History and Impact
The 2007 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reviewed the quality of care of all severely injured patients in England and Wales. At this time there were no formal regional trauma systems in place and the report showed inadequacies in the quality of care for 60% of severely injured patients. Three years later in April 2010, the Greater London urban area became the first in the world to implement a trauma system for a population of 10 million people. The NCEPOD study described quality of trauma care prior to implementation of the LTS, therefore we had a unique opportunity to evaluate the impact of regionalisation care in London.
For the Evaluation of the London Trauma System (ELoTS) study we used the same core methodology as NCEPOD and evaluated the quality and processes of care for severely injured patients over a three month period. ELoTS findings showed that overall quality of care significantly improved as a result of regionalisation. Quality improvements were primarily achieved through better organisational processes such increased helicopter emergency services, senior doctors available earlier to expedite decision making, quicker diagnostic imaging and timely urgent operations. Improved processes of care were associated with improved survival, where in NCEPOD 18% of patients died, compared to 7% in ELoTS.
However, some of the quality improvements seen in major trauma centres were less apparent in trauma units, with variations seen in clinical care. Organisational changes due to regionalisation may not automatically lead to a reduction in preventable errors or improvements in clinical care for all patients. To avoid clinical variance and provide optimal care for all injured patients in the UK, robust system wide performance improvement programmes with multidisciplinary education and on-going trauma training are required. Further evaluation of regionalisation of care at a national level is needed.
More information about the ELoTS study can be found here.
Further reading: Trauma, Who Cares?
