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Enhancing Trauma Care: Evidence-Based Improvements from the Midland Trauma Service

This program focuses on evidence-based quality improvement in trauma care, detailing processes, statistics, and outcomes from the Midland Trauma Research Centre (MTRS). With significant metrics such as a mortality rate of 0.7% and a reduced length of stay from 5.6 to 3.8 days, the initiatives involved holistic patient management, strong collaboration among multiple stakeholders, and comprehensive data collection. Our goal is to align trauma patient care with best practices, promoting effective treatment across diverse patient needs.

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Enhancing Trauma Care: Evidence-Based Improvements from the Midland Trauma Service

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  1. An Evidence-based, Trauma Quality Improvement Program Grant Christey Ballooning Issues 31 March 2014

  2. Reality

  3. Numbers • Time Pre-hospital 2 hours • Time in ED = 1.5 hours • Time in Hospital = 134 days • Operations = 22 • Changes of dressings = about 75 • Tracheostomy suctionings = about 140 • Nursing hours 134 days x 4 hrs/d = 536h • Physio hours = 112 days x 2 hrs/d = 224h • Family car expenses to visit = $10,000 • National value of statistical life = $2.8m

  4. Services Involved Occupational Therapy St John Ambulance Emergency Department Anaesthesia ICU/HDU Trauma Service Theatres Cardiothoracic Surgery OrthopaedicSurgery Occupational Therapy Physiotherapy Social Work Pain Service Nutrition Service Psychiatric Liaison Nursing Vascular Surgery Rehab Services Blood Bank Laboratory Police etc

  5. Paradigms • Single organ injury (90%) • Anatomic • Multiple organ system injury (10%) • Physiologic • Anatomic • Social degradation: Family/ Work/ Friends • Emotional / Grief / Loss/ PTSD / Psych • Financial loss • “A New Life’ or ‘The End of Life’

  6. MRTS • Launched in 2010 • Hub and spoke structure • 890,000 population in Midland • Based on Waikato Trauma Service (2006) • Functional unit is nurse-doctor combo • Synchronous clinical work and data collection • 5350 admissions; 4800 patients; 450 majors

  7. Tasks • Understand the complexity of patient needs and address them holistically (well beyond anatomic reconstruction) • Use evidence and best practice to drive system change.

  8. Multiple Stakeholders Visions of Quality • A wide range of firmly held beliefs based on specialised knowledge. • Support is language-dependent • By necessity, MRTS has to cover all the languages • We need to show effectiveness • We are holistic • We need (hard) evidence to gain traction • We have a comprehensive regional registry as our platform for evidence-based change.

  9. be

  10. Outcomes • Overall mortality = 0.7% (MRTS target is <1%) • Mortality in Severely injured (ISS>15) 2006 (estimated) = 15.6% 2012-13 (actual) = 8.4% (MRTS target was < 10%) Total Lives saved – 134 • Length of Stay 2007 (estimated) = 5.6 days 2013 (actual) = 3.8 days

  11. Activity • Midland Trauma Research Centre • University partnership; Multiple stakeholders • Validation studies • Incidence: Paeds, Rural, Ethnicity, Elderly, TBI, Spine.. • Spatial econometrics; ‘Trauma Track’ • Multiple quality audits • Ongoing TQIP development • Collaboration and information sharing

  12. Summary • Trauma QI systems improve outcomes • System change depends on a compelling argument high quality data • Triple Aim provides a conceptual framework • The registry is the core of services and TQIP • Enthusiasm and evidence are a powerful combination! Patients Come First

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