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October 26, 2015
The London Trauma System has greatly increased quality of care for trauma patients, according to research from Queen Mary University of London and the London Regional Trauma System.
In the UK, around 48,000 people experience severe injury each year, and traumatic injury is the major cause of death for people under the age of 44. Injury is also a leading cause of death and disability worldwide, accounting for 9% of all mortality, and more annual deaths than HIV, TB and malaria combined.
In 2007, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found that 60% of trauma patients in England had suboptimal management in relation to quality, clinical intervention and organisation of care. In April 2010, the UK’s first regional trauma system for the greater London area was established, covering 10 million people. The model aimed to greatly improve the timeliness and appropriateness of treatment received by trauma patients from point of injury to rehabilitation, including from ambulance services, hospitals, and community providers.
The new study, published in the Annals of Surgery, evaluated care after the implementation of the London Regional Trauma System. Hospitals receiving trauma patients are designated as either Major Trauma Centres or Trauma Units. Major Trauma Centres, like the Royal London, Imperial, Kings College and St Georges hospitals have expert resources available 24 hours a day to manage severely injured patients, while Trauma Units are responsible for the local management of patients with less severe injuries.
The study was led by Dr Ross Davenport, Clinical Academic Lecturer and Dr Elaine Cole, Senior Research Fellow at C4TS at QMUL’s Centre for Trauma Sciences (C4TS) based at the Blizard Institute. Dr Davenport said “Our study demonstrates that the London Trauma System has been highly successful in improving quality and outcomes for the majority of severely injured patients. Survival rates increased by 50% over 5 years, saving an estimated 610 lives – more than a 747 plane full of passengers”.
Dr Cole added “This primarily reflects improvements in the timely delivery of specialist multidisciplinary trauma care and other organisational changes. It’s therefore heartening that other regional trauma systems have now been rolled out across the UK, and data from the Trauma Audit and Research Network shows that outcomes for trauma patients nation-wide have improved as a result”.
Further information
Study title: The Impact of a Pan-regional Inclusive Trauma System on Quality of Care - Annals of Surgery Oct 2015
Abstract
OBJECTIVES:
To evaluate the impact of the implementation of an inclusive pan-regional trauma system on quality of care.
BACKGROUND:
Inclusive trauma systems ensure access to quality injury care for a designated population. The 2007 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found quality deficits for 60% of severely injured patients. In 2010, London implemented an inclusive trauma system. This represented an opportunity to evaluate the impact of a pan-regional trauma system on quality of care.
METHODS:
Evaluation of the London Trauma System (ELoTS) utilized the NCEPOD study core methodology. Severely injured patients were identified prospectively over a 3-month period. Data were collected from prehospital care to 72 h following admission or death. Quality, processes of care, and outcome were assessed by expert review using NCEPOD criteria.
RESULTS:
Three hundred and twenty one severely injured patients were included of which 84% were taken directly to a major trauma center, in contrast to 16% in NCEPOD. Overall quality improved with the proportion of patients receiving "good overall care" increasing significantly [NCEPOD: 48% vs ALL-ELoTS: 69%, RR 1.3 (1.2 to 1.4), P < 0.01], primarily through improvements in organizational processes rather than clinical care. Improved quality was associated with increased early survival, with the greatest benefit for critically injured patients [NCEPOD: 31% vs All-ELoTS 11%, RR 0.37 (0.33 to 0.99), P = 0.04].
CONCLUSIONS:
Inclusive trauma systems deliver quality and process improvements, primarily through organizational change. Most improvements were seen in major trauma centers; however, systems implementation did not automatically lead to a reduction in clinical deficits in care.
More background to the study can be found here.
