NCEPOD: Trauma - Who Cares? - London Health Programmes

CHAPTER 5 - Hospital receptionOverall assessment and appropriateness ofinitial responsePart of the advisors’ role was to come to an overallassessment of each case using the grading systemdescribed in the method section. Table 48 shows how thepatients classifi ed as having an inappropriate initial responsewere graded (94/699 from Table 47).Table 48. Overall assessment in patients withinappropriate initial responseNumber of patients %Good practice 8 8.5Room for improvement28 29.8clinicalRoom for improvementorganisationalRoom for improvementclinical andorganisational17 18.121 22.3Less than satisfactory 17 18.1Insuffi cient data 3 3.2Total 94Only a small number of the cases (8/94) were graded asgood practice. Additionally, in the view of the advisors, 17patients received less than satisfactory care. The aboverefl ects the importance of the initial response, in terms ofclinical decision-making and overall care for the severelyinjured patient.Key findingsA pre-alert from the ambulance crew to the receivingemergency department was documented for only 50.1%of patients in this study.One in fi ve hospitals admitting severely injured patientsdid not have a formal trauma team.When a pre-alert was made to the receiving emergencydepartment, there was no trauma response in one infour cases.A trauma team response was documented for only59.7% of patients in this study.A consultant was the team leader/ fi rst reviewer in only169/419 (40.3%) of cases.Advisors felt that the patient’s initial management wasinappropriate in 23.5% of cases where an SHO was theteam leader/ fi rst reviewer compared to 3.1% of caseswhere a consultant was the team leader/ fi rst reviewer.If no trauma response was activated, then it was morelikely that an SHO was the fi rst reviewer or team leaderfor the severely injured patient.176/419 (42%) patients were not seen by a consultant inthe emergency department.89/795 (11.2%) patients did not have a primary surveydocumented in their casenotes.The initial management of the patient was thought to beinappropriate in 94/699 cases (13.4%).60