Ministry perspective can ’t provide HA monies but the Ministry and the PHSA to use monies to leverage better service delivery Monies got “mixed” Forensic tracking of the original monies for trauma (2002 investment) within sites when it is now “mixed” with HA monies (monetary uplifts to positions, new positions created and Trauma Services and TTL programs funding base has evolved) Provincial Leadership positions are presently “Influential Leaders” and in establishing a base budget for the office and positions the potential exists for moving existing monies under their control providing better reporting and accountability. What are we going to use the monies for and what will it provide for patients on the ground. Provincial working groups for specialized populations (MD compensation) to standard care/transport/commmunication for high $ trauma care( Hypothermia/Spinal cord)
Opportunities to bring a Provincial lens and coordination to Trauma system development across BC Ministry awareness to ensure discrete HA trauma planning aligns with the provincial work plan for trauma delivery
Distinction is an optional program that offers a rigorous and highly specialized review process based on in-depth standards and performance measures. The program recognizes organizations for outstanding commitment to excellence and leadership in a specific field of expertise.
Transcript of "Quality Day:Trauma Services BC"
June 4th,2013 BC Critical CareQuality Day:Trauma Services BC;Catherine Jones , Executive DirectorDr. Ross Brown, Medical Director
Objectives1. Describe the development, current and future state of TraumaServices British Columbia2. Describe the Integration within the BCEHS partners in the deliveryof Trauma Care across BC3. Showcase present initiatives that demonstrate areas of integrationbetween BCAS , Medical programs ,PTN and Trauma Services2
• Ministry of Healthcommissioned reports in 1990and 1998 to define optimaltrauma care• VGH trauma program—1991• Code 99 protocols GVRD-1991• BC Trauma Registry-1992• TAC National trauma systemguidelines -1993• BCTAC formed-1999• Regional trauma Centersidentified -1999- Only 7 original designatedtrauma sites with $ support forleadership positions maintained- Regional view of trauma“system” versus “site” viewascribed by TAC -2005- Trauma Accreditation for eachHA contained in the 2006/7GLE- Fulsome proposal by BCTACChair to Ministry in 2007outlining present view ofTrauma system developmentand monies requiredTrauma Care in BC2001-2006/71990-2000
Progress 2008-Present• 2009- VIHA was successfully TAC Accredited• 2010- VCH was successfully re-accredited (previous 2005)• 2011- NHA was successfully TAC Accredited• 2012- Trauma Services BC program was struck and formally sitedwithin BC Emergency Health Services (BCEHS) within PHSA.• 2012 BCTAC transitioned to TSBC Council with reps from Level Isites, Regions, BCTR, BCAS, PTN, MMU and other ad hocmembers• Forensic tracking of the original monies for trauma (2002investment) to start to align with TSBC deliverables• Provincial Leadership positions appointed (“Influential Leaders”without operational control at the time of hire)4
Establishment of Provincial Lead Agency• Opportunities– A home on the “org chart”!– Enthusiastic leadership and council– Momentum– Recognition by other programs andagencies• Leaders:BC Trauma ProgramC Jones/R Brown5
6Trauma Services BC VisionTo provide a high performing,comprehensive, integrated, andinclusive trauma system for BC.Everyone has a role and knows it!
Area of Integration within BCEHS partners: Data• Trauma Field Triage Destination Protocols→ Alignment of the 2011 updated Field triage criteria for traumaacross HA in order to provide standardized criteria for BCASpre-hospital providers where possible• BCAS Electronic Patient Care Record (ePCR)→ Injury descriptors within the patient care record have beenaligned with BCTR language for common injury coding frompre-hospital to acute care• Quality metrics:→ Trauma destination compliance by BCAS crews- in progress7
Other Data Sources Collecting Trauma/Injury Care• Opportunities to capturethe “n” of trauma /injurybeyond BCTR→ Existing DAD data tocapture Moderate trauma#’s in Emergency→ NACRS( admitted and D/C)→Coroners, Public Health,Population Health→ Newer methodologiesbeyond TRISS8
Quality –Standardized Clinical Care Guidelines anddesignated site destinations for specific major traumapopulations1. Major burns population: (High acuity/ low volume)→ N~ 120 patients (adult and pediatric)/yr in BC→ High resource and specialized skills set required for optimum outcomes→ Long LOS in Critical Care or high acuity units→ Small volume –competency and confidence in care requiredOpportunity:Provincial Burns working group to standardize a model of burn care for BC designatereceiving sites for level of burn care required, Same resuscitative CPGs used in pre-hospital care delivery, PTN sends those same CPGs to locale where initial care occurs(usually rural sites)2. Spinal Cord Injuries3. Hypothermia requiring ECMO/CPB4. Trauma Radiology9
Technology to support Trauma Care beyond the Acutecare stage• Use of Telemedicine,Tele-radiology, Tele-Burn→ Utilization of Telehealth platform to support excellence and physicianspecialist oversight and ongoing care beyond the largetertiary/Quaternary centers in each HAInvestigating Opportunities:• Partner with and through PTN to support repatriation care throughTelehealth/medicine for patients returning to their home community• Existing pilot with Tele-Burn and Cardiology• Earlier repatriation from tertiary hospital to home community with rehabsupports and specialty evaluation provided through Telehealth• Rural supports to all types of medical/health practitioners for educationand skill acquisition10
Accreditation Canada• BCAS is undergoing it’s first accreditation by Accreditation Canada(AC) in 2014• Trauma Association of Canada has partnered with AC to align theAccreditation processes with Trauma following the Distinctionprogram• Affords several BCEHS programs the opportunity for commonprocess, quality and outcome indicator alignment through a highlyregarded review process• Better alignment will ensure that there are more opportunities tomirror language and data elements across these programs on thecare continuum for trauma patients11
Critical Care impacts• TSBC council members ensure communication withrelevant acute care service areas in particular for theMajor Trauma population• The specialized trauma population work (Major Burns,Spinal Cord, Hypothermia) will need to be brought to theacute care services affected by the changes underconsideration (ICU, OR, PAR, high acuity specialty units)for their input• Point in time partnership for other initiatives that impactCritical Care service delivery or practice12
Conclusions• TSBC has been aligned and will continue to work withkey partners in the provisions of trauma Care across BCwithin regions, sites and transport partners• TSBC will ensure integration with partners for a sharedservice delivery for our patients• Strong focus on the patient journey from pre-hospitaltransfer to acute care through to repatriation ensuing thatcoordinated, standardized care and optimum outcomesare delivered throughout the continuum13