 and 69:
CHAPTER 6 - Airway and breathingFig
Page 70 and 71:
CHAPTER 6 - Airway and breathingTab
Page 72 and 73: CHAPTER 7 - Management of circulati
Page 88 and 89: CHAPTER 8 - Head injury managementI
Page 90 and 91: CHAPTER 8 - Head injury managementT
Page 94 and 95: CHAPTER 8 - Head injury managementA
Page 98 and 99: CHAPTER 8 - Head injury managementH
Page 100 and 101: CHAPTER 8 - Head injury managementC
Page 102 and 103: CHAPTER 8 - Head injury managementf
Page 108 and 109: CHAPTER 8 - Head injury managementF
Page 110 and 111: CHAPTER 8 - Head injury managementK
Page 112 and 113: CHAPTER 8 - Head injury management1
Page 114 and 115: CHAPTER 9 - Paediatric careOrganisa
Page 116 and 117: CHAPTER 9 - Paediatric careClinical
Page 118 and 119: CHAPTER 9 - Paediatric careKey find
Page 120 and 121: CHAPTER 10 - TransfersIntroductionM
Page 124 and 125: CHAPTER 10 - TransfersFigure 52. De
Page 126 and 127: CHAPTER 10 - TransfersKey findingsR
Page 128 and 129: CHAPTER 11 -Incidence of trauma and
Page 130 and 131: CHAPTER 11 - Incidence of trauma an
Page 136 and 137: APPENDIX B - Injury severity scoreA
Page 138 and 139: APPENDIX C - Adult and paediatric G
Page 140 and 141: APPENDIX D - An example of an excel
Page 142 and 143: APPENDIX E - Level 1 trauma careAs
Page 144 and 145: APPENDIX F - ParticipationTrustCase
Page 150 and 151: APPENDIX G - Corporate structureThe
Page 152: Published November 2007 by the Nati
show all

NCEPOD: Trauma - Who Cares? - London Health Programmes

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?