Six areas for improving treatment of trauma patients identified
The National Institute for Health and Care Excellence identifies the priority areas for improvement in the treatment of trauma patients
Following a 2010 audit report which found unacceptable variation in the treatment of trauma patients, the National Institute for Health and Care Excellence has developed six quality statements identified as priority areas for improvement
Major trauma patients have serious and often multiple injuries where there is a strong possibility of death or disability. In England, the most common cause is a road accident. There are at least 20,000 cases of major trauma each year in England resulting in 5,400 deaths and many others resulting in permanent disabilities requiring long-term care, according to a 2010 National Audit Office report.
There are around a further 28,000 cases which, although not meeting the precise definition of major trauma, would be cared for in the same way.
This report found unacceptable variation in the treatment of trauma patients. Regional trauma networks were developed across England from April 2012 to improve access to specialist trauma care.
All major trauma centres should have acute specialist services for rehabilitation after major trauma, and for children and older people, according to new guidance.
The National Institute for Health and Care Excellence (NICE) says access to specialist services currently varies between major trauma centres. Ensuring that major trauma centres provide all the specialist services that a patient might need can reduce length of hospital stay, lower mortality and improve patient experience.
This is one of six quality statements identified as priority areas for improvement in assessing and managing trauma in adults, young people and children.
NICE also calls for all major trauma centres to have a dedicated trauma ward for patients with multisystem injuries and a designated consultant available to contact 24 hours a day, seven days a week.
High-quality care for airway support, image reporting, assessing cervical spine injury and fracture management is also included in the document.
People with major trauma who cannot maintain their airway should have drug‑assisted rapid sequence induction of anaesthesia and intubation within 45 minutes of the initial call to the emergency services. Performing intubation quickly, preferably at the scene of the incident improves ventilation, increasing the probability of survival and reducing long-term morbidity, NICE says.
People with open fractures of long bones, the hindfoot or midfoot, should have fixation and definitive soft tissue cover within 72 hours of injury if this cannot be performed at the same time as debridement.
Implications for nurses
- People with full in-line spinal immobilisation should have their risk of cervical spine injury assessed using the Canadian C‑spine rule as quickly as possible. Continuing immobilisation for longer than necessary can lead to avoidable adverse effects, such as discomfort and skin breakdown
- Be aware that patients who have had urgent 3D imaging for major trauma should have a provisional written radiology report within 60 minutes of the scan. Obtaining the results of imaging for chest trauma, haemorrhage and spinal injury as soon as possible allows for earlier diagnosis and decisions to be made on management
Cliff Evans, consultant nurse in the emergency department at Medway NHS Foundation Trust
‘The challenges to effectively treating patients experiencing major trauma have significantly diversified over recent years. This guidance identifies six recommendations to improve patient outcomes from the scene of the injury through to the rehabilitation phase of care.
'The growing body of evidence supporting 24/7 consultant-led care and earlier senior specialist input for vulnerable groups are key features. Areas pertinent to emergency nurses are incorporating the Canadian C-spine rules into the nursing assessment process for alert patients with neck pain.
'This approach will empower nurses to expedite the removal of unnecessary spinal immobilisation, or to arrange earlier imaging.
‘The guidelines empower educationalists to continue the professional development of emergency nurses and challenge historical professional boundaries. They will aid those working in the frontline to make increasingly evidence-based decisions and to raise expectations of other service providers to the benefit of patients.’
Find out more
- Armstrong B, Crouch R, Read C et al (2013). Training nurses in trauma management. Emergency Nurse.
- Canadian C-spine rule
- Longhurst C (2016) Regional trauma centre boosts survival rates by more than half.
- Major trauma care in England report
- NICE guidance on major trauma: assessment and initial management
- NICE trauma quality standards