Peter Oakley Report to West Midlands SHA on 30th June 2010
Upcoming SlideShare
Loading in...5
×
 

Peter Oakley Report to West Midlands SHA on 30th June 2010

on

  • 741 views

 

Statistics

Views

Total Views
741
Views on SlideShare
736
Embed Views
5

Actions

Likes
0
Downloads
3
Comments
0

1 Embed 5

https://groups.its-services.org.uk 5

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • GOS at 3 months. Mendelow death (GOS 1) = 16.9% = worse; GOS 5 = 59% = same. Seelig death 57% = worse; GOS 4&5 = 34% = worse
  • GOS at 3 months. No correlation between time from injury to craniotomy and GOS
  • April 2011
  • < 0.2% of work of ED; public consultation; expertise at start with later care nearer home.

Peter Oakley Report to West Midlands SHA on 30th June 2010 Peter Oakley Report to West Midlands SHA on 30th June 2010 Presentation Transcript

  • 1999-2000 Report of the Working Party on the Management of Patients with Head Injuries 1999
  • 2007
  • 2008
  • 2009
  • 2009
  • ? 2010
  • MAJOR TRAUMA IMPROVEMENT SUMMIT improving treatment and rehabilitation for major trauma patients May 2010
  • Pre-Hospital Care
    • Paramedic in Control Room
    • Clinical advice and support
    • Enhanced care teams
    • Major trauma to major centre
    • 45-minute isochrones
    • Clinical Advisory Group Recommendations to the
    • Department of Health
  • The New Rules
    • All major trauma patients go to a major trauma centre:
      • If journey < 45 minutes, directly
      • If journey > 45 minutes, they still go to the major trauma centre – indirectly or directly
      • If deteriorating, they still go to the major trauma centre – indirectly or directly
    • Exceptions
      • If treated immediately at trauma unit and no longer at risk
      • If immediate trauma unit assessment excludes major trauma
    Advisory Group on Pre-Hospital Care 2010
  •  
  • Stoke-on-Trent Birmingham Coventry 60 miles
  • 60 miles 45 minutes by land ambulance 45 minutes by helicopter Stoke-on-Trent Birmingham Coventry
  • ACS 2006 Physiology Anatomy Mechanism Special features
  • Accuracy of ACS Triage Criteria
  • Acute Care and Surgery Trauma Team and activation Trauma Team Leader Emergency Radiology Emergency Surgery Clinical Advisory Group Recommendations to the Department of Health
  • Care should be led by consultants experienced in major trauma Major trauma is most likely to occur at night-time or at weekends National Audit Office 2010
  • Resident Consultant Trauma Team Leaders in Major Trauma Centres
    • 24-hour consultant presence in emergency departments treating major trauma patients
    • Resident consultant team leader in major trauma centre and ≥ ST4 in trauma unit
    • Other consultants available within 30 minutes
  • Trauma Team Leader
    • Often but not necessarily emergency medicine
    • Resident status or immediately available
    • No conflicting duties – dedicated role
    • 1-4 PA per hour versus 1 PA per week
  •  
  •  
  •  
  • Ongoing Care and Reconstruction Patient-centred care Dedicated trauma wards and theatres Intensive care Repatriation Clinical Advisory Group Recommendations to the Department of Health
  • Head Injury ‘Scandal’ 1 Time to decompression
  • Mendelow AD, et al . Extradural haematoma: effect of delayed treatment. British Medical Journal 1979; 1 :1240-1241 Acute extradural haematomas have a better outcome if evacuated promptly A delay of more than 2 hours from clinical deterioration to haematoma evacuation led to significantly worse outcome
  • Leach P, et al. Transfer times for patients with extradural and subdural haematomas to neurosurgery in Greater Manchester British Journal of Neurosurgery 2007; 21 :11-15 * Mendelow 1979 ** Seelig 1981 59.0% (59*) GOS 5 (good recovery)‏ 7.2% 7.7% GOS 2 & 3 (PVS or severe disability)‏ 54.8% (34**) 23.1% GOS 4 (moderate disability)‏ 38.1% (57**) 10.3% (17*) GOS 1 (death)‏ 6.0 h 5.25 h Overall transfer time 0.75 h 0.75 h Arrival to surgery 2.38 h 2.5 h CT to arrival 2.25 h 2.0 h Deterioration or injury to CT 42 39 Number of patients Acute Subdural Haematoma Acute Extradural Haematoma
  • Sergides IG, et al. Is the recommended target of 4 hours from head injury to emergency craniotomy achievable? British Journal of Neurosurgery 2006; 20 :301-305 Number of patients 23 Isolated extradural 9 Mixed extradural and subdural 1 Isolated subdural 7 Intracerebral 4 Mixed subdural and intracerebral 2 Number operated < 4 hours of injury 0 GOS 1 (death) 21.7% GOS 2 & 3 (PVS or severe disability) 13.0% GOS 4 (moderate disability) 21.7% GOS 5 (good recovery) 43.5%
  • Head Injury ‘Scandal’ 2 Refusing non-operable cases
  •  
  • Old and New Rules
    • Closed door to non-operable head injuries
    • Gatekeeper protectionism
    • Open door to life-threatening intracranial haematomas
    • Immediate transfer of responsibility to neurosurgeons
    NHS East Midlands NHS North West
  • Head Injury ‘Scandal’ 3 Inappropriate repatriation
  • Appointments
    • Director/Clinical Lead in Major Trauma Care
    • Trauma Nurse Coordinator(s)
    • To oversee and review early trauma care
    • To deliver ‘real-time’ clinical governance
    • To serve as a bridge between the immediate care and rehabilitation teams
  • Rehabilitation Early start Director of Rehabilitation Coordination Country-wide review Clinical Advisory Group Recommendations to the Department of Health
  • Appointments
    • Clinical Lead in Acute Trauma Rehabilitation
    • Trauma Rehabilitation Coordinator(s)
    • To coordinate and deliver early trauma rehabilitation
    • To serve as a single point of contact for patients, family and other support
  • Journal of Rehabilitation Medicine 2010; 42 :(in press)
  •  
  • Uncoupling Acute Care from Rehabilitation
    • As soon as appropriate after injury
    • Converts a ‘push’ system to a ‘pull’ one
    Professor Keith Willett (in development)
  • The costs of major trauma are not fully understood, and there is no national tariff to underpin the commissioning of services Funding arrangements do not reflect the true costs National Audit Office 2010
  • HRG Grid for Major Trauma Professor Keith Willett (in development)
  • Network Organisation Definitions and designation Boundaries based on needs Responsibility for transfer TARN mandatory Performance framework Clinical Advisory Group Recommendations to the Department of Health
  • By September 2011: TARN Compliance Primary care trusts should use their commissioning powers to require all acute and foundations trusts with emergency departments that receive trauma patients to submit data to TARN National Audit Office 2010
  •  
  •  
  •  
  • Incidence of Major Trauma
    • 200 per million per year NCEPOD
    • 300 per million per year admitted to hospital Intercollegiate Group
  • Avery B. Nathens; Gregory J. Jurkovich; Ronald V. Maier; et al. Relationship Between Trauma Center Volume and Outcomes JAMA. 2001;285(9):1164-1171
  • Penetrating Abdominal Injury Multisystem Blunt Trauma
  •  
  •  
  •  
  •