Quality statement 5: Major trauma service

Quality statement

Major trauma centres have a dedicated trauma ward for patients with multisystem injuries and a designated consultant available to contact 24 hours a day, 7 days a week.

Rationale

People with major trauma frequently have multisystem injuries that need management input from more than one specialist. This can mean that management is spread across multiple settings and specialities, which can lead to delays in treatment and a lack of coordinated care, resulting in a poorer outcome for the person. Having a consultant-led multidisciplinary service with input from all the relevant specialties can improve continuity of care, prevent delays in treatment and result in shorter hospital stays, lower mortality and improved patient experience.

Quality measures

Structure

a) Evidence of a dedicated trauma ward for patients with multisystem injuries.

Data source: Local data collection, for example from service specifications.

b) Evidence of the availability of a designated consultant 24 hours a day, 7 days a week, who has responsibility and authority for the hospital trauma service and leads the multidisciplinary team care.

Data source: Local data collection, for example from staff rotas.

Outcomes

a) Mortality rates from major trauma.

Data source: Local data collection, for example using the Office for National Statistics mortality database. The Trauma Audit and Research Network also collects data on deaths of trauma patients.

b) Length of hospital stay for people who have had major trauma.

Data source: Local data collection, for example using Hospital Episode Statistics data from NHS Digital. The Trauma Audit and Research Network also collects data on length of stay in hospital for trauma patients.

c) Patient experience of major trauma services.

Data source: Local data collection, for example patient surveys.

What the quality statement means for different audiences

Service providers (major trauma centres) ensure that they have a dedicated multidisciplinary trauma ward led by a consultant 24 hours a day, 7 days a week, to treat patients with multisystem injuries.

Healthcare professionals (doctors, nurses and allied health professionals) work together to treat patients with multisystem injuries in a dedicated trauma ward. A consultant is available to lead the multidisciplinary team 24 hours a day, 7 days a week. A key worker (often a senior nurse) coordinates care at each stage of the care pathway.

Commissioners (NHS England) ensure that they commission services using a service specification that states that there should be a dedicated trauma ward for patients with multisystem injuries and a designated consultant available to contact 24 hours a day, 7 days a week. They monitor contracts and seek evidence that service providers have these available.

People who have serious injuries to different areas of the body can have all of their injuries treated in a special trauma ward. A consultant doctor is available who can be contacted 24 hours a day, 7 days a week and is in charge of the ward. Each person also has a named key worker, such as a senior nurse, who coordinates their care in hospital. The key worker stays in contact with the person, their family and carers, and the other healthcare professionals who are providing their care.

Source guidance

Major trauma: service delivery (2016) NICE guideline NG40, recommendation 1.6.2

Definitions of terms used in this quality statement

Major trauma centre

A specialist hospital responsible for the care of the most severely injured patients involved in major trauma across the region. It provides 24/7 emergency access to consultant-delivered care for a wide range of specialist clinical services and expertise. It is optimised for the definitive care of injured patients.

[NICE's full guideline on major trauma: assessment and initial management, glossary]

Dedicated trauma ward

A multidisciplinary ward for people with multisystem injuries where different specialties input into the care of the patient.

[NICE's full guideline on major trauma: assessment and initial management]

Designated consultant

A consultant who has responsibility and authority for the hospital trauma service and leads the multidisciplinary team care. This can be a subspecialty consultant who has extensive experience of trauma.

[NICE's full guideline on major trauma: assessment and initial management]