Evaluation of the London Trauma System on Quality and Process of Care

Inclusive trauma systems are public health models that aim to assure access to high 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 England and Wales.

Three years later Greater London implemented an inclusive trauma system for a contiguous population of over 10 million people. This represented a unique opportunity to understand the strengths, weaknesses and impact of an organised system on the quality of trauma care.

Evaluation of the London Trauma System (ELoTS) utilised the core methodology in the original NCEPOD study. Severely injured patients (adult and paediatric) were identified prospectively within the London Trauma System (LTS) over a three-month period. Data were collected from prehospital care through to 72 hours following hospital admission. Quality and processes of care was assessed by expert peer review using original NCEPOD criteria. The main objective was to assess the quality of trauma care and outcome (early mortality) following regionalisation.

321 severely injured patients were included of which 84% were taken directly to specialist care at a major trauma centre (MTC), in contrast to 16% in the NCEPOD study.

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 organisational processes rather than clinical aspects of care.  Improved processes of care were 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).   

We concluded that most quality improvements were seen in MTCs with only minimal changes in healthcare delivery observed for patients presenting initially to trauma units. However data availability was limited for the analysis of patients who remained at trauma units precluding any detailed analysis. Inclusive trauma systems deliver quality and outcomes improvement, primarily through organisational change. Systems implementation does not automatically lead to a reduction in clinical deficits in care. This study underpins the need for a national trauma system evaluation.

More information about the study can be found in this article.


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