Improving the Quality of Trauma Care in NSW: Trauma Services Model of Care
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NSW Institute of Trauma and Injury Management Improving the Quality of Trauma Care in NSW: Trauma Services Model of Care 2019 The Agency for Clinical Innovation (ACI) is the lead agency for innovation in clinical care. We bring consumers, clinicians and healthcare managers together to support the design, assessment and implementation of clinical innovations across the NSW public health system to change the way that care is delivered. The ACI’s clinical networks, institutes and taskforces are chaired by senior clinicians and consumers who have a keen interest and track record in innovative clinical care. We also work closely with the Ministry of Health and the four other pillars of NSW Health to pilot, scale and spread solutions to healthcare system-wide challenges. We seek to improve the care and outcomes for patients by re-designing and transforming the NSW public health system. Our innovations are: • person-centred • clinically-led • evidence-based • value-driven. www.aci.health.nsw.gov.au AGENCY FOR CLINICAL INNOVATION Level 4, 67 Albert Avenue Chatswood NSW 2067 PO Box 699 Chatswood NSW 2057 T +61 2 9464 4666 | F +61 2 9464 4728 E [email protected] | aci.health.nsw.gov.au SHPN (ACI)190603, ISBN 978-1-76081-293-5 Produced by: NSW Institute of Trauma and Injury Management. Further copies of this publication can be obtained from the Agency for Clinical Innovation website at www.aci.health.nsw.gov.au Suggested citation: NSW Agency for Clinical Innovation. Improving the Quality of Trauma Care in NSW: Trauma Services Model of Care. Sydney: ACI; 2019. Disclaimer: Content within this publication was accurate at the time of publication. This work is copyright. It may be reproduced in whole or part for study or training purposes subject to the inclusion of an acknowledgment of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above, requires written permission from the Agency for Clinical Innovation. Version: 1.0 Trim: ACI/D19/258 © Agency for Clinical Innovation 2019 NSW ITIM – Improving the Quality of Trauma Care in NSW: Trauma Services Model of Care i Acknowledgments NSW Institute of Trauma and Injury Management (ITIM) • Ms Kelly Dee • Associate Professor Michael Dinh • Mr Benjamin Hall • Ms Christine Lassen • Dr Pooria Sarrami • Mr Hardeep Singh • Mr Glenn Sisson Endorsement NSW ITIM Executive Committee (2019) • Dr Zsolt Balogh, Trauma Director, John Hunter Hospital, Hunter New England LHD • Dr Brian Burns, Trauma Director and Medical Retrieval Specialist, Orange Base Hospital, Western NSW LHD • Dr Scott D’Amours, Trauma Director, Liverpool Hospital, South Western Sydney LHD • Dr Sarah Dalton, Clinical Executive Director, PRISM, ACI • Dr Michael Dinh, Clinical Director NSW ITIM, ACI • Dr Jeremy Hsu, Trauma Director, Westmead Hospital, Western Sydney LHD • Ms Christine Lassen, Manager, NSW ITIM, ACI • Ms Elizabeth Leonard, Trauma Coordinator, Royal Prince Alfred Hospital, Sydney LHDMs Karon McDonell, Trauma Coordinator, St Vincent’s Hospital • Dr Clare Richmond, Emergency Physician and Medical Retrieval Specialist, Greater Sydney Area Helicopter Emergency Medical Service • Mr Dwight Robinson, Manager Emergency Management Unit, Liverpool Hospital, South Western Sydney LHD • Dr Patricia Saccasan Whelan, Director Critical Care Unit, Goulburn Base Hospital, Murrumbidgee and Southern NSW LHDs • Dr Yashvi Wimasalena, Emergency Physician, Lismore Base Hospital, Northern NSW LHD NSW ITIM – Improving the Quality of Trauma Care in NSW: Trauma Services Model of Care ii Abbreviations ACI Agency for Clinical Innovation ACS American College of Surgeons CNC Clinical nurse consultant CNS Clinical nurse specialist FTE Full-time equivalent ICU Intensive care unit ISS Injury Severity Score ITIM Institute of Trauma and Injury Management LHD Local health district MTS Major Trauma Service NSQHS National Safety and Quality in Health Service NSW New South Wales PTS Paediatric Trauma Service RACS Royal Australasian College of Surgeons RTS Regional Trauma Service SAC Severity Assessment Code TORQUE Trauma Outcomes Registry and Quality Evaluation TPOE2 Trauma Patient Outcome Evaluation NSW ITIM – Improving the Quality of Trauma Care in NSW: Trauma Services Model of Care iii Supporting documents • NSW Health. Selected Specialty and Statewide Service Plans: NSW Trauma Services (2009) • NSW Health. Guide to the Role Delineation of Clinical Services (2018) • NSW Health. Critical Care Tertiary Referral Networks and Transfer of Care (Adults) PD 2018_11 • NSW Health. Critical Care Tertiary Referral Networks (Paediatrics) PD 2010_030 • NSW Health. Critical Care Tertiary Referral Networks (Perinatal) PD 2010_069 • Royal Australasian College of Surgeons (Aug 2018). Model Resource Criteria for Level I, II, III & IV Trauma Services in Australasia • NSW Institute of Trauma and Injury Management. Trauma Patient Outcome Evaluation Qualitative Report. NSW Agency for Clinical Innovation, 2016 • Australian Commission on Safety and Quality in Health Care (November 2017). National Safety and Quality Health Service Standards, Second Edition • NSW Institute of Trauma and Injury Management. A Guide to the NSW Trauma Process Indicators. NSW Agency for Clinical Innovation, 2017 • Rehabilitation Network. NSW Rehabilitation Model of Care. NSW Agency for Clinical Innovation, 2015 Important note The scope of this document is limited to describing the resourcing, activity and performance of designated NSW trauma services in the acute care hospital phase. It is acknowledged that this does not encompass all aspects of trauma care such as pre-hospital, rehabilitation or community based care. As such, this document should read and considered in conjunction with other key supporting documents as listed above. The criteria outlined within this document represent model of care standards for designated trauma hospitals in NSW to meet minimum requirements and functions. Trauma hospital designation is determined by the NSW Ministry of Health in Selected Specialty and Statewide Service Plans: NSW Trauma Services (NSW Trauma Plan).1 The following document provides a framework by which the NSW Institute of Trauma and Injury Management specifically and the Agency for Clinical Innovation (ACI) as a whole can assess resourcing, activity and performance of designated trauma services. NSW ITIM – Improving the Quality of Trauma Care in NSW: Trauma Services Model of Care iv Executive summary Trauma services coordinate and ensure the highest level of care for trauma patients admitted to hospitals across NSW. To fulfil these functions, trauma services need to be adequately staffed and resourced. The Trauma Patient Outcome Evaluation Qualitative Report (2016) was a needs analysis conducted in consultation with all trauma services, local health district (LHD) and hospital executives and other stakeholders. The analysis identified substantial variation in staffing and models of care in trauma centres across NSW2, and this has been associated with unwarranted clinical variation with respect to separately reported major trauma mortality rates.20 This document is a response to the Trauma Patient Outcome Evaluation Qualitative Report (2016) and aims to address gaps in service delivery by outlining performance, responsibilities and expectations of trauma services. It provides a basis for NSW Health pillars, LHDs, specialty health networks, and external accreditation agencies to assess local resourcing requirements and functional activity of trauma services. The document represents the structural component of an overarching statewide trauma quality improvement program comprising the NSW Trauma Outcomes Registry and Quality Evaluation (NSW TORQUE) and the Trauma Death Monitoring and Review programs. These have been identified as key enablers to address gaps in trauma care delivery in NSW. Addressing these gaps is expected to result in improved access to specialist trauma care particularly in rural and regional NSW, increased ability to meet performance and quality improvement standards, and ultimately leading to a reduction in unwarranted clinical variation across the NSW trauma system. NSW ITIM – Improving the Quality of Trauma Care in NSW: Trauma Services Model of Care v Contents Acknowledgments ........................................................................................................................ ii Endorsement ................................................................................................................................. ii Abbreviations ............................................................................................................................... iii Supporting documents ................................................................................................................ iv Important note .............................................................................................................................. iv Executive Summary ...................................................................................................................... v Introduction ................................................................................................................................... 1 Background ........................................................................................................................... 1 Cost of trauma ....................................................................................................................... 1 Health