From Department of Health
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The Minister for Health today published the report of the Trauma Steering Group, A Trauma System for Ireland.
The Minister for Health, Simon Harris TD, has said that the new Trauma System for Ireland will lead to better outcomes for patients by making sure they get to the right place, for the right care, first time. The Minister today published the report of the Trauma Steering Group, A Trauma System for Ireland, following Government approval.
Minister Harris said:
“The Trauma Steering Group was established by Government to bring about better outcomes for the 1,600 patients who suffer a major trauma in Ireland every year. The aim is to reduce death and disability, and ensure high quality trauma services are available to everyone in the country, whether they live in a city or in rural Ireland. The Steering Group was led by clinicians, with a key input from patients, and its recommendations are evidence based. This is about providing the right care to patients and increasing services and expertise.”
The report recommends the establishment of an inclusive trauma system which will include two regional trauma networks, one Central and one South. There will be one designated Major Trauma Centre in each of these networks, which should treat a minimum number of major trauma patients in order to maintain a critical mass of specialist expertise. The networks will also include a number of other Trauma Units and, in addition, a Trauma Unit with Specialist Services, which will also deal with trauma cases. This approach of an inclusive trauma system with two networks recognises both the geographical spread of our population and current hospital configuration.
Major trauma involves complex injuries that have the potential to cause prolonged disability or death – estimates are that around 1,600 patients a year in Ireland suffer major trauma. While this is a small number within more than 1.1 million Emergency Department attendances, it is essential that these patients receive the right care in the right place, first time.
At the moment we do not have a trauma system in Ireland. We have Emergency Departments that are equipped to a greater or lesser extent to deal with trauma, and we have pre-hospital emergency care services that bring people to those hospitals without having adequate clear protocols around trauma. This means that currently, patients may present to any acute hospital, regardless of how much expertise and experience in trauma exists there. We know that patients often need to be transferred to a second hospital to receive definitive care for their injuries. This can mean delays in decision-making and treatment that can result in poorer outcomes and preventable disability or death. Internationally, the evidence is clear – the introduction of a trauma system is associated with a reduction in death and disability.
Minister Harris said:
“The vision for a national trauma system set out in this major report is to prevent unnecessary deaths, to reduce disabilities and to significantly improve the patient’s chances of attaining the fullest possible recovery. Evidence-based and informed by population needs, it addresses the entire care pathway from prevention and pre-hospital emergency care through to rehabilitation. The overall aim of this Report is to address the needs of all injured patients wherever they are injured, and wherever they receive care. There is a relatively low incidence of major trauma in Ireland but the cost to individuals and their families can be very high. The Trauma System for Ireland will enhance the chance of survival and lead to better patient outcomes. I want to thank the members of the Steering Group, and particularly its Chair, Professor Eilis McGovern, and the members of the Working Groups, for their in-depth, evidence-based and patient-centred approach to this work. I also want to thank all those patients and clinicians who participated in the development of the report. It provides us with a comprehensive and sound foundation on which to move forward for Irish patients.”
The Minister also noted the important role of the Major Trauma Audit:
“Having good data to inform our service planning and delivery is paramount to providing a safe and effective health service for our citizens. The phased introduction of National Office of Clinical Audit’s (NOCA) Major Trauma Audit since 2014 provided the Steering Group with access to information that would not have previously been available. Such information supports decision making in how we structure our trauma systems for the future.”
Patients who have used trauma services and clinicians were at the heart of the development of the report.
The Chair of the Trauma Steering Group, Professor Eilis McGovern said:
“The Trauma Steering Group looks forward to the implementation of this new Trauma System for Ireland and to the benefits for trauma patients which will follow – a decreased incidence of trauma due to a robust prevention strategy, and better outcomes reflected by improved survival and reduced disability. I want to acknowledge the commitment and hard work of all those involved in the process and, in particular, the patients who took part in our Working Groups and brought their direct experience to bear on this important work.”
Colm Whooley, former CEO of Spinal Injuries Ireland, a former patient involved in the development of the Report, said:
“As someone very familiar with the dynamics of trauma care, both from a personal perspective and from my work with Spinal Injuries Ireland over 21 years, I was fortunate enough to have been involved directly in the development of this report. I believe its recommendations will make a significant positive impact on survival rates, outcomes and the reduction in disability.”
The Director General of the Health Service, Mr Tony O’Brien, welcomed the publication of the report and said:
“The HSE is working to ensure the delivery of as much care as possible close to home, while also recognising the need to ensure complex care is delivered in specialist centres with the necessary critical mass. The recommendations of this report are key to achieving this for trauma patients. I look forward to progressing the establishment of the National Office for Trauma Services and the appointment of a National Clinical Lead as soon as possible, to commence implementation of the Trauma System for Ireland.”
ENDS
On 20 July 2017, the Trauma Steering Group established by the Minister in 2015 completed its final report, which was submitted for the Minister’s consideration and approval.
The Trauma Steering Group, established in 2015 and chaired by Professor Eilis McGovern, was tasked with examining the international evidence base with regard to the most efficient and effective organisation of trauma services, in order to reduce preventable death and disability, and to improve patient outcomes.
Major trauma involves serious and often multiple injuries which have the potential to cause prolonged disability or death. Major trauma cases are typically a very small part of the total number of trauma cases (estimated to be fewer than 1 in 1,000 ED admissions). Estimates suggest Ireland is likely to have 1,600 major trauma cases per year. Currently, significant numbers of major trauma patients go to hospitals that cannot provide necessary and definitive care.
Trauma systems may be exclusive or inclusive. In exclusive Trauma Systems, the focus is predominantly on Major Trauma Centres. An inclusive Trauma System is a network of facilities co-operating in the care of injured patients.
Inclusive trauma systems have been demonstrated to provide better patient outcomes than exclusive systems. In addition, geographically dispersed and less densely populated regions, such as Ireland, are likely better served within an inclusive trauma system. There is a large body of evidence on the benefits of providing trauma care as part of an integrated and inclusive trauma system. The report of the Trauma Steering Group recommends an inclusive hub-and-spoke trauma system for Ireland.
The Steering Group recommends the establishment of an inclusive trauma system, and sets out key recommendations for the organisation of trauma care and the provision of patient-centred trauma services. It takes a whole system approach addressing the five phases of the trauma care pathway including prevention, pre-hospital care, acute hospital care, rehabilitation and supported discharge, as follows:
It should be noted that the report addresses the provision of trauma care for adults. The provision of trauma care for children has been considered separately by the relevant National Clinical Programmes, and in the context of the development of the new children’s hospital which will be the paediatric Major Trauma Centre.
By international standards, Ireland could have one trauma network with one Major Trauma Centre linked to a number of Trauma Units. However, given the geographical spread of the population, and current hospital configuration, the report recommends the establishment of a trauma system consisting of two regional trauma networks (Central and South). Each will have a designated Major Trauma Centre, which should treat a minimum number of major trauma patients in order to maintain a critical mass of specialist expertise. Networks should also include a number of Trauma Units. The report recommends that:
Other hospitals with 24/7 Emergency Departments (Local Emergency Hospitals), which do not have the required range of services or expertise to safely manage major trauma patients, should continue to treat injuries of lesser severity within the Trauma Networks, as well as non-trauma related illnesses requiring urgent treatment. Injury Units should continue to treat injuries of lesser severity that are unlikely to need admission to hospital.
The report sets out immediate actions to be commenced within the first three months of implementation: