NCEPOD: Trauma - Who Cares? - London Health Programmes

More documents

Recommendations

Info

IntroductionReferences1. Chaira 0, Cimbanissi S. Organized trauma care: doesvolume matter and do trauma centers save lives?Curr Opin Crit Care 2003; 9:510-42. http://www. tarn.ac.uk/content/images/53/overview%2006.pdf3. Our Healthier Nation – A contract for Health. Departmentof Health, 19984. The Royal College of Surgeons of England and the BritishOrthopaedic Society. Better Care for the Severely Injured.20005. Department for Transport, Table 33, Casualties: by age,road user type and severity: 2001, 2002 and 20036. Gorman DF, Teanby DN, Sinha MP, Wotherspoon J, BootDA, Molokhia A. The epidemiology of major injuries inMersey and North Wales. Injury 1995; 26(1):51-47. Offi ce for National Statistics http://www.statistics.gov.uk/8. Report of the working party on the management ofpatients with major injury. Royal College of Surgeons ofEngland, London. 19889. Lecky FE, Woodford M, Bouamra O, Yates DW, on behalfof the Trauma Audit and Research Network. Lack ofchange in trauma care in England and Wales since 1994.Emerg Med J 2002; 19:520-310. Crystal R, Bleetman A, Steyn R. Ambulance crewassessment of trauma severity and alertingpractice for trauma patients brought to ageneral hospital. Resuscitation 2004; 60:279-8211. Oakley PA, MacKenzie G, Templeton J, Cook AL, KirbyRM. Longitudinal trends in trauma mortality andsurvival in Stoke-on-Trent 1992-1998. Injury 2004;35:379-8512. McGinn GH, MacKenzie RE, Donnelly JA, Smith EA,Runcie CJ. Interhospital transfer of the criticallyill trauma patient: the potential role of a specialisttransport system. J Accid Emerg Med 1996; 13:90-213. Cooke RS, McNicholl BP, Byrnes DP. Earlymanagement of severe head injury in Northern Ireland.Injury 1995; 26(6):395-714. Lloyd DA, Patterson M, Robson J, Phillips B.A stratifi ed response system for the emergencymanagement of the severely injured. Ann R Coll SurgEngl 2001; 83:15-2015. Clayton TJ, Nelson RJ, Manara AR. Reduction inmortality from severe head injury following introductionof a protocol for intensive care management.British Journal of Anaesthesia 2004; 93(6):761-716. McKeating EG, Andrews PJD, Tocher JI, Menon DK.The intensive care of severe head injury: a survey of nonneurosurgicalcentres in the United Kingdom.British Journal of Neurosurgery 1998; 12(1):7-1417. Lecky F, Woodford M, Yates DW. Trends in traumacare in England and Wales 1989-1997. Lancet 2000;355:1771-518. The First Decade 1990-2000. Trauma Audit andResearch Network, 200019. Report of the Working Party on the Managementof Patients with Head Injuries. Royal College of Surgeonsof England, London. 199920. Triage, assessment, investigation and earlymanagement of head injury in infants, childrenand adults: NICE guidelines, 200321. Darzi A. Framework for Action. 2007.http://www.healthcareforlondon.nhs.uk/framework_for_ action.asp16
MethodMethodStudy aimThe aim of this study was to examine the process of care forseverely injured patients and identify variations that affect theachievement of agreed endpoints.The expert group identifi ed six main thematic areasthat would address the overall aim of the study:1. Timeliness of events making up the clinicalmanagement process.2. Issues associated with prehospital care at the siteof injury and transfer to hospital.3. Issues associated with the care team that performsthe initial resuscitation.4. Processes and procedures associated withsecondary transfers.5. Issues associated with pathways, handoversand communication.6. Membership of the Trauma Audit Research Network(TARN).Expert groupA multidisciplinary group of experts comprising cliniciansfrom emergency medicine, general surgery, neurosurgery,radiology, anaesthetics, and lay representatives contributedto the design of the study and reviewed the combinedanalysis of the data; both from the questionnaires and theextra information from the advisory groups.Case identificationPatients were identifi ed prospectively. A nominated contactin the emergency department identifi ed patients as severelyinjured based primarily on their, and their colleagues’, clinicaljudgement. A list of patients (which included a patientidentifi er and the date and time of admission) was thenforwarded to the NCEPOD local reporter who completed amonthly spreadsheet which contained additional information(for example, the name of the admitting clinician). Datacollection ran for three months from February 1st 2006to April 30th 2006. Patients of all ages were eligible forinclusion. After each month of sampling, a spreadsheetwas returned, password-protected, to NCEPOD along withphotocopies of all of the casenotes for the fi rst 72 hoursin hospital. The casenotes were used by NCEPOD staffto calculate an injury severity score (ISS) for each patient(see Appendix B). Patients with an ISS of 16 or more wereincluded in the study. The casenotes of included patientswere subsequently used for the peer review process.ExclusionsThe following patient groups were excluded:• Death by hanging or drowning (the pathology isasphyxia rather than trauma); and• Patients brought in for confirmation of death.17
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 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 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 74 and 75:
Page 76 and 77:
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
CHAPTER 8 - Head injury managementI
Page 90 and 91:
CHAPTER 8 - Head injury managementT
Page 92 and 93:
Page 94 and 95:
CHAPTER 8 - Head injury managementA
Page 96 and 97:
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 104 and 105:
Page 106 and 107:
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 122 and 123:
CHAPTER 10 - TransfersArrangement o
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 132 and 133:
Page 134 and 135:
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 146 and 147:
Page 148 and 149:
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

Create successful ePaper yourself

Delete template?

Save as template?