1. Background
An inclusive trauma system leverages the capacity and capability among all providers that
may be involved in the care of an injured patient. Such a system makes it possible to
deliver the right care at the right time in the right setting by the right healthcare provider,
in order to achieve the best possible health outcomes for injured patients.
A Regional Trauma Network (RTN) serves a population in a defined geographical area to
reduce death and disability following injury by optimizing the use of resources.
In the early 1990s, the Ministry of Health and Long-Term Care designated eleven (11)
hospitals as Lead Trauma Hospitals (LTHs) to provide coordinated trauma services across
the province of Ontario. LTHs are located throughout Ontario and serve to provide
leadership and coordinated specialized care to moderately and severely injured patients.
Regional Trauma Network boundaries will be based on the LTHs’ catchment areas, rather
than on the fourteen (14) Local Health Integration Networks (LHINs) in the province,
because the organization of trauma services may cross LHIN boundaries.
Process evaluation & findings
In October 2015, CCSO conducted a process evaluation of the experiences of the two (2)
pilot RTNS and drew the following findings:
1. The implementation plan should be simple and clear to all stakeholders. It is crucial to
have widespread consensus about the plan’s value among all stakeholders.
2. The chances of success are likely to be increased by strong leadership and active
engagement of a broad range of implementers.
3. Membership should be based on referral patterns between and among the hospitals.
For the RTN team to be effective, team representation should include both an
administrator and a clinical representative from each hospital.
4. The implementation plan should be flexible and adaptable to the local situation. The
plan should be open to including both opportunities to learn through action and a
way to share lessons of experience in improving the ongoing implementation of the
program. A phased scaling-up of the program provides opportunities to learn.
Pilot projects
In 2013, as part of its regional system development work to improve system integration, Critical Care Services Ontario (CCSO) in collaboration with the Ontario Trauma Advisory Committee (OTAC)
developed a model for an inclusive trauma system in Ontario, and established a multi-disciplinary advisory committee to develop a framework of key components for implementing the model
through RTNs. Using this framework, CCSO collaborated with two (2) LTHs to develop two (2) pilot RTNs: the Champlain RTN and the Central South RTN. The Champlain RTN covers LHIN 1
(Champlain); the Central South RTN encompasses LHIN 3 (Waterloo Wellington), LHIN 4 (Hamilton Niagara Haldimand Brant), and the Halton portion of LHIN 6 (Mississauga Halton). The pilot RTNs
used a hub-and-spoke model, with the LTHs working in partnership with their referring hospitals and transport providers as a multi-disciplinary team to improve patient access to an appropriate
level of care. The objectives of the pilot RTNs were to improve communication, standardize referral and repatriation practices, and improve trauma service delivery throughout the province, while
addressing areas of priority within their respective regions. Both pilot RTNs demonstrated considerable progress toward achieving these objectives within the 18- to 24-month pilot project period.
Expansion strategy
Based on the success of the pilot projects, the findings of the process evaluation, as well as an extensive literature review and jurisdictional scan, CCSO developed a strategy to expand the
implementation of the RTN model throughout Ontario. In June 2016, CCSO launched the provincial strategy at an in-person event attended by all LTHs and system partners. There are currently six
(6) new RTNs in development, in addition to the ongoing evolution of the two (2) RTNs that were involved in the pilot projects. Figure 1 above illustrates the timeline of events leading up to the
launch. The RTN model, depicted in Figure 2 above, brings together a multi-disciplinary team of stakeholders and system partners to develop networks around the LTHs. CCSO compiled a
comprehensive set of tools and templates, as highlighted in Figure 3 below, to support the RTN development initiative. In particular, CCSO created a 42-page guide containing a phased
implementation plan; plotted all LTHs, referring hospitals, LHIN boundaries, and current referral patterns in an interactive, online map using Google’s My Maps; and is hosting a series of monthly
webinars over a 9-month period to provide a forum for LTHs to share knowledge and their RTN development experiences.
For additional information, contact CCSO by email: info@ccso.ca
Performance measures and sustainability plan
To demonstrate that RTNs improve trauma service delivery, CCSO has identified a preliminary set of three (3) performance measures: referring hospital time to transfer, patient arrival to Trauma
Team Leader response time to bedside, and risk-adjusted mortality rate; and will track these indicators over the next 2 to 4 years to gather data on RTN effectiveness in Ontario. As the system
matures, it may become feasible to track additional measures of trauma response, acute care, and post-trauma recovery care.
Throughout the maintenance phase of the implementation plan, CCSO will provide system-level leadership and education, and facilitate knowledge transfer and exchange by providing a forum for
stakeholders to interact. Over time, under CCSO’s continual system oversight and guidance, and with performance data to provide evidence of effectiveness, the RTNs are expected to become self-
sustaining, bringing Ontario , Canada closer to achieving an inclusive trauma system.
Aim
To formulate a provincial strategy for the development of Regional Trauma Networks
as building blocks toward achieving an inclusive trauma system and fulfilment of the triple
aim (equity, quality, and value) in trauma care for the population of Ontario, Canada.
Figure 1: Timeline of events leading up to the launch of Ontario’s provincial strategy for Regional Trauma Network development
Figure 2: A multi-disciplinary stakeholder team, and system partners work together to form each Regional Trauma Network
Figure 3: CCSO created tools to support the RTN expansion strategy: (1) Regional Trauma Network Development: A guide for Ontario Hospitals; (2) phased implementation plan, supported through monthly webinar series; and (3) interactive online map of LTHs and catchment areas
(1) (2) (3)
Formulating a provincial strategy for Regional Trauma Network development
Cherryl Koylass MBA PMP, Bernard Lawless MD MHSc FRCSC, Linda Kostrzewa RN MHSc, Nancy Xisto BA
Acknowledgement
To the dedicated staff at Critical Care Services Ontario for their contributions to this work and their constant efforts to improve access, quality and system integration across critical care services in Ontario.