PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM)

Transcription

1 PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM) Regional Trauma Network Trauma Centre Trauma Service RMTN Manchester Collaborative MTC Greater Manchester Major Trauma Centre Collaborative Network Organisation Measures (T13-1C-1) /14 Peer Review Visit Date 19th May 2014 Compliance NETWORK ORGANISATION MEASURES Zonal Statement Completed By Job Title Self Assessment % (0/0) Marie Cummins Programme Manager Peer Review 100.0% (8/8) Date Completed 29/05/14 Agreed By (Clinical Lead/Quality Director) Julia Hill Date Agreed Key Themes Network Governance Measures The Greater Manchester Major Trauma Network (GM MTN) covers the population of Greater Manchester which is approximately 2.8 million. It consists of three Major Trauma Centres (Manchester Royal Infirmary, Salford Royal and Wythenshawe Hospital), three Trauma Units; Royal Oldham, Stepping Hill and Wigan, five local Emergency Departments, one Children's Hospital and one Ambulance service, North West Ambulance Service (NWAS). North West Air Ambulance also supports the collaborative. There was some concern about the total number of ISS>15 patients being seen within the collaborative. This requires further clarity because the review panel recognise the work that has been done and on-going discussions in relation to a reconfiguration in which the total numbers of patients with ISS>15 will impact on the reconfiguration of services. It is recognised by the review panel that the previous peer review happened six months ago and even though some recommendations have been implemented others are still in progress. The PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Network Organisation Measures (published: 24th July 2014) Page: 1/3

2 review was based on evidence from all three Major Trauma Centres however, for this visit it took place at the SRFT site. Overall the Greater Manchester Major Trauma Network has made good progress which needs to be congratulated and there are examples of innovations and drivers to push the collaborative further forward. Good Practice Good Practice/Significant Achievements 1. The review panel applauded the improved outcomes at all three sites. 2. The review panel commend the Clinical Effectiveness Committee and recognise the value of the work achieved in order to create an inclusive network. 3. The review panel recognised the good working relationships with the Specialist Commissioners, especially in relation to the willingness to support a Rehabilitation ODN, which is to be commended. Concerns and Recommendations Immediate Risks Identified? Immediate Risks Immediate Risks Resolved? Not Applicable Immediate Risks Resolution Serious Concerns Identified? Serious Concerns Serious Concerns Resolved? PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Network Organisation Measures (published: 24th July 2014) Page: 2/3

3 Not Applicable Serious Concerns Resolution Concerns 1. The review panel have concerns about the reconfiguration of major trauma services in the Greater Manchester region and require assurance that further discussions take place across all three sites with the Specialist Commissioners in order to ensure a seamless patient pathway is secured. PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Network Organisation Measures (published: 24th July 2014) Page: 3/3

4 PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM) Regional Trauma Network Trauma Centre Trauma Service RMTN Manchester Collaborative MTC Greater Manchester Major Trauma Centre Collaborative Pre-Hospital Measures (T13-2A-1) /14 Peer Review Visit Date 19th May 2014 Compliance PRE-HOSPITAL MEASURES Zonal Statement Completed By Job Title Self Assessment % (0/0) Marie Cummins Programme Manager Peer Review 90.0% (9/10) Date Completed 29/05/14 Agreed By (Clinical Lead/Quality Director) Julia Hill Date Agreed Key Themes Pre-Hospital Measures The Greater Manchester Major Trauma Network (GM MTN) covers the entire geography of Greater Manchester and includes three Major Trauma Centres; Central Manchester University Hospitals NHS Foundation Trust (CMFT), Salford Royal NHS Foundation Trust (SRFT) and University Hospital South Manchester (UHSM). The North West Ambulance Service (NWAS) provide cover for the collaborative Network. North West Ambulance Service (NWAS) use a Major Trauma Pathfinder Triage Tool which identifies major trauma and allows for bypass to a Major Trauma Centre (MTC) within 45 minutes. NWAS have created a Trauma Cell alongside the Air Ambulance Desk; the Trauma Cell is staffed by Advanced Paramedics. The Advanced paramedic notifies the appropriate MTC that a patient has been taken to a Trauma Unit (TU) and the Ambulance Service facilitates a 'Trauma Blue' transfer to the MTC if required. PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Pre-Hospital Measures (published: 24th July 2014) Page: 1/3

5 A Red and Amber pre-alert system was introduced across the network, however for major trauma cases there is currently only a Red pre-alert system in use. The majority of trauma pre-alerts are co-ordinated through the Trauma Cell which enables clinician to clinician communication. The review panel recognise the development of the MERIT which initially will be bronze and silver capability for major incidents. It was indicated that this was the first stage in the development and work is on-going to establish fully and appropriately trained medical practitioners to support the paramedic teams in the Northwest in general. Definitive planning and financial commitment needs to be given at the Salford and Central Manchester sites for the development of an on-site helipad. Good Practice Good Practice/Significant Achievements 1. The review panel recognised the effectiveness of the pathfinder system for the pre-hospital patient triage. Concerns and Recommendations Immediate Risks Identified? Immediate Risks Immediate Risks Resolved? Not Applicable Immediate Risks Resolution Serious Concerns Identified? Serious Concerns Serious Concerns Resolved? PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Pre-Hospital Measures (published: 24th July 2014) Page: 2/3

6 Not Applicable Serious Concerns Resolution Concerns 1. The review panel recommend an audit of the administration of tranexamic acid and the use of pelvic binders. 2. The review panel recognised the introduction of a MERIT system but would recomend strongly that this not only provides a bronze and silver capability in the event of a major incident but work is carried out to develop a system whereby there is provision of 24/7 advanced medical support particularly in relation to patients with life threatening injuries who are trapped in road traffic collisions. 2. A further recommendation is the planning and financial commitment for the development of an on-site helipad at the Salford and Central Manchester sites. PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Pre-Hospital Measures (published: 24th July 2014) Page: 3/3

7 PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM) Regional Trauma Network Trauma Centre Trauma Service RMTN Manchester Collaborative MTC Greater Manchester Major Trauma Centre Collaborative Reception and Resuscitation Measures (T13-2B-1) /14 Peer Review Visit Date 19th May 2014 Compliance RECEPTION AND RESUSCITATION MEASURES Zonal Statement Completed By Job Title Self Assessment % (0/0) Marie Cummins Programme Manager Peer Review 91.7% (22/24) Date Completed 29/05/14 Agreed By (Clinical Lead/Quality Director) Julia Hill Date Agreed Key Themes RECEPTION There is a Consultant Trauma Team Leader (TTL) available in the Emergency Department at all three Major Trauma Centres between and midnight, but this is not 24/7. However, at CMFT and SRFT there is a phased implementation of a 24/7 Consultant TTL. This model is currently being discussed at UHSM. All three sites are prepared to accept immediate patient transfers without prior warning. All three sites have the equipment within their Emergency Departments to undertake thoracotomy if required. RADIOLOGY At the CMFT site there are two CT scanners within the Radiology Department which is next door to the Emergency Department and three major audits are about to start in the Emergency PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Reception and Resuscitation Measures (published: 24th July 2014) Page: 1/5

8 Department regarding CT in Major Trauma. Since the last peer review a swipe card access to radiology overnight for the Trauma Team staff and padded spinal boards have been purchased and implemented. At the SRFT site there is a co-located CT scanner in the Emergency Department and a CT Radiographer is on site 24/7 in the Emergency Department. The Radiologist and Radiographer are part of the Trauma Team response. At the UHSM site there are two CT scanners both co-located in the Emergency Department. The Radiologist and Radiographer are part of the Trauma Team response. All three sites provide a to 8.00pm, Monday to Friday MRI scanning facility with an out of hours 'on-call' service. The GM MTN has a Vascular Interventional Radiology Consultant 'on call' 24/7 who is able to attend all three sites within 60 minutes. They are based at CMFT and UHSM sites. SURGERY There is 24/7 access to a fully staffed emergency theatre at all three sites. The Network is committed to ensuring that all Emergency Trauma Surgeons attend the Damage Control Surgery training. All three sites and Trauma Units have resident General Surgical Middle Grade rotas and Orthopaedic Middle Grade are available to attend within 30 minutes. Speciality Consultants are able to attend within 30 minutes of a call from the Trauma Team Leader (TTL). INTENSIVE CARE All three sites have fully staffed Intensive Care Units and all submit to Intensive Care National Audit & Research Centre (ICNARC) case mix programme. The MTCC Critical Care services are all active members of the Greater Manchester Critical Care Operational Delivery Network PAIN MANAGEMENT All three sites have fully staffed acute pain services. The acute pain team comprises of three Specialist Nurses and four Consultants Anaesthetists. The Network has recently agreed a protocol for the pain management of patients with rib fractures. TRANSFUSION A massive transfusion protocol is in place at all three sites. Activations are regularly audited and the results are shared and reviewed through the Network's Clinical Effectiveness Committee. PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Reception and Resuscitation Measures (published: 24th July 2014) Page: 2/5

9 Good Practice Good Practice/Significant Achievements 1. Excellent collaboration regarding the ownership of major trauma patients. Concerns and Recommendations Immediate Risks Identified? Immediate Risks Immediate Risks Resolved? Not Applicable Immediate Risks Resolution Serious Concerns Identified? Identified Serious Concerns 1. The absence of a 24/7 Consultant TTL on all three sites was raised as a serious concern, however the review panel acknowledged the phased implementation at the CMFT and SRFT sites. Serious Concerns Resolved? Resolved Serious Concerns Resolution 1. The absence of an on-site 24/7 Consultant Trauma Team Leader on all three sites was raised PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Reception and Resuscitation Measures (published: 24th July 2014) Page: 3/5

10 as a serious concern Action plans have been received from all three Major Trauma Centres: Salford Royal NHS Foundation Trust (SRFT): A phased introduction of a 24/7 Trauma Team Leader has been implemented, for Friday, Saturday and Sunday nights. A financial commitment to cover the remaining weekday nights was confirmed and the number of nights covered is increasing. The key challenge to achieving the standard is recruitment of Consultant staff due to a National shortage of Emergency Department trainees becoming available for Consultant posts. i)planned recruitment of an additional 6 Emergency Department Consultants. An additional post has been filled but recruitment of Emergency Department Consultants is difficult at present and will take several months to secure. ii)emergency Department Consultants from local Trauma Units and District General Hospitals to participate in covering the overnight shift. Two local Trauma Units are willing to provide cover for some of the shifts. Formal agreements to support an agreed number of nights by networked neighbouring Trusts are being progressed. The benefit of support from hospitals within Greater Manchester is that it will assist in strengthening consistency of practice across the Network, maintaining skill sets at non Major Trauma Centre sites and in further developing local relationships. iii)locum shifts - shifts not covered by internal locums are offered out to agency but take up is variable, as it is dependent on available staff. iv)trauma Team Leader support of specialities outside of Emergency Department - contribution to cover by Intensivists is a longer term plan but requires additional staff and a restructure of their rotas. The Trust anticipates that full compliance will be achieved by December Central Manchester University Hospitals NHS Foundation Trust (Manchester Royal Infirmary): A phased introduction of a 24/7 Trauma Team Leader has been implemented, for Friday, Saturday and Sunday nights. A financial commitment to cover the remaining weekday nights was confirmed and the number of nights covered is increasing. The key challenge to achieving the standard is recruitment of Consultant staff due to a National shortage. i)planned funded recruitment of an additional 4 Emergency Department Consultants in 2014/15. ii)emergency Department Consultants from local Trauma Units and District General Hospitals to participate in the Trauma Team Leader role. iii)trauma Team Leader support from Consultant staff from Critical Care and Anaesthesia. iv)redesign the working pattern for Emergency Department Consultant staff. University Hospital of South Manchester NHS Foundation Trust (Wythenshawe Hospital): i)the intention going forward is to appoint 7 extra Consultants required to achieve a 24/7 on-site presence. ii) An interim solution is to move the midnight finishing Consultant to staying overnight, being available for immediate call. PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Reception and Resuscitation Measures (published: 24th July 2014) Page: 4/5

11 Concerns 1. The review panel recommend that there should be an on-site SpR present 24/7 from Trauma and Orthopaedics at all three Major Trauma Centres. This is important from both a clinical and training perspective. 2. The review panel recommend that all Trauma Team Leaders should undertake the Trauma Team Leader Course. PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Reception and Resuscitation Measures (published: 24th July 2014) Page: 5/5

12 PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM) Regional Trauma Network Trauma Centre Trauma Service RMTN Manchester Collaborative MTC Greater Manchester Major Trauma Centre Collaborative Definitive Care Measures (T13-2C-1) /14 Peer Review Visit Date 19th May 2014 Compliance DEFINITIVE CARE MEASURES Zonal Statement Completed By Job Title Self Assessment % (0/0) Marie Cummins Programme Manager Peer Review 100.0% (17/17) Date Completed 29/05/14 Agreed By (Clinical Lead/Quality Director) Julia Hill Date Agreed Key Themes Definitive Care Measures There is a Consultant Trauma Lead at each of the three sites and each site has a Major Trauma Co-ordinator and Rehabilitation Co-ordinator. Each site has a governance system that allows for MDT case review. CMFT has a dedicated trauma ward and the Major Trauma Co-ordinator and Rehabilitation Co-ordinator are based on the ward. There is a daily Consultant ward round for all Major Trauma patients and twice weekly Rehabilitation Consultant ward round. A weekly Friday morning meeting takes place to discuss all new Major Trauma patients and a clinical management plan is agreed, including early rehabilitation needs. SRFT has a dedicated Trauma Assessment Ward (TAU) and all patients who have suffered Major Trauma but do not require Intensive Care are admitted to the TAU. All major trauma admissions are reviewed within 24 hours of arrival by the Major Trauma Co-ordinator and twice weekly MDT, because of the high level of neurosurgical cases this is led by the neuro surgical PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Definitive Care Measures (published: 24th July 2014) Page: 1/3

13 and neuro rehabilitation team. Included in the MDT is the Aging and Complex Medicine Consultant. The Major Trauma Co-ordinators are based on the ward. All trauma calls are reviewed the following day as part of the 'Daily Breach Review Meeting'. A regular trauma training session takes place on a Friday afternoon. Major Trauma patients at UHSM are admitted to a dedicated Major Trauma ward and some patients are admitted to a speciality ward, that deals with the nature of their primary injury until they are deemed clinically safe to move to the generic Rehabilitation ward. There is a daily clinical MDT and all Major Trauma patients are discussed. Tertiary surveys are carried out at 24hrs at all three sites. The designated Burns Centre is at the UHSM site with dedicated Intensive Care beds and theatre 24 hours a day. Good Practice Good Practice/Significant Achievements 1. The reduction in time to acute neurosurgery was recognised and applauded by the review panel. 2. The review panel commended the implementation of the Trauma Intermediate Life Support (TILS) course and the Friday afternoon teaching which the panel hoped would be replicated across the collaborative. 3. The review panel acknowledged the positive Patient Experiences (PREMS) at the SRFT site. 4. 'Consultant of the Week' to be applauded. Concerns and Recommendations Immediate Risks Identified? Immediate Risks Immediate Risks Resolved? Not Applicable Immediate Risks Resolution PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Definitive Care Measures (published: 24th July 2014) Page: 2/3

14 Serious Concerns Identified? Serious Concerns Serious Concerns Resolved? Not Applicable Serious Concerns Resolution Concerns 1. The review panel stressed the importance that the Hepatobiliary Surgeons who will soon be picking up the general surgical emergencies at the CMFT site should be Damage Control Surgically trained. 2. The review panel recognised the need for an on-site 24/7 arrangement for a Pelvic Surgery capability, both CMFT and SRFT are currently in discussion with Wrightington, Wigan and Leigh (WWL) Foundation Trust to secure on-site pelvic surgical capacity, this is not in place at present. The pelvic team from WWL does currently attend at the MTC if the patient is too unwell to transfer. 3. A concern raised by the review panel was in relation to the lack of an on-site 'out of hours' resident Senior Registrar in Trauma & Orthopaedics. PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Definitive Care Measures (published: 24th July 2014) Page: 3/3

15 PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM) Regional Trauma Network Trauma Centre Trauma Service RMTN Manchester Collaborative MTC Greater Manchester Major Trauma Centre Collaborative Rehabilitation Measures (T13-2D-1) /14 Peer Review Visit Date 19th May 2014 Compliance REHABILITATION MEASURES Zonal Statement Completed By Job Title Self Assessment % (0/0) Marie Cummins Programme Manager Peer Review 78.6% (11/14) Date Completed 29/05/14 Agreed By (Clinical Lead/Quality Director) Julia Hill Date Agreed Key Themes Rehabilitation Measures There is not presently a Director of Rehabilitation Medicine for the Greater Manchester Major Trauma Network (GM MTN). There is a Clinical Lead for Rehabilitation who is Chair of the Rehabilitation Group, which is a sub-group of the GM MTN. This group meets quarterly and is responsible for determining the Rehabilitation strategy. A recent meeting for the five Trusts who manage Neuro-Rehabilitation agreed to establish a Neuro-Rehabilitation Operational Delivery Network supported by the Commissioners in the region. At the CMFT site there is an MDT approach to assessment and rehabilitation of Major Trauma patients. Patients receive specialist rehabilitation by teams of AHPs. MSK patients are treated on the CMFT site. At the SRFT site there are 12 Trauma Rehabilitation beds on the Trauma Assessment Unit (TAU) and these beds are managed by the Consultant in Rehabilitation Medicine. A psychologist is based on the TAU. PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Rehabilitation Measures (published: 24th July 2014) Page: 1/3

16 At the UHSM site patients requiring Neuro-Rehabilitation are referred to one of four services in Greater Manchester depending where the patient lives. A designated and dedicated Trauma Rehabilitation Unit has been created for patients with polytrauma. The Consultant in Rehabilitation links with the GM MTN and takes part in the Neuro-Rehabilitation rota across Greater Manchester. Access to psychology and neuropsychology for patients in the community is difficult because of the poor provision across Greater Manchester. The Rehabilitation Co-ordinators meet bi-monthly and Rehabilitation Prescriptions have been rolled out. The Rehabilitation Co-ordinator acts as the Key Worker. There is not a Directory of Services and progress is being made for the development of this. A Reverse Transfer policy has been agreed through the GM MTN Operations Group, which aims to ensure that Major Trauma patients are transferred to their local hospital when there is no further clinical need to be at the Major Trauma Centre. Even with the policy delays are still occurring because of the pressures on bed availability. Good Practice Good Practice/Significant Achievements 1. The review panel applauded the agreed funding to establish a Rehabilitation ODN and it was felt that this needed to be fully integrated with the Major Trauma Centre and they would need to ensure that there is effective Network governance in relation to this initiative. 2. The review panel commended the commitment and energy by the Clinical Lead at the SRFT site. 3. The Rehabilitation Prescription is fully embedded. Concerns and Recommendations Immediate Risks Identified? Immediate Risks Immediate Risks Resolved? Not Applicable Immediate Risks Resolution PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Rehabilitation Measures (published: 24th July 2014) Page: 2/3

17 Serious Concerns Identified? Serious Concerns Serious Concerns Resolved? Not Applicable Serious Concerns Resolution Concerns 1. There remains an absence of a post for the Director for Rehabilitation Medicine, however it was recognised by the review panel that this post was being discussed by Commissioners. 2. It was recognised by the review panel that an increase in establishment of the Major Trauma Co-ordinator and Rehabilitation Co-ordinator at the SRFT site was required in order to develop this post further. 3. The development of a Directory of Services across the collaborative is recommended by the review panel. 4. The review panel raised a concern in relation to the gap in MSK Rehabilitation and it was recommended that more pathway development is required. 5. The review panel recommended the process for Reverse Transfers required review where the mean time is currently five days. PEER REVIEW VISIT REPORT for Greater Manchester Major Trauma Centre Collaborative - Rehabilitation Measures (published: 24th July 2014) Page: 3/3