The London Trauma System Progress to date

1
The London Trauma System Progress to date

• Simon Robbins
• Senior Responsible Officer
• Major Trauma Project
• 10th September 2009

2
Context

3
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

4
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
5
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

6
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

7
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

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The Trauma System comprised of networks
9
Exploration Phase - Incidence
Around 1,600 major trauma cases per year /-
400 About one case a week for most AEs (lt 0.1
of total workload) Most Major Trauma occurs in
central London
10
Travel times

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

11
Public Consultation
12
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

13
Four networks JCPCT preferred option
14
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