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September 2013

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Network 03003303999

Lee Van Rensburg lee.van-rensburg@addenbrookes.nhs.uk NHS sec 01223 216103

Rod Mckenzie Trauma Director MTC

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Why MTC and networks Network - East of England MTC – Cambridge University Hospitals NHS

Foundation Trust OTU – Orthopaedic trauma unit

Repatriation Boast 4

Adrian BoyleRod MackenzieSimon Lewis

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Networks and pathways established over time

60% of ISS > 15 patients received less than optimal care

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Trauma: Who cares?

A report of the National Confidential Enquiryinto Patient Outcome and Death (2007)

Why change

You must readthis report!

Disorganised pre-hospital care

Low frequency (< one per week per hospital)

Inadequate trauma team response

Lack of seniority in immediate hospital care

Lack of appreciation of seriousness Lack of urgency Incorrect decision making

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Reasons?

• Importance of:– Tempo– Seniority– Resources– Systems– Philosophy

Recommendations

"Current services for people who suffer major trauma are not good enough.

There is unacceptable variation, which means that if you are unlucky enough to have an accident at night or at the weekend, in many areas you are likely to receive worse quality of care and are more likely to die.

The Department of Health and the NHS must get a grip on coordinating services …."

Amyas Morse, head of the National Audit Office, 5 February 2010

Political engagement

Our Network

www.excellence.eastmidlands.nhs.uk

This document refers to all severely injured patients, meaning those who have suffered potentially life-threatening or life-changing physical injuries, i.e. all those who could benefit from regional networks.

• 18 Acute Hospitals

• One regional Ambulance Service (EEAST)

• Range of charity sector pre-hospital ‘enhanced care’ providers (e.g. Air Ambulance Charities)

• Range of specialist acute, reconstruction and rehabilitation services

• Range of specialist and general community rehabilitation services

East of England … past

EoE Hospital Type 1 ED

EoE Major Trauma Centre

Primary (peak and off –peak45 minute) transfer zone

Drive-time isochrones on this map were generated using averaged GPS-

based road segment speeds fromITIS GPS Floating Vehicle Data

against the Navteq Premium Streets database.

For normal peak speeds, ITIS vehicle (car) speeds between the hours 07:00-09:00 and 16:00-19:00 were averaged. For off-peak speeds, ITIS vehicle (car)

speeds excluding the hours 07:00-09:00 and 16:00-19:00

were averaged.

Primary transfer zone?

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Ambulance Service

Ambulance Service

Network Co-

ordination Service

Network Co-

ordination Service

Trauma Units

Trauma Units

Network Transfer Services

Network Transfer Services

Major Trauma Centre

Major Trauma Centre

Re-habilitation Services

Re-habilitation Services

Trauma Network OfficeTrauma Network Office

East of EnglandIntegrated Trauma System

EoE Hospital Type 1 EDEoE Major Trauma Centre

Primary (peak and off –peak45 minute) transfer zone*Burns Centre secondary transfer pathways

Brain injury secondary transfer pathways

Network Co-ordination provides three key functions: 

(1) co-ordination of components of the trauma system (from acute care through to rehabilitation);

 (2) a dedicated 24/7 single point of telephone contact for healthcare

professionals seeking access to immediate clinical advice, bed bureau functions related to critical care / specialist beds and access to a directory of services for complex injury and rehabilitation services;

(3) a means for monitoring patient flow and system performance (for professionals, patients and families).

Network Co-ordination

03003303999

Addenbrooke’s and the Rosie Hospitals

Innovation and Excellence in Health and Care

Major Trauma Centre

Major Trauma

(ISS > 15)

12(11-13)

Major Trauma

(ISS > 15)

12(11-13)

Severe Injury (ISS >8)

22(20-23)

Severe Injury (ISS >8)

22(20-23)

SeriousInjury

34(32-36)

SeriousInjury

34(32-36)

Survival to hospital

46(42-48)

Survival to hospital

46(42-48)

Serious injury

55(53-57)

Serious injury

55(53-57)

Admitted with significant injury (meeting UK TARN entry criteria) 1

Admitted with significant injury (meeting UK TARN entry criteria) 1

Survive to hospital

Survive to hospital

Pre-hospital System

Pre-hospital System

999Call

2623 3

999Call

2623 3

Age-standardised population rate per 100,000 (95% CI) 2

Age-standardised population rate per 100,000 (95% CI) 2

Burden of Disease (Count of patients, 95% CI)

(1) See www.tarn.ac.uk(2) Directly age-standardised rate per 100,000 resident population with 95% confidence interval

(3) Based on estimate from Ambulance Service related to 999 call burden for trauma related AMPDS codes (150000/year)

Burden of disease

MTC Activity?

Implementation

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Major Trauma Centre

www.tarn.ac.uk

Major Trauma Centre

DH Peer Review Feedback

Overview

“The strengths of the EoE trauma network are multiple.

It has from the outset planned to be a true trauma network. The panel noted from the visit as well as the supporting documentation that the

network is well developed and benefits from excellent engagement and clinical leadership.

The network has focused on an inclusive design with evidence of strong commitment and clinical consensus achieved through appropriate boards and other trauma groups, which are held regularly and have clear governance in place.

The patient pathway is well defined and there are good facilities throughout the ED and supporting departments.”

DH Peer Review Feedback

Commended

• True attempts at whole network engagement

• The TEMPO resource

• The outreach service (NCS and facilitated transfer)

• The well-developed and defined Trauma service delivery pathway

• Trauma team processes (activation, composition, leadership)

• Radiology provision

• The flexibility and commitment shown by the ITU team

• The work undertaken to improve the provision of rehabilitation

DH Peer Review Feedback

Commended

• Rehabilitation is an undoubted success and is one of the strong points within the Network.

• The service is well developed compared to a number of other Trauma Networks and this is as a result of good clinical leadership and investment in a complete new unit.

• The appointment of rehab consultants to lead this has been an undoubted success

• The [RAAR] has a good multi-disciplinary team, who appear to have the necessary skills, to deliver effective rehabilitation to trauma patients. The unit is very well equipped.

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5 Consultants special interest in trauma Subspeciality interest

Mr Lee Van Rensburg – Upper limb Mr Alan Norrish – Lower limb/ frames/ infection Mr Peter Hull – Pelvic and Acetabular/ lower limb Mr Matija Krkovic – Frames / lower limb Mr Andrew Carrothers – Pelvic and acetabular/ lower limb

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East Midlands Major Trauma NetworkTrauma & Orthopaedics: over-triaged patients

Over-triaged patientat QMC

No significantinjury

Home

Outpatient fracturee.g. wrist

ED to ED call: patient given local new-patient Fracture clinic appointment

Patient given:Copy relevant notesCD of x-rays

Inpatient fracturee.g. closed tibia shaft

What is best for patient?What does the patient want?What is the surgical capacity?

Local Trauma Unit

Remain at QMC

Definitive care

Definitive care

Trauma coordinators

East Midlands Major Trauma NetworkTrauma & Orthopaedics: Patients with multiple trauma

Major Trauma

Trauma Unit EDTrauma Unit

Trauma Coordinator

Queens’s Medical CentreTrauma

ConferenceDefinitive care Fit for transfer

EMAS triage

Secondary triageat Trauma Unit

Admissionrecorde-mail

T&O consultant

ED consultant

Rehabilitation lead

Fit for home

QMC Rehabilitation Team

Trauma UnitTrauma Coordinator

48 hoursnotice

Identify namedT&O consultant

Identify ward and bed

Transfer with:- Rehab prescription- Copy notes- E-transfer x-rays- Fracture clinic follow-up

Addenbrooke’s and the Rosie Hospitals

Innovation and Excellence in Health and Care

Questions and

Comments?

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