Review: Injury Severity Score (ISS) >15 in trauma units within the South West London and Surrey Major Trauma Network

Abstract

Background: In April 2014, the South West London and Surrey Major Trauma Network entered its 4th year as an operational network, consisting of one Major Trauma Centre (MTC) and 7 acute Trauma Units (TUs) over a wide geographical area. In the year ending March 2014, 75% of the major trauma patients were taken to the MTC. However many patients with ISS >15 were admitted to TUs. Regular governance meetings are key to ensure these patients have received an appropriate level of care. Case description: A service evaluation of care provided under governance framework, using the ISS as a guideline, was carried out. Patients who sustain traumatic injuries are managed in accordance with the Major Trauma Clinical Standards, the Trauma Audit and Research Network (TARN) measurable quality indicators and Trauma Quality Network System (TQuINS) recommendations. Available data indicates that there is a possibility that patients who present to a TU rather than a MTC may receive less than optimal care. In order to mitigate this difference it is necessary to have a governance system to ensure the patient care is optimal. Methods: A proforma was developed for data collection with key trauma measures as quality indicators and the results collated in an Excel spreadsheet. A standard operating procedure and flow chart processes were developed to review major trauma cases. The TARN Office identified suitable patients and a multidisciplinary team reviewed the notes. Issues with care were formally registered with trust incident reporting system and registered in the trauma risk register. Findings were presented in the trust audit study day, in the Trust governance committee and disseminated for development. Conclusions: Initiating a robust governance system and process will minimise substandard care and help standardise care across the network.