NCEPOD: Trauma - Who Cares? - London Health Programmes

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CHAPTER 11 -Incidence of trauma and organisation of trauma servicesIntroductionAlmost all of the evidence of the effectiveness ofimprovements in the organisation of trauma care servicescomes from developed countries. In most cases, the betterorganisation comes in the form of two related activities:(1) planning of integrated systems for traumamanagement; and(2) verifi cation of trauma services throughhospital inspections.Verifi cation applies to a review of individual facilities asregards their provision of a variety of items, includinghuman resources (e.g. availability of personnel with certainqualifi cations), physical resources (equipment and supplies)and administrative and organisational functions, such asquality improvement, audit (including outcome comparisons)and implementation of protocols (e.g. Advanced <strong>Trauma</strong>Life Support (ATLS). The American College of Surgeons hasmade signifi cant progress in this area 1 .The planning of systems for trauma management impliesseveral integrated functions. This includes regionaldesignation of those hospitals able to fulfi l the roles of traumacentres at varying levels of complexity; ranging from largeurban trauma centres to small rural hospitals and clinics.It also implies the planning of mobile emergency medicalservices, prehospital triage (to determine which patientsshould go to which types of designated facilities), transfercriteria and transfer arrangements between hospitals.patients. This relationship between volume, quality of careand outcome in trauma has been in the literature for someyears 2,3 . This suggests that there is a need to integrate andconcentrate major trauma in fewer centres, thus giving abetter quality of care.The incidence of severe trauma defi ned by an injury severityscore of 16 or more is estimated to be four per millionper week in the UK 4 ; a lower prevalence than in the USA.Burdett-Smith et al estimated that there are between 10,000and 10,600 patients suffering multiple injuries in the UKeach year 5 . Given the above estimates, the average acutehospital in the UK is not likely to be called upon to treatmore than one severely injured patient each week. Such lownumbers suggest that some acute hospitals may have toolittle experience to give these patients their best chance ofoptimum outcome. Adequate experience in the defi nitivemanagement of such diffi cult problems is hard to acquirewithout reorganisation of trauma services. Furthermore, it isalmost certainly unrealistic to expect every hospital to havethe necessary staff and services to be able to provide thestandard of care required 24 hours per day, 7 days per week.ResultsIn this study, 795 patients with a verifi ed injury severity scoreof 16 or more were identifi ed over a 12 week period. Table94 shows data concerning the number of severely injuredpatients seen by each emergency department in the 12week study period.Much of the data collected in this study pertains to the fi rstcategory above (verifi cation). However, the incidence of majortrauma in the UK is actually quite low and this has a directbearing on the ability to provide high quality care to trauma126
11Incidence of trauma andorganisation of trauma servicesTable 94. Number of patients seen per hospitalNumber of hospitals1-2 483-4 295-6 297-8 149-10 311-12 613-14 315-16 217-18 219-20 1> 20 4Total 141Only 12 emergency departments treated more than oneseverely injured patient per week during the study period andmany departments only treated one to two patients in thewhole 12 week study period.During the study, 243 patients were admitted initially tohospitals that reported 1-5 patients in the study, 226 patientsto hospitals that admitted 6-10 patients, 197 patients tohospitals that admitted 11-20 patients to the study and 129patients to hospitals that admitted more than 20 patients tothe study. Figure 53 illustrates the advisors’ assessment ofoverall care analysed by number of patients includedin the study.It can be seen that the high volume hospitals (>20 patients inthe study) were assessed as providing a higher percentageof good practice and a lower percentage of all othercategories, including insuffi cient data (Figure 53).Figure 53. Number of patients per hospital vs. advisors’ overall assessment70Percentage of group6050403020101-56-1011-20>200Good practiceRoom forimprovement -clinicalRoom forimprovement -organisationalRoom forimprovement -clinical andorganisationalLess thansatisfactoryInsufficient data127
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Trauma: Who cares?A report of the N
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ContentsAcknowledgements 4Foreword
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AcknowledgementsThis is the twenty
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AcknowledgementsThe organisations t
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ForewordSevere injury - a car crash
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Summary of fi ndingsThis study show
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Principal recommendationsOrganisati
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IntroductionTrauma remains the four
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IntroductionReferences1. Chaira 0,
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MethodQuestionnaires and casenotesT
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MethodQuality and confidentialityA
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CHAPTER 1 - Data overviewFigure 2.
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CHAPTER 1 - Data overviewMode of ar
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CHAPTER 2 - Organisational dataTabl
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CHAPTER 3 - Overall assessmentAll c
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CHAPTER 3 - Overall assessmentKey f
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CHAPTER 4 - Prehospital careRespons
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CHAPTER 4 - Prehospital careFigure
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CHAPTER 4 - Prehospital careTranspo
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CHAPTER 4 - Prehospital careAdequac
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CHAPTER 4 - Prehospital careIn 40/5
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CHAPTER 4 - Prehospital carecaused
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CHAPTER 5 - Hospital receptionIntro
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CHAPTER 5 - Hospital receptionTable
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CHAPTER 5 - Hospital receptionTraum
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CHAPTER 5 - Hospital receptionTable
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CHAPTER 5 - Hospital receptionThese
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CHAPTER 5 - Hospital receptionOvera
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CHAPTER 6 - Airway and breathingInt
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CHAPTER 6 - Airway and breathingFig
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CHAPTER 6 - Airway and breathingFig
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CHAPTER 6 - Airway and breathingTab
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CHAPTER 7 - Management of circulati
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Page 114 and 115: CHAPTER 9 - Paediatric careOrganisa
Page 116 and 117: CHAPTER 9 - Paediatric careClinical
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Page 120 and 121: CHAPTER 10 - TransfersIntroductionM
Page 122 and 123: CHAPTER 10 - TransfersArrangement o
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Page 126 and 127: CHAPTER 10 - TransfersKey findingsR
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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
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