PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM)
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1 PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM) Regional Trauma Network Trauma Centre Trauma Service RMTN Network Organisation Measures (T13-1C-1) /14 Peer Review Visit Date 27th February 2014 Compliance NETWORK ORGANISATION MEASURES Zonal Statement Completed By Job Title Self Assessment % (0/0) Marie Cummins Programme Manager Peer Review 100.0% (8/8) Date Completed 12/03/14 Agreed By (Clinical Lead/Quality Director) Julia Hill Date Agreed Key Themes Network Governance Measures The Lancashire and South Cumbria (L&SC) Trauma Network covers a geographical area from Barrow in the north to Chorley in the south and Burnley in the east to Blackpool in the west. Tourists influx into areas such as Blackpool and the Lake District. The estimated population is about 1.6 million. It consists of a Major Trauma Centres (, Lancashire Teaching Hospitals), four Trauma Units (Blackpool Victoria Hospital, Royal Blackburn Hospital, Furness General Hospital and Lancaster Royal Infirmary), Pre Hospital providers are North West Ambulance Service (NWAS), North West Air Ambulance and Great North Air Ambulance. The network is recognised as an Operational Delivery Network (ODN). Overall the Lancashire and South Cumbria (L&SC) Trauma Network has made good progress which needs to be congratulated. It continues to strive for improved outcomes and equity of access to specialist care. PEER REVIEW VISIT REPORT for - Network Organisation Measures (published: 5th June 2014) Page: 1/3
2 Good Practice Good Practice/Significant Achievements 1. There is good evidence of collaborative working. 2. There is a valuable recognition of separating the roles of the MTC lead and Network lead. 3. An escalation policy is in place for ISS>15 patients in TU's that are not transferred to the MTC. 4. An exceptional executive 'buy-in' of major trauma is recognised and the importance to drive forward the five year plan. Concerns and Recommendations Immediate Risks Identified? Immediate Risks Immediate Risks Resolved? Immediate Risks Resolution Serious Concerns Identified? Serious Concerns Serious Concerns Resolved? Serious Concerns Resolution PEER REVIEW VISIT REPORT for - Network Organisation Measures (published: 5th June 2014) Page: 2/3
3 Concerns 1. There remains a low TARN data completeness and submission from the TU's and this needs to be driven more, it is acknowledged that an action plan has been agreed to assist with this. 2. The review panel recommend that the roles of the Major Trauma Centre and Network lead are specific and separate. PEER REVIEW VISIT REPORT for - Network Organisation Measures (published: 5th June 2014) Page: 3/3
4 PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM) Regional Trauma Network Trauma Centre Trauma Service RMTN Pre-Hospital Measures (T13-2A-1) /14 Peer Review Visit Date 27th February 2014 Compliance PRE-HOSPITAL MEASURES Zonal Statement Completed By Job Title Self Assessment % (0/0) Marie Cummins Programme Manager Peer Review 90.0% (9/10) Date Completed 12/03/14 Agreed By (Clinical Lead/Quality Director) Julia Hill Date Agreed Key Themes Pre-Hospital Measures The Lancashire and South Cumbria (L&SC) Trauma Network covers the geography from Barrow in the north to Chorley in the south and Burnley in the east to Blackpool in the west. The North West Ambulance Service (NWAS) provide cover for L&SC, which includes support from North West Air Ambulance and Great North Air Ambulance. North West Ambulance Service (NWAS) use a Major Trauma Pathfinder Triage Tool which identifies major trauma and allows for bypass to a Major Trauma Centre (MTC) within 45 minutes. NWAS have created a Trauma Cell alongside the Air Ambulance Desk; the Trauma Cell is staffed by Advanced Paramedics. The Advanced paramedic notifies the appropriate MTC that a patient has been taken to a Trauma Unit (TU) and the Ambulance Service facilitates a 'Trauma Blue' transfer to the MTC if required. A Red and Amber pre-alert system was introduced across the network. The majority of trauma PEER REVIEW VISIT REPORT for - Pre-Hospital Measures (published: 5th June 2014) Page: 1/3
5 pre-alerts are co-ordinated through the Trauma Cell which enables Clinician to Clinician communication. Good Practice Good Practice/Significant Achievements 1. Secondary transfers are robust and the process is well embedded. Concerns and Recommendations Immediate Risks Identified? Immediate Risks Immediate Risks Resolved? Immediate Risks Resolution Serious Concerns Identified? Serious Concerns Serious Concerns Resolved? Serious Concerns Resolution PEER REVIEW VISIT REPORT for - Pre-Hospital Measures (published: 5th June 2014) Page: 2/3
6 Concerns 1. North West Ambulance Service (NWAS) has successfully commissioned a MERIT service to fulfil the civil contingencies act to provide medical advice to major incidents and mass casualties and staff are currently being recruited. There remains a gap in providing an Enhanced Care team to deliver direct medical care on scene with no plans to develop this service. PEER REVIEW VISIT REPORT for - Pre-Hospital Measures (published: 5th June 2014) Page: 3/3
7 PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM) Regional Trauma Network Trauma Centre Trauma Service RMTN Reception and Resuscitation Measures (T13-2B-1) /14 Peer Review Visit Date 27th February 2014 Compliance RECEPTION AND RESUSCITATION MEASURES Zonal Statement Completed By Job Title Self Assessment % (0/0) Marie Cummins Programme Manager Peer Review 91.7% (22/24) Date Completed 12/03/14 Agreed By (Clinical Lead/Quality Director) Julia Hill Date Agreed Key Themes RECEPTION The Major Trauma Centre (MTC) has a Trauma Team Activation protocol. For each call three to four Consultants arrive within working hours which is very good practice. The Trauma Team Leader is not on site 24/7. RADIOLOGY The CT scanner is currently not co-located with the Emergency Department, however the MTC is going through a redevelopment and the new location will improve the transfer of patients following major trauma much more readily and an improvement demonstrated by the major trauma dashboard is expected. All scans are reported by a Consultant within 12 hours. The current commissioning surrounding the regional vascular service has not been agreed PEER REVIEW VISIT REPORT for - Reception and Resuscitation Measures (published: 5th June 2014) Page: 1/3
8 which means that at the moment an â out of hoursâ Interventional Radiology service is shared with Wigan and Bolton. SURGERY There is 24/7 access to a fully staffed emergency theatre. The principles of Damage Control surgery have been rolled out. INTENSIVE CARE The Intensive Care Unit at the MTC comprises of a mix of level 3 and 2 beds. Bed modelling in relation to neurosurgical patients is taking place at the moment, because of the potential increase to capacity. The unit submits to ICNARC (Intensive Care National Audit & Research Centre). PAIN MANAGEMENT A comprehensive acute pain service, with a Consultant lead is in place at the MTC. TRANSFUSION A massive transfusion protocol is in place at the MTC and Pre-hospital providers are able to activate the protocol. Good Practice Good Practice/Significant Achievements 1. The Trauma Team Activation Protocol supports three to four Consultants which attend needs to be applauded. Concerns and Recommendations Immediate Risks Identified? Immediate Risks PEER REVIEW VISIT REPORT for - Reception and Resuscitation Measures (published: 5th June 2014) Page: 2/3
9 Immediate Risks Resolved? Immediate Risks Resolution Serious Concerns Identified? Identified Serious Concerns 1. The absence of a 24/7 Consultant Trauma Team Leader was felt by the panel to be a serious concern which needed to be examined. Serious Concerns Resolved? Not Resolved Serious Concerns Resolution Concerns 1. CT scanner is not co-located, but the redevelopment will address this concern. 2. The uncertainty regarding the vascular reconfiguration is creating a â blockerâ to the further progression of the MTC and network and this requires a speedy agreement in order to enable the MTC to push forward their development plans for major trauma PEER REVIEW VISIT REPORT for - Reception and Resuscitation Measures (published: 5th June 2014) Page: 3/3
10 PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM) Regional Trauma Network Trauma Centre Trauma Service RMTN Definitive Care Measures (T13-2C-1) /14 Peer Review Visit Date 27th February 2014 Compliance DEFINITIVE CARE MEASURES Zonal Statement Completed By Job Title Self Assessment % (0/0) Marie Cummins Programme Manager Peer Review 82.4% (14/17) Date Completed 12/03/14 Agreed By (Clinical Lead/Quality Director) Julia Hill Date Agreed Key Themes Definitive Care Measures Availability of all specialities required to provide definitive care following major trauma are available at the Lancashire and South Cumbria (L&SC) Trauma Network. Overall responsibility for major trauma patients is the Emergency Department Trauma Team Leader. A business case has been submitted to develop a 12 bedded dedicated trauma ward at the Major Trauma Centre (MTC) and it's activity and performance will be reviewed at the next peer review. It is expected that major trauma patients will be admitted under the care of the Orthopaedic Consultants and the multidisciplinary input into the major trauma service will be appraised at the next peer review. Pelvic fracture surgery is currently undertaken by the regional team, which may require the patient to be transferred for surgical intervention and plans are in place to appoint a local pelvic surgeon, working with the regional service to provide on site surgical care. The role of a Major Trauma Network Nurse has been established and tertiary surveys are carried out. PEER REVIEW VISIT REPORT for - Definitive Care Measures (published: 5th June 2014) Page: 1/3
11 The orthopaedic registrars are not resident; a recently carried out audit shows that the orthopaedic registrar always arrives when called within the specified 30 mins. If a patient has sustained an isolated cardiothoracic injury the patient will be transferred straight to Blackpool which is the regional cardiothoracic centre. However, a patient who has suffered polytrauma will be admitted to the MTC and the cardiothoracic surgeons will operate at the MTC. Patients with spinal cord injury are admitted to either a neurosurgical ward or an orthopaedic ward and after stabilisation they are then transferred under the care of the spinal team. The MTC is the designated regional burns unit. Good Practice Good Practice/Significant Achievements 1. The progression of the Major Trauma ward needs to be commended. 2. Dedicated Orthopaedic Consultant delievered care is to be applauded. 3. The role of the Major Trauma Network Nurse (MTNN) is to be congratulated. Concerns and Recommendations Immediate Risks Identified? Immediate Risks Immediate Risks Resolved? Immediate Risks Resolution Serious Concerns Identified? Serious Concerns PEER REVIEW VISIT REPORT for - Definitive Care Measures (published: 5th June 2014) Page: 2/3
12 Serious Concerns Resolved? Serious Concerns Resolution Concerns 1. The lack of a resident orthopaedic registrar needs to be reviewed. PEER REVIEW VISIT REPORT for - Definitive Care Measures (published: 5th June 2014) Page: 3/3
13 PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM) Regional Trauma Network Trauma Centre Trauma Service RMTN Rehabilitation Measures (T13-2D-1) /14 Peer Review Visit Date 27th February 2014 Compliance REHABILITATION MEASURES Zonal Statement Completed By Job Title Self Assessment % (0/0) Marie Cummins Programme Manager Peer Review 85.7% (12/14) Date Completed 12/03/14 Agreed By (Clinical Lead/Quality Director) Julia Hill Date Agreed Key Themes Rehabilitation Measures Trauma Rehabilitation is supported from a commissioning perspective and â activity based commissioningâ has been used in order to increase the capacity of trauma rehabilitation services. A Medical Director for Rehabilitation Medicine and a Clinical Lead has been appointed. The Rehabilitation Prescription is completed by the Rehabilitation Co-ordinator and all in-patients have an identified key worker. Good Practice Good Practice/Significant Achievements 1. Increase in the rehabilitation services being provided. 2. The Rehabilitation Prescription is fully embedded. PEER REVIEW VISIT REPORT for - Rehabilitation Measures (published: 5th June 2014) Page: 1/2
14 Concerns and Recommendations Immediate Risks Identified? Immediate Risks Immediate Risks Resolved? Immediate Risks Resolution Serious Concerns Identified? Serious Concerns Serious Concerns Resolved? Serious Concerns Resolution Concerns PEER REVIEW VISIT REPORT for - Rehabilitation Measures (published: 5th June 2014) Page: 2/2
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