Major trauma audit: Metrics for improving care

Abstract

A regional system of Major Trauma Networks has been developed in England to improve care and outcome following major trauma for a population of 58 million. The nine regions of England each have a Trauma Network served by 29 Major Trauma Centres (MTCs). The system went live in England in April 2012. Methods: As part of the funding and accreditation structure, each MTC must submit prospectively collected audit data to the national trauma audit system – The Trauma Audit & Research Network (TARN) – to support comparisons between Trauma Networks. TRISS-like methodology is used to standardise case-mix and compare mortality rates. Audit data is also used to review three performance areas: data quality, evidence-based measures and system indicators and these make up the “Major Trauma Dashboard”. Results: Over the12-month period April 2012–2013, data on 37,353 patients have been submitted. 13,260 (35.4%) had an ISS > 15 and 17,414 (46.6%) an ISS 9–15. There was a trimodal age distribution with a median age of 56.2 years. Injury mechanism was blunt trauma in 96.9% and penetrating trauma in 3.1%. Within the MTCs there have been stepwise improvements in data quality. Improvements in the system of care have resulted in a reduction in the time to CT scan for patients with head trauma, increases in the number of trauma teams led by a consultant and a marked improvement in the speed of referral of secondary transfers. The 5 years trend for odds of survival, adjusted for any difference in age, gender, severity of injury (ISS) and presenting conscious level (GCS) shows an increase, but is not yet statistically significant. Conclusions: This ongoing study indicates that a combination of regional Trauma Networks, financial incentives and audit can rapidly improve the standards of major trauma care for a large population.