Beyond the trauma registry.

Abstract

There is currently rapid progress in regionalization of trauma care in the UK following recommendations from the RCS(Eng), NCEPOD and the ‘Darzi’ Report. This process will result in groups of hospitals cooperating together to provide comprehensive trauma care within a region. The policy framework within the Department of Health (DoH) is also changing. Trauma care has become a priority area, and the recent appointment of a National Clinical Director for Trauma Care will help to align DoH policy with clinical need. This change in the configuration of services for the severely injured means that the quality system for trauma care also has to change. In the past, trauma audit has been based on individual hospital provider units, with about half of UK hospitals opting into the Trauma Audit and Research Network (TARN) system. This system is directed to clinicians at hospital trust level, providing information about individual hospital performance in the form of quarterly reports and other analyses, which are then used as the basis for multidisciplinary trauma audit meetings. There is significant variation in the attention paid to the quality of trauma care among Hospital Trusts. Those with a greater interest in trauma care hold regular (usually quarterly) multidisciplinary trauma meetings where information provided by the TARN trauma audit system is reviewed and individual cases presented to highlight areas for improvement or areas of good practice. These meetings usually rotate between a series of themes (head, limb, abdominal, thoracic and spinal injury). In contrast many (probably most) hospitals do not have a multidisciplinary trauma audit system and, at best, undertake trauma audit within specific departments (usually the Emergency Department). The regionalization of trauma care means that trauma audit will have to change its focus from the individual hospital trust to the whole regional trauma system, and will have to consider other stakeholders such as patients, regional trauma system managers, purchasers and regulators. Each of these groups will have their own perspective – so fulfilling such diverse needs will be a challenge. We will have to move further away from the American concept of a ‘trauma registry’ towards a very practical focus on the information needs of the quality assurance process within the regionalized trauma systems. In the future the quality system will need to be based on the whole regional trauma system rather than simply looking at individual hospitals. Future patient pathways are likely to involve several different healthcare providers and outcomes are likely to be crucially dependent on performance at the interfaces (patient handovers and transfers of care). The future need for a trauma quality system will therefore be on three levels: