Quality statement 6: Specialist services

Quality statement

Major trauma centres have acute specialist services for rehabilitation after major trauma, and for children and older people.

Rationale

People with major trauma might need input from specialist services, but access and provision of these services varies between major trauma centres. This can mean that there are delays in treatment and suboptimal outcomes for the person. Ensuring that major trauma centres provide all the specialist services that a patient might need can reduce length of hospital stay, lower mortality and improve patient experience.

Quality measures

Structure

a) Evidence of the availability of acute specialist services for rehabilitation after major trauma.

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

b) Evidence of the availability of acute specialist services for children.

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

c) Evidence of the availability of acute specialist services for older people.

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

Outcomes

a) Morbidity from major trauma.

Data source: Local data collection, for example, local audit of patient records.

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 acute specialist services for rehabilitation after major trauma, and for children and older people. Acute specialist services for trauma rehabilitation have a multiprofessional team who have undergone recognised specialist training in rehabilitation, which is led or supported by a consultant trained and accredited in rehabilitation medicine. Acute specialist services for children and older people have a multidisciplinary team that specialises in care for these age groups, and is led or supported by a consultant from the specialty.

Health and social care practitioners (consultants in rehabilitation medicine, geriatricians, paediatricians, nurses, allied health professionals, social workers and safeguarding teams) work together as part of a multidisciplinary trauma service to ensure that people with major trauma receive the specialist input they need to get the best outcomes.

Commissioners (NHS England) ensure that they commission services that have acute specialist services for rehabilitation after major trauma, and for children and older people. They monitor contracts and seek evidence that service providers have these available.

People who have had a major injury have access to specialist rehabilitation services to help them recover and get back to their normal activities as much as possible.

Children and older people who have had a major injury have access to special services that care for their age group.

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]

Acute specialist services for rehabilitation after major trauma

Specialist rehabilitation is the total active care of patients with complex disabilities by a multi-professional team who have undergone recognised specialist training in rehabilitation, led or supported by a consultant trained and accredited in rehabilitation medicine.

[Healthcare Quality Improvement Partnership's Specialist rehabilitation for patients with complex needs following major injury]

Acute specialist services for children and older people

Specialist inpatient acute paediatrics, acute ageing and complex medicine multidisciplinary teams that can ensure age appropriate care for children and older people in hospital. They are led or supported by consultants in those specialities, and liaise closely with social workers and safeguarding teams.

[Expert opinion]