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Regional Networks for Major Trauma

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Regional Networks for Major Trauma Regional Networks for Major Trauma NHS Clinical Advisory Groups Report September 2010 Contents Contents Summary ............................................................................................................................... 3 1 Case for change......................................................................................................... 5 1.1 Definitions............................................................................................................... 5 1.2 Context................................................................................................................... 7 1.3 The trauma pathway............................................................................................... 8 1.4 Rationale for change – stage by stage.................................................................... 9 2 Pre-hospital care ...................................................................................................... 19 2.1 Overview .............................................................................................................. 19 2.2 Clinical Advisory Group report summary............................................................... 19 2.3 Clinical Advisory Group recommendations ........................................................... 21 2.4 Stakeholder support and challenge ......................................................................28 3 Acute care................................................................................................................ 31 3.1 Overview .............................................................................................................. 31 3.2 Clinical Advisory Group report summary............................................................... 31 3.3 Clinical Advisory Group recommendations ........................................................... 33 3.4 Stakeholder support and challenge ......................................................................41 4 Ongoing care and reconstruction.............................................................................. 43 4.1 Overview .............................................................................................................. 43 4.2 Clinical Advisory Group report summary............................................................... 43 4.3 Clinical Advisory Group recommendations ........................................................... 47 4.4 Stakeholder support and challenge ......................................................................63 5 Rehabilitation ........................................................................................................... 67 5.1 Overview .............................................................................................................. 67 5.2 Clinical Advisory Group report summary............................................................... 68 5.3 Clinical Advisory Group recommendations ........................................................... 69 5.4 Stakeholder support and challenge ......................................................................81 6 Network organisation................................................................................................ 83 6.1 Overview .............................................................................................................. 83 6.2 Clinical Advisory Group report summary............................................................... 83 6.3 Clinical Advisory Group recommendations ........................................................... 86 6.4 Stakeholder support and challenge ......................................................................96 7 Appendices .............................................................................................................. 99 Appendix A – Pre-hospital Major Trauma Triage Tool .................................................... 99 Appendix B – ATMIST................................................................................................. 101 Appendix C: System and Network Formation ...............................................................102 Appendix D: Quality Improvement Programmes........................................................... 109 Appendix E: Emergency Preparedness........................................................................ 117 Appendix F: Research in Trauma Systems .................................................................. 118 Acknowledgements............................................................................................................ 119 References ........................................................................................................................ 123 Abbreviations Abbreviations A&E – Accident & Emergency DH – Department of Health ED – Emergency Department ITS – Inclusive Trauma System CAG – Clinical Advisory Group LEH – Local Emergency Hospital MTC – Major Trauma Centre MTOS – UK Major Trauma Outcomes Study NAO – National Audit Office NCEPOD – National Confidential Enquiry into Patient Outcome and Death NHS – National Health Service PACS – Picture Archiving and Communications Systems PROMs – Patient Recorded Outcome Measures PCT – Primary Care Trust QI – Quality Improvement RCSEng – Royal College of Surgeons in England SHA – Strategic Health Authority TARN – Trauma Audit and Research Network TCP – Trauma Care Pathway TN – Trauma Network TU – Trauma Unit UH – Undesignated Hospital Advice from NHS Clinical Advisory Group on Trauma page 1 Regional Networks for Major Trauma This document contains advice offered by the NHS Clinical Advisory Groups (CAG) for Major Trauma to their colleagues in the NHS. Strategic Health Authorities (SHAs) declared their intentions to support the establishment of improved regional services for Major Trauma, primarily through the development of regional Trauma Networks in 2008. The Revised Operating Framework of June 2010 confirmed that the expectation that these commitments would be fulfilled, despite the recent change of Government. The NHS Clinical Advisory Groups hope that SHAs, commissioners, providers, local Trauma Network leads and project managers will find this advice useful. It is intended to assist local planning for the main elements of the Major Trauma pathway from pre-hospital care to rehabilitation and to ensure the best fit of local service configurations, geography, patient expectation and needs. The document is also informed by stakeholder evidence gathered through Major Trauma engagement work (see supporting documentation ‘stakeholder engagement’). Clinical Advisory Group Membership Members of the CAG were drawn from medical, nursing, health professionals, NHS managers and those with a strong patient / carer involvement. They were appointed from across all SHAs for their personal experience and expertise, and not to represent any organisation or faction. The diversity of membership was intended to enrich contributions and provide a soundly based patient-focussed approach to improving services and outcomes for people suffering from Major Trauma. Please see Acknowledgements towards the end of this report for the members who contributed to this report. page 2 Advice from NHS Clinical Advisory Group on Trauma Summary Summary The NHS Clinical Advisory Groups investigated the evidence, national and international guidance and research required to assist regions in the successful design and implications of regional trauma networks. The document provides advice on delivering treatment for everyone which is based around the needs of individuals irrespective of where they suffer those injuries; delivers the patient as rapidly and safely as possible to the hospital that can manage the definitive care for their injuries either directly or by expedited inter-hospital transfer; and moves the responsibility for definitive patient care from the receiving clinical team to the trauma network when the initial receiving unit is incapable of that care. The document defines a comprehensive picture of the issues and lack of focus to date on rehabilitation. This document is structured to follow the patient pathway from pre-hospital care though to Rehabilitation. Advice is provided for each stage of the pathway and is intended to assist bespoke local planning. Following the case for change, which includes the trauma care pathway and the rational for change, each section of the care pathway holds an overview of the chapter, CAG recommendations and advice, weaved together with stakeholder support and challenge. This document deals largely with Adult Trauma – specific advice related to Children will follow as an appendix to this document. Equally, the implications for the workforce and training curriculum, burns patients, and spinal cord injury are currently being considered and will be released in due course. This report should be read in conjunction with the following supporting documents: • Literature review (TARN) • TARN Activity Analysis (both National and SHA specific) • ICNARC Activity Analysis (both National and SHA specific) • Planned Development of the Tariff Structure • Executive Summary of Stakeholders’ Views • Stakeholder Engagement Strands Advice from NHS Clinical Advisory Group on Trauma page 3 Regional Networks for Major Trauma page 4 Advice from NHS Clinical Advisory Group on Trauma Case for change 1 Case for change This section lays out the CAGs case for change. It defines the components of a regionalised approach to trauma
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