Y&H Commissioning Support Apologies A Port South Tees

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1 Northern Trauma Network Meeting: NTN Executive Board Date: Time: 09:30-11:30 AM Venue: Penshaw Room, Waterfront 4 Present: Name Organisation D Bramley (Chair) City Hospitals Sunderland B Harrison V McGurk Northern Trauma Network K Han NEAS L Thomson NEAS S Srihari (Minutes) Northern Trauma Network J Hancock Y&H Commissioning Support Apologies A Port South Tees J Forty B Sen A Dragone F Carney South Tees J Gregson Northumbria K Bremner (host) City Hospitals Sunderland L Graham 1. INTRODUCTION Action Enclosure 1.1 Welcome and Apologies As above. 1.2 Minutes of the Previous Meeting Approved. 1.3 Matters Arising General: DB suggested inviting Phil Godfrey ( Trauma clinical lead - JCUH) and Jeremy Henning (STees and CRG Representative) to future meetings. This was agreed by the group. SS DB said that it is not always practical to standardise protocols nationally or regionally, as regions/catchment area as well as requirements for each Trauma Unit/MTC vary, and the focus should be to identify the most appropriate pathway/ ways of working while keeping within the parameters of national guidelines. For example it was acknowledged nationally that a standardised national policy for blood transfusion was not the right approach. It was agreed that CAG will review all protocols and will approve as appropriate with a view to standardise protocols if possible. For policies/guidelines which cannot be standardised, the Network will form an /DB 1

2 overarching policy by bringing together and acknowledging the various policies for the TUs and MTCs. MERIT KH to follow up and let the team know of progress. (Update after the meeting: The MERIT proposal is now agreed). 2. AGENDA ITEMS 2.1 Network Development Hosting/ODN DM had discussed this with Ken Bremner rearding funding, and not much has progressed since he had formally written to all the CEO s. The group raised concerns; and this will be a risk identified during the Peer Review. informed that job descriptions have now been drafted for the Network Manager and Administrator/Analyst posts. The group identified that the timelines for recruitment were slipping and the Network might not have managerial and admin support come April agreed to approach Roy McLachlan for continued support from NESCN to fill the gap. 2.2 National Update CRG update JH informed via that there was no update as the CRG had not met since last NTN EG. CRG is meeting next week when he expects they will consider the 2 working groups (Elderly Trauma and 60 minute transfer time). All The group flagged up that elderly trauma patients with high ISS will not always trigger major trauma mechanism. Also the clinicians are not sure if it is appropriate to put these cases through the MTC pathway. It was acknowledged that ISS scores would go up for patients with pre-existing co-morbidities which may not be apparent while admission, this delays time to CT and will be flagged up on TARN as breach. informed that CQUIN indicators for Trauma have been suggested to NECS, however it is not expected that these recommendations will be included in the final CQUIN list. 2

3 2.3 Update from MTCs/TUs/Ambulance Service MDT Feedback Due to the pressures of Peer Review submissions, the MDT proformas have not been chased. It was agreed that a more rigorous system for timely submission of MDT proformas would be introduced from April James Cook KH informed that the network has acknowledged that YAS and NEAS have slightly different pathways for transferring patients to JCUH. While NEAS has agreed to the extension to 60 minutes, YAS is still to confirm. John Hancock agreed to chase up. The EG has formally agreed that given the geography of the region and location of MTCs, adopting 60 minutes pathway will give both the Ambulance Services and MTCs the necessary flexibility to determine the appropriate care for the patient. The Network has formally agreed the extension of 45 minutes transfer time to 60 minutes, but as the Network is in the midst of Peer Review, changes to this policy will be adopted formally after April JH NEAS confirmed that the extension will not have any significant impact on NEAS; and is looking at ways to implement. RVI RVI saw an increase in trauma cases from the same period last year. Sunderland No particular issues, PR submission in progress. GNAAS GNAAS now carrying blood; waiting to hear about out of hours provision. NEAS The cases of under triage is reducing. Pre-alerts are still an issue, but this is improving. Major trauma where ISS is higher than 15 (ISS >15) is now triaged better. 2.4 Peer Review informed that the network PR evidence documents 3

4 are ready for sign off and would be submitted on The EG acknowledged that given the very short timescales for submission and training, the TUs, MTCs, Ambulance Service and the Network had displayed good team effort and support in pulling together the evidence for submission. informed that the inspection teams have been recruited now. Training for Peer Reviewers is planned for John Hancock asked if the EG expected any areas to fall short in PR. DM informed that a few risks were identified as below: - Uncertainty around funding for ODN. - Issues about head injury management; patients with high ISS sometimes being managed in TUs, which is a national issue. - Not having all Network agreed guidelines in place, though we have a safe process, the guidelines will be finalised during Recommended Ortho BOAST 4 criteria for skin cover in 72 hours not met in all cases. Pathway for skin badly damaged cases is not consistent throughout the network as all TUs do not have similar access to plastic surgery. - Struggling with standardisation of templates, but this is a national issue. - Should do more work on patient experience and involvement. 2.5 Head and Chest Injuries Cumbria Cumbria to NCL transfers have been discussed at the NCL MDT. DB had raised concerns with Gus Vincent that the threshold applied to elsewhere for accepting patients may not be suitable to the patients transferring from Cumbria due to the delayed transfer time. Awaiting a response. 2.6 Rehabilitation Laura Graham is appointed as the Rehab Clinical lead for the Network as of DB/GV A Network Directory of Services for Rehab is now in place; this is a living document that will continue to evolve and the Network aims to include private sector providers in the directory. 4

5 Finalising the referral guidelines for the region are progressing. A revised Rehab prescription is in place which is being used by both the MTCs. to send a copy of the rehab prescription to DB. John Hancock requested to be included in the Rehab group. The Network acknowledges that the rehab process for the region is under resourced and this has impacted progress. The group discussed that a comprehensive rehab centre would ideally be the way forward. talked about the regional rehab event NESCN held in November, where some regions had reported as having successfully implemented Rehab huts; to share the information with the group. 3. STANDING ITEMS 3.1 NTN Workplan Work Plan discussed and amended. to update. It was agreed that the CCGs should be formally informed of the Peer Review. LT agreed to do a presentation on Trauma Hotspots for the region. 3.2 Network Governance It was agreed to sign off the Network Governance document, provided the TOR for CAG, EG and Rehab group is added to the document. The Network Governance document is now formally signed off. SS LT Risk Register The following Risks are now closed: 1. Poor engagement with Ambulance Services outside the North East could lead to delays in treatment. LT informed that communication lines were established. 2. High risk ISS head injuries routinely managed in trauma units - This is now closed, and will be reviewed when ODN is formally established on 1 st April It was agreed to add another risk to the risk register as below: - Winter pressures and impact for Trauma. The discussion asked to consider if winter pressures have any effect on the number of 5

6 Trauma cases. LT agreed to look at the data to see if there is any increase in the region and any particular issues around managing Trauma. 3.3 Any Other Business No other business. 3.4 Next Meeting Monday 16 March 2015 at 09:30 in Penshaw Room, Waterfront MEETING CLOSE LT 6

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