Appendix Q10 JCHC Response:
Through the governance structures established by the National Office of Clinical Audit (NOCA), the deployment
of Major Trauma Audit (MTA) is now well advanced.
Trauma is the leading cause of death and disability in the first four decades of life. For every trauma death
three to four people are seriously injured
(1)
. International research and education has resulted in improved
outcomes for injured patients and has transformed the delivery of modern trauma care
(2-4)
of which MTA is a
crucial component. MTA provides the necessary intelligence to support the development of trauma systems.
Published literature indicates that severely injured patients are 15-20% less likely to die if admitted to a
Trauma Centre within an organised Trauma System (4).
Trauma care involves multiple medical and surgical specialties as well as healthcare organisations and other
agencies and all have a contribution to make to the development of MTA.
Improvements in trauma
management are necessary at all stages of the patient journey from pre-hospital care to rehabilitation to
reduce trauma morbidity and mortality. The establishment of MTA will provide analysis of the combined
effectiveness of the elements of trauma patient care and support greater integration of the work of trauma
service providers. It will also provide essential data to support injury prevention that is an integral part of any
trauma care system.
NOCA is currently working to bring all 27 major trauma receiving hospitals through training and registration for
the collection of MTA data. NOCA currently has 22 hospitals contributing, the initial 11 commenced data
collection in October 2013, followed by a subsequent training programme in April 2014.
Through NOCA Governance and individual hospital monitoring of data on an ongoing basis, it is intended that
when all 27 hospitals have contributed at least one year’s full data, an annual report will be produced. These
reports will include composite data for major trauma in Ireland.
The core purpose of NOCA and its
establishment of national clinical audits such as MTA is to provide continual learning to our health system
through evidence based audit methodologies and practices that will ultimately improve clinical outcomes for
patients in Ireland.
NOCA supports hospitals to contribute data through an MTA framework to collect standardised data on patient
injury, care processes including time metrics and patient outcomes. It will also support hospital management
to interpret and action MTA reports.
Considerable commitment from all hospitals will be required to ensure sustainability of MTA. NOCA has found
engagement and willingness to participate has been extremely positive, primarily due to combined leadership
of clinicians and hospital executives.
National Office of Clinical Audit, Beaux Lane House, Lr Mercer Street, Dublin 2 Tel: 4028577
Page 1 of 3
An initial 11 trauma receiving hospitals commenced collection and submission of MTA data from 1 st October
2013;

Beaumont Hospital, Dublin 9

Our Lady of Lourdes Hospital, Co Louth

Cavan General Hospital, Co Cavan

The Adelaide and Meath Hospital inc. The National Children's Hospital, Dublin 24

Naas General Hospital, Co. Kildare

St. Vincent's University Hospital, Dublin 4

Cork University Hospital, Co. Cork

South Tipperary General Hospital, Co. Tipperary

Letterkenny General Hospital, Co. Donegal

Sligo General Hospital, Co. Sligo

Children’s University Hospital, Temple St, Dublin 1.
From 1st April, 2014, an additional 11 trauma receiving hospitals commenced MTA data collection and
submission.

Mater Misericordiae University Hospital

Connolly Hospital Blanchardstown

Wexford General Hospital

University Hospital Waterford

Midland Regional Hospital Portlaoise

Midland Regional Hospital Mullingar

Midland Regional Hospital, Tullamore

University Hospital Limerick

Kerry General Hospital

Mercy University Hospital

St Luke’s General Hospital, Kilkenny
NOCA continues to work directly with the remaining 5 trauma receiving hospitals to ensure full collection of
data can be achieved within 2014.
MTA Methodology
Eligible trauma receiving hospitals with were identified by NOCA in consultation with the National Emergency
Medicine Programme. Participating sites have been required to provide commitment, within existing
resources, through the provision of:

MTA Lead Clinician (Consultant level from trauma-related specialties)

MTA Data Coordinator (from within existing staffing)
National Office of Clinical Audit, Beaux Lane House, Lr Mercer Street, Dublin 2 Tel: 4028577
Page 2 of 3

Support of hospital governance (Quality and Safety) committee
NOCA has engaged internationally recognised Trauma Audit and Research Network (TARN) to provide its
methodological approach for MTA in Ireland. TARN has been in operation in the UK since the 1990s and has
been at the forefront of quality and research initiatives in trauma care. It is the largest trauma registry in
Europe and is clinically led, academic and independent.
TARN has been at the forefront of quality and
research initiatives in trauma care, most recently supporting the development of Major Trauma Networks in
the UK and internationally. Training and support for MTA is delivered by TARN trainers. Further support to
hospitals is provided by the NOCA Audit Coordinator, Marina Cronin and Clinical Lead, Dr Conor Deasy, from
the National Office of Clinical Audit.
TARN employs collection of a standardised dataset for trauma patients, allowing review of care at
organisational and national level, thereby quality assuring trauma care. TARN receives, analyses and reports
on anonymised MTA submissions from participating Irish hospitals. This high quality data will have potential to
facilitate peer reviewed research in an Irish context to drive clinical change.
NOCA has established a multidisciplinary Governance Committee, with clinical leadership from Emergency
Medicine and Trauma Specialists.
This ensures that Irish audit data is reviewed with oversight of multi-
specialty governance.
References
1.
World Health Organisation, (2009) Guidelines for trauma quality improvement programmes.
Available at: http://whqlibdoc.who.int/publications/2009/9789241597746_eng.pd.
2.
Victoria State Trauma System (2009) Trauma towards 2014- Review and future directions of
the Victorian State Trauma System. Available at:
http://docs.health.vic.gov.au/docs/doc/Trauma-towards-2014-–-Review-and-futuredirections-of-the-Victorian-State-Trauma-System.
3.
London Trauma Office (2011) Mid-Year Report for the period April-September 2010. NHS.
Available at: http://www.londontraumaoffice.nhs.uk/silo/files/london-trauma-officemidyear-report.pdf.
4.
Celso B., Tepas J., Langland-Orban B., Pracht E,. Papa L., Lottenberg L., and Flint L., (2006) A
systematic review and meta-analysis comparing outcome of severely injured patients treated
in trauma centres following the establishment of trauma systems. The Journal of Trauma,
60(2), 371-8.
Further queries in relation to all NOCA audits should be directed to:
Fiona Cahill fionacahill@noca.ie / Tel: 087 2857726
National Office of Clinical Audit, Beaux Lane House, Lr Mercer Street, Dublin 2 Tel: 4028577
Page 3 of 3