Incremental cost-effectiveness of trauma service improvements for road trauma casualties: experience of an Australian major trauma centre

2016 ◽  
Vol 40 (4) ◽  
pp. 385
Author(s):  
Michael M. Dinh ◽  
Kendall J. Bein ◽  
Delia Hendrie ◽  
Belinda Gabbe ◽  
Christopher M. Byrne ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Major Trauma ◽  
Cost Effective ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Trauma Service ◽  
Major Trauma Centre ◽  
Improvement Programs

Objective The aim of the present study was to estimate the cost-effectiveness of trauma service funding enhancements at an inner city major trauma centre. Methods The present study was a cost-effectiveness analysis using retrospective trauma registry data of all major trauma patients (injury severity score >15) presenting after road trauma between 2001 and 2012. The primary outcome was cost per life year gained associated with the intervention period (2007–12) compared with the pre-intervention period (2001–06). Incremental costs were represented by all trauma-related funding enhancements undertaken between 2007 and 2010. Risk adjustment for years of life lost was conducted using zero-inflated negative binomial regression modelling. All costs were expressed in 2012 Australian dollar values. Results In all, 876 patients were identified during the study period. The incremental cost of trauma enhancements between 2007 and 2012 totalled $7.91 million, of which $2.86 million (36%) was attributable to road trauma patients. After adjustment for important covariates, the odds of in-hospital mortality reduced by around half (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.27, 0.82; P = 0.01). The incremental cost-effectiveness ratio was A$7600 per life year gained (95% CI A$5524, $19333). Conclusion Trauma service funding enhancements that enabled a quality improvement program at a single major trauma centre were found to be cost-effective based on current international and Australian standards. What is known about this topic? Trauma quality improvement programs have been implemented across most designated trauma hospitals in an effort to improve hospital care processes and outcomes for injured patients. These involve a combination of education and training, the use of audit and key performance indicators. What does this paper add? A trauma quality improvement program initiated at an Australian Major Trauma Centre was found to be cost-effective over 12 years with respect to years of life saved in road trauma patients. What are the implications for practitioners? The results suggest that adequate resourcing of trauma centres to enable quality improvement programs may be a cost-effective measure to reduce in-hospital mortality following road trauma.

scholarly journals 1403 Leadership and Teamwork in The Major Trauma Service – Implementation of A New Approach to Secondary Surveys

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Jefferies ◽  
A Walls ◽  
P McKeag ◽  
R Houston ◽  
D Kealey
Keyword(s):  
Quality Improvement ◽  
Major Trauma ◽  
Trauma Centre ◽  
Research Network ◽  
Improvement Project ◽  
Orthopaedic Care ◽  
Trauma Service ◽  
Major Trauma Centre ◽  
Secondary Survey ◽  
Group 2

Abstract Aim Trauma Audit and Research Network (TARN) guidelines at a Major Trauma Centre in Northern Ireland state that all patients admitted with Major Trauma should have a secondary survey completed and documented within 24 hours of admission. Method All patients admitted with major trauma had their medical notes reviewed on discharge to look for evidence of a documented secondary survey. Two audit cycles were completed. The first from January 2018 to April 2018 (n = 38). Following a quality improvement project with specific interventions to improve compliance, including improved communication behaviours and the implementation of a revised trauma booklet, a second cycle was performed from October 2019 to January 2019 (n = 44) Results 58% of group 1 and 75% of group 2 had a documented secondary survey within 24 hours of admission. The interventions therefore resulted in an overall 17% increase in the number of secondary surveys completed within 24 hours. Patients admitted under Orthopaedic care had a significant improvement of 26% between cycles to 89% compliance. Cardiothoracics (33% to 40%), Neurosurgery (14% to 43%) and General Surgery (75% to 66%). Conclusions A quality improvement drive led by the Orthopaedic team involving the education of doctors, improving communication channels and the introduction of revised trauma documentation, resulted in a significant increase in the number of secondary surveys completed within 24 hours. Patients under the care of Orthopaedics were more likely to have a survey completed compared with other specialties. This highlights the need for more education and engagement of other specialities to increase compliance in secondary surveys.

scholarly journals 118 Trauma in COVID-19: A comparison analysis of trauma calls at a Major Trauma Centre in the UK during the CoVID pandemic restrictions

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Naseem ◽  
J Lee
Keyword(s):  
Major Trauma ◽  
Road Traffic ◽  
Fold Increase ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Deliberate Self Harm ◽  
Trauma Service ◽  
Major Trauma Centre ◽  
Self Harm ◽  
The Uk

Abstract Aim Varying restrictions placed on the UK public to manage the COVID-19 Pandemic impacted on the day-to-day lives of most people and changed the presentation and nature of trauma presenting at our UK Major Trauma Centre. Trauma activity during the November and March 2020 lockdown periods were compared and the changes in trauma activity were used to inform workforce planning. During the most restrictive period, March 2020, trauma activity initially decreased compared with 6 weeks preceding lockdown, before returning and then exceeding beyond pre-lockdown levels. Method Prospective data was collected for all ED trauma calls and regional referrals to the Major Trauma Service. We compared the initial 27-day lockdown periods in November to March 2020; specifically comparing trends in code red calls, silver trauma, road traffic collisions and injuries resulting from deliberate self-harm. Results There were a similar number of RTCs (18 vs 16) in both periods. There was a 28% increase in the number of trauma calls (103 vs 80), and a 4-fold increase in Code RED calls (8 vs 2) and injuries due to deliberate self-harm (8 vs 2). There were almost double the number of silver trauma patients. Interestingly, there was a 30% decrease in alcohol related trauma alerts. Conclusions Our results reflected the level of restrictions in place; a higher incidence of trauma calls including code reds and RTCs in November. The higher incidence of self-harm noticed in the second lockdown may reflect the psychological impact of the pandemic and change in restrictions over time.

Comparison of routine blood alcohol tests and ICD-10-AM coding of alcohol involvement for major trauma patients

2021 ◽  
pp. 183335832110371
Author(s):  
Georgina Lau ◽  
Belinda J Gabbe ◽  
Biswadev Mitra ◽  
Paul M Dietze ◽  
Sandra Braaf ◽  
...  
Keyword(s):  
Administrative Data ◽  
Major Trauma ◽  
Blood Alcohol Concentration ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Alcohol Involvement ◽  
Preventable Risk Factor ◽  
Major Trauma Centre ◽  
Icd 10

Background: Alcohol use is a key preventable risk factor for serious injury. To effectively prevent alcohol-related injuries, we rely on the accurate surveillance of alcohol involvement in injury events. This often involves the use of administrative data, such as International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding. Objective: To evaluate the completeness and accuracy of using administrative coding for the surveillance of alcohol involvement in major trauma injury events by comparing patient blood alcohol concentration (BAC) with ICD-10-AM coding. Method: This retrospective cohort study examined 2918 injury patients aged ≥18 years who presented to a major trauma centre in Victoria, Australia, over a 2-year period, of which 78% ( n = 2286) had BAC data available. Results: While 15% of patients had a non-zero BAC, only 4% had an ICD-10-AM code suggesting acute alcohol involvement. The agreement between blood alcohol test results and ICD-10-AM coding of acute alcohol involvement was fair ( κ = 0.33, 95% confidence interval: 0.27–0.38). Of the 341 patients with a non-zero BAC, 82 (24.0%) had ICD-10-AM codes related to acute alcohol involvement. Supplementary factors Y90 Evidence of alcohol involvement determined by blood alcohol level codes, which specifically describe patient BAC, were assigned to just 29% of eligible patients with a non-zero BAC. Conclusion: ICD-10-AM coding underestimated the proportion of alcohol-related injuries compared to patient BAC. Implications: Given the current role of administrative data in the surveillance of alcohol-related injuries, these findings may have significant implications for the implementation of cost-effective strategies for preventing alcohol-related injuries.

A trauma quality improvement programme associated with improved patient outcomes: 21 years of experience at an Australian Major Trauma Centre

Injury ◽  
2014 ◽  
Vol 45 (5) ◽  
pp. 830-834 ◽  
Author(s):  
Michael M. Dinh ◽  
Kendall J. Bein ◽  
Belinda J. Gabbe ◽  
Christopher M. Byrne ◽  
Jeffrey Petchell ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Outcomes ◽  
Major Trauma ◽  
Trauma Centre ◽  
Years Of Experience ◽  
Quality Improvement Programme ◽  
Major Trauma Centre ◽  
Improvement Programme

UP-03.135 Urology Trauma: Urban Battlefield: Our Experience of Establishing a Urology Trauma Service at a London Major Trauma Centre

Urology ◽  
2011 ◽  
Vol 78 (3) ◽  
pp. S388
Author(s):  
J. Makanjuola ◽  
G. Kooiman ◽  
C. Brown ◽  
P. Grange ◽  
D. Sharma
Keyword(s):  
Major Trauma ◽  
Trauma Centre ◽  
Trauma Service ◽  
Major Trauma Centre

scholarly journals Management of open fractures of the lower limb during the COVID-19 pandemic: are the standards of treatment being maintained? a study from a major trauma centre in England

2021 ◽  
Author(s):  
Rajan Choudhary ◽  
Madhumita Gupta ◽  
Shahidul Haq ◽  
Wareth Maamoun
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Major Trauma ◽  
Trauma Centre ◽  
Open Fractures ◽  
Trauma Service ◽  
Major Trauma Centre ◽  
Notable Increase ◽  
Definitive Surgery ◽  
Limb Fractures

<p class="abstract"><strong>Background: </strong>Coronavirus disease 2019 (COVID 19) has created an immense strain on the NHS. During the height of the pandemic, trauma services were affected by redeployment, reduced theatre capacity and staff illness, and COVID BOAST guidelines were introduced.</p><p class="abstract"><strong>Methods: </strong>This retrospective study aimed to evaluate the standards of management of open fractures of the lower limb at a Major Trauma Centre in the United Kingdom during the COVID-19 pandemic and compare the same with the pre-pandemic period. Patient demographics, mechanism of injury, timing and mechanism of initial debridement and definitive soft tissue and skeletal fixation were noted. Outcomes including duration of hospital stay, 30 day and 1 year mortality were also assessed.</p><p class="abstract"><strong>Results: </strong>There was an overall 21% reduction in admissions with open lower limb fractures during the pandemic period with a 48% reduction during the first lockdown. There was a significant reduction in time taken from Emergency Department presentation to first debridement as well as a notable increase in operating outside of regular theatre hours. There was little difference in operative technique used for skeletal or soft tissue management at initial and definitive surgery, though fewer cases were performed as a two stage procedure. There was no difference in amputation rate in the two years. Length of stay was reduced from 21 days to 17, and 30 day mortality remained the same.</p><p class="abstract"><strong>Conclusions:</strong> Our study shows this Major Trauma Centre was able to provide a trauma service in accordance to the BOAST4 guidelines despite the increased pressures of the COVID-19 pandemic.</p>

The sensitivity of pre-hospital and in-hospital tools for the identification of major trauma patients presenting to a major trauma centre.

2013 ◽  
Vol 99 (1) ◽  
pp. 16-19
Author(s):  
D Potter ◽  
A Kehoe ◽  
JE Smith
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Trauma Centre ◽  
Research Network ◽  
Trauma Network ◽  
Trauma Patients ◽  
Major Trauma Centre ◽  
Injury Assessment ◽  
Trauma Response ◽  
Retrospective Database

AbstractThe identification of major trauma patients before arrival in hospital allows the activation of an appropriate trauma response. The Wessex triage tool (WTT) uses a combination of anatomical injury assessment and physiological criteria to identify patients with major trauma suitable for triage direct to a major trauma centre (MTC), and has been adopted by the South-West Peninsula Trauma Network (PTN). A retrospective database review, using the Trauma Audit Research Network (TARN) database, was undertaken to identify a population of patients presenting to Derriford Hospital with an injury severity score (ISS) > 15. The WTT was then applied to this population to identify the sensitivity of the tool. The sensitivity of the WTT at identifying patients with an ISS>15 was 53%. One of the reasons for this finding was that elderly patients who are defined as having major trauma due to the nature of their injuries, but who did not have a mechanism to suggest they had sustained major trauma (such as a fall from standing height), were not identified by these triage tools. The implications of this are discussed.

scholarly journals Prehospital critical care is associated with increased survival in adult trauma patients in Scotland

2020 ◽  
Vol 37 (3) ◽  
pp. 141-145 ◽  
Author(s):  
Alistair Maddock ◽  
Alasdair R Corfield ◽  
Michael J Donald ◽  
Richard M Lyon ◽  
Neil Sinclair ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Critical Care ◽  
Major Trauma ◽  
Injury Severity ◽  
Prehospital Care ◽  
National Registry ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Data Set ◽  
Major Trauma Centre

BackgroundScotland has three prehospital critical care teams (PHCCTs) providing enhanced care support to a usually paramedic-delivered ambulance service. The effect of the PHCCTs on patient survival following trauma in Scotland is not currently known nationally.MethodsNational registry-based retrospective cohort study using 2011–2016 data from the Scottish Trauma Audit Group. 30-day mortality was compared between groups after multivariate analysis to account for confounding variables.ResultsOur data set comprised 17 157 patients, with a mean age of 54.7 years and 8206 (57.5%) of male gender. 2877 patients in the registry were excluded due to incomplete data on their level of prehospital care, leaving an eligible group of 14 280. 13 504 injured adults who received care from ambulance clinicians (paramedics or technicians) were compared with 776 whose care included input from a PHCCT. The median Injury Severity Score (ISS) across all eligible patients was 9; 3076 patients (21.5%) met the ISS>15 criterion for major trauma. Patients in the PHCCT cohort were statistically significantly (all p<0.01) more likely to be male; be transported to a prospective Major Trauma Centre; have suffered major trauma; have suffered a severe head injury; be transported by air and be intubated prior to arrival in hospital. Following multivariate analysis, the OR for 30-day mortality for patients seen by a PHCCT was 0.56 (95% CI 0.36 to 0.86, p=0.01).ConclusionPrehospital care provided by a physician-led critical care team was associated with an increased chance of survival at 30 days when compared with care provided by ambulance clinicians.

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