Regionalisation of trauma care in England
2016
Aims We aimed to determine whether there is evidence of improved patient
outcomes in Major Trauma Centres following the regionalisation of
trauma care in England. Patients and Methods An observational study was undertaken using the Trauma Audit
and Research Network (TARN), Hospital Episode Statistics (HES) and
national death registrations. The outcome measures were indicators
of the quality of trauma care, such as treatment by a senior doctor
and clinical outcomes, such as mortality in hospital. Results and Conclusion A total of 20 181 major trauma cases were reported to TARN during
the study period, which was 270 days before and after each hospital
became a Major Trauma Centre. Following regionalisation of trauma
services, all indicators of the quality of care improved, fewer
patients required secondary transfer between hospitals and a greater proportion
were discharged with a Glasgow Outcome Score of “good recovery”. In this early post-implementation analysis, there were a number
of apparent process improvements (e.g. time to CT) but no differences
in either crude or adjusted mortality. The overall number of deaths
following trauma in England did not change following the national
reconfiguration of trauma services. Evidence from other countries that
have regionalised trauma services suggests that further benefits
may become apparent after a period of maturing of the trauma system. Cite this article: Bone Joint J 2016;98-B:1253–61.
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