The London Trauma System –
Progress to date
Simon Robbins
Senior Responsible Officer
Major 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
NonLondon
Rehab
Trauma
Centre
Rehab
Rehab
Trauma
Centre
Rehab
Trauma
Centre
Rehab
The Trauma System comprised of networks
Trauma
Centre
Rehab
Major
Trauma
Centre
Rehab
Network
Director
Rehab
Special.
Rehab
Trauma
Centre
Trauma
Centre
London
Director
Rehab
Rehab
Rehab
Rehab
Rehab
Network
Director
Major
Trauma
Centre
Rehab
Rehab
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 criterion
Factor to differentiate between options
Clinical quality
Critical mass
Major Incident compatibility
Sustainable & optimal quality
Ease of deliverability
MTC capacity
Deliverability and sustainability of networks
Speed of implementation
Comprehensive coverage
Travel time / Coverage
Strategic Coherence
Reconfiguration alignment
• JCPCT decision announced Monday 20th July
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