The London Trauma System – Progress to date

Simon Robbins Senior Responsible OfficerMajor Trauma Project

10th September 2009

Context

Case for Change

NCEPOD 2007• 60% of severely injured patients received sub-optimal care.

• Organisational• Needs regional planning• Data collection

• Clinical• Lack of appreciation of injury severity• Incorrect clinical decision making• Lack of seniority of staff especially at night and weekends

Victoria Australia – established Trauma System – 8 years of data• The proportion of road trauma victims admitted to MTCs

increased from 34% to 62%• Unadjusted in-hospital death rate fell from 15% 2001-2002 to

11% 2005 - 2006 • Adjusted odds ratio for death in major trauma patients fell 38%

across all patient groups, 44% for road trauma and 38% for serious head injury

Project Objective

To design and implement an inclusive trauma system

that assures the care of all injured patients and

ensures that optimal care is provided at all stages of

the patient journey

Benefits of a London Trauma System

• Improved patient outcomes

• A system-wide prevention strategy to reduce the number of people suffering severe injury

• Improved education and training of those delivering trauma care

• Increased ability to deliver a pan-London Major Incident Plan

• More people surviving injury and returning to optimum social and economic functioning

Project Phases

Phase 1 – Exploration – Until August 2008

• Design a trauma system and trauma pathway for London

• Run a preliminary phase to determine provider interest

• Develop designation criteria and process

• Determine incidence, travel times

Phase 2 – Preparation – August 2008 – Summer 2009

• Run designation process x 2

• Public consultation on options

• Implementation planning

Phase 3 – Implementation – Summer 2009 onwards

• Decision by Joint Committee of PCTs (31 in London)

• Commissioning elements of the London Trauma System

Principles of the London Trauma System

• Comprised of networks• Led by London Trauma Director• Triage to Major Trauma Centre (MTC) or Trauma Centre

(TC)• Triage supported by clinical co-ordination desk• Under-triaged patients do not require “permission” for

transfer from TC to MTC• Agreement around rapid repatriation to TC• Rehabilitation – at network and system level• Pan-London and local protocols

The Trauma System comprised of networks

Major Trauma Centre R

eha

bMajor Trauma Centre R

eha

b

Trauma Centre R

eha

b

Trauma Centre R

eha

bTrauma Centre R

eha

b

Trauma Centre R

eha

b

Trauma Centre

Rehab

Rehab

Rehab

Rehab

Network Director

Non-London Rehab

Major Trauma Centre R

eha

bMajor Trauma Centre R

eha

b

Trauma Centre R

eha

b

Trauma Centre R

eha

b

Trauma Centre R

eha

b

Trauma Centre R

eha

b

Trauma Centre

Rehab

Rehab

Rehab

Network Director

Rehab

Special. Rehab

London Director

Exploration Phase - Incidence

Around 1,600 major trauma cases per year +/- 400

About one case a week for most A&Es (< 0.1% of total workload)

Most Major Trauma occurs in central London

Travel times

• All MTCs within 45 mins by blue light• Public expectation - videos• London compared to rural areas• Helicopters

Public Consultation

Public Consultation

• 3 networks with April 2010 delivery date• 2 networks for delivery by April 2012• How to arrive at a preferred option?

• JCPCT decision announced Monday 20th July

Speed of implementation

Deliverability and sustainability of networks

MTC capacity

Ease of deliverability

Major Incident compatibility

Reconfiguration alignmentStrategic Coherence

Travel time / CoverageComprehensive coverage

Critical mass

Clinical quality

Sustainable & optimal quality

Factor to differentiate between optionsJCPCT criterion

Speed of implementation

Deliverability and sustainability of networks

MTC capacity

Ease of deliverability

Major Incident compatibility

Reconfiguration alignmentStrategic Coherence

Travel time / CoverageComprehensive coverage

Critical mass

Clinical quality

Sustainable & optimal quality

Factor to differentiate between optionsJCPCT criterion

Four networks – JCPCT preferred option

Next Steps

• Implementation• London Trauma Director in post• Establish London Trauma Office

– System-wide TARN – Performance monitoring and quality imporvement

• Commissioning and Finance– LSCG will commission Major Trauma Centres and

Trauma Networks – Trauma Centres will be commissioned by SACUs

• Service specification is agreed• TARN sign up and data submission in all TCs