IR for Trauma & Trauma Networks Professor Keith Willett Working in partnership with

Delivering the Service: Interventional Radiology for Major Trauma Networks Prof. Keith Willett National Clinical Director for Trauma Care Improving Interventional Radiology 2010

What is major trauma? Life threatening or life changing serious physical injury – often multiple 11,000 major trauma cases 23,000 need specialist care 91,000 critical care beddays 3 MAJOR TRAUMA Typified by delay, inappropriate care, avoidable death and disability

National Audit Office: Feb MAJOR TRAUMA

Coalition Government: 5 MAJOR TRAUMA Revision to the Operating Framework for the NHS in England 2010/11 “the National Audit Office report published in February 2010 set out the need to improve the planning and design of major trauma networks. Proposals to raise the standard of trauma care should proceed this year.”

So why do we need networks? 6 MAJOR TRAUMA

TARN activity data: percentage of patients requiring urgent surgery: 7 MAJOR TRAUMA 100% 0% Major pelvis Vascular pelvis neck viscera Cardiothoracic

Time of Day Number of prehospital incidents Number of cases ISS >15 8 MAJOR TRAUMA

TARN current activity data: delayed transfers – median too late for IR MAJOR TRAUMA 0.7% 37% 24hrs 6.5% 88% major pelvic bleed 18hrs

Changing trauma practice for quality improvement in the NHS: TARN aorta 10 MAJOR TRAUMA Traumatic aortic dissection 2005 to 2009 –139 patients –Age 44, male 70% –ISS 39 –75% no intervention –5% surgery, –21% stented

Trauma Networks and IR: 11 MAJOR TRAUMA … to deliver the patient rapidly and safely to a hospital that can manage the definitive care of their injuries irrespective of where they suffer those injuries Evolve care models and pathways based on patients needs, local expertise, geography, facilities and transport options - bespoke inclusive networks - with ongoing monitoring of performance against professional standards (NCA – TARN)

12 MAJOR TRAUMA Addressing the issues in Major Trauma: East of England: Mapping activity and specialist acute and rehab services Developing travel isochrones for each region Designate MTC and Trauma Units

Changing trauma practice for quality improvement in the NHS:.. 13 MAJOR TRAUMA Five clinical and patient advisory groups Defence Medical Services representation in all: a)Pre-hospital and inter-hospital transfers b)Patient reception, emergency surgery/critical care c)Network organisation / modus operandi, public and patient education, quality assurance d)On-going care, reconstruction surgery e) Rehabilitation

Changing trauma practice for quality improvement in the NHS:... the plan 14 MAJOR TRAUMA Clinical Advisory Groups Review of all current guidelines Activity data from TARN and HES NICE Health Economics Recommendations Measurable Commissionable PbR tariffs SHA Cost-effective

Preferred acute patient pathway 15 MAJOR TRAUMA On scene triage 24/7 network coordinator in Ambulance Service on-call Medical Consultant direct transfer (< 45 mins) indirect transfer (geography, time critical intervention) MAJOR TRAUMA CENTRE Consultant led trauma team Immediate operating theatre All specialties Immediate CT scan Interventional radiology Specialist critical care Trauma Unit trauma team immediate CT resus, assess and ? transfer ?

Clinical Advisory Group: Pre-hospital and acute care: Acute intervention including damage control surgery, interventional radiology, haemorrhage control, and blood transfusion. Interventional suites should be ideally co-located with operating rooms and/or resuscitation areas. Interventional radiology (IR) taking place within an MTC should be available 24 hours a day. Patients requiring acute intervention for haemorrhage control should be in a definitive management area (operating room or IR suite) within 60 minutes of arrival. The Royal College of Radiologists. BFCR(08)13 Standards for providing a 24-hour interventional radiology service. London: The Royal College of Radiologists MAJOR TRAUMA

How far have we progressed? SHA Project Boards for commissioning –Initiate network development –Agree enhanced specification for MTCs (and TUs) Network compliance will be in National Contracts Clinical Advisory Groups – designation criteria for Major Trauma Centres and Trauma Units Engaging patient, public, charities, Colleges, professional associations event and interactive website 17 MAJOR TRAUMA

How have we progressed the funding? Payment by Results – “moving the money to MTCs” –Single injury PbR tariff unchanged mapping and predicting increase (2-3 fold) in activity –Mandated day rate for critical care from April 2011/12 –Multiple injuries HRGs (Chapter VA) grid (agreed D. Flory NHS Director of Finance) –RTA cost recovery programme ambulance, in-patient, out-patient cost capped £43k 18 MAJOR TRAUMA

What is there still to do? Phase II Children’s, burns, spinal cord injury Workforce Education and skills training Phase III Rehabilitation –PbR and tariff –Rehabilitation coordinator model Trauma outcomes –TARN UKROC pilot –Outcome measures feasibility 19 MAJOR TRAUMA

All you need to know welcome/improving-care/emergency- urgent-care/major-trauma/nhs-clinical- advisory-group/ 20 MAJOR TRAUMA