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National Clinical Guideline Centre (UK). Major Trauma: Service Delivery. London: National Institute for Health and Care Excellence (UK); 2016 Feb. (NICE Guideline, No. 40.)

Cover of Major Trauma: Service Delivery

Major Trauma: Service Delivery.

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2Introduction

A trauma service provides care for people who have sustained physical injuries. These injuries are often the result of an accident but can be sustained in other circumstances. Injuries range from minor to serious life-threatening trauma. The scope of this guidance is the delivery of services for people with major trauma in the initial phase of care, exploring areas of uncertainty and variation.

The National Audit Office (2000) reported that there is ‘unacceptable variation in major trauma care in England depending upon where and when people are treated. Care for patients who have suffered major trauma, for example following a road accident or a fall, has not significantly improved in the past 20 years despite numerous reports identifying poor practice, and services are not being delivered efficiently or effectively.’

There is no doubt that the optimal management of a person with major trauma and potentially life-threatening injuries requires the right staff, with the right skills, in the right place at the right time.

The NHS Trauma Clinical Advisory Group (CAG) provides recommendations on the regionalisation of trauma care, setting out service standards for the provision and delivery of trauma care. Regionalisation of trauma services involves developing inclusive trauma systems through trauma networks.

A trauma network includes all providers of trauma care, particularly pre-hospital services, hospitals receiving acute trauma admissions and rehabilitation services. The network has appropriate links to the social care and the voluntary/community sector. Within a trauma network the specialist services needed to treat a person with major trauma are established regionally. Major trauma centres (MTC) are designated to deliver high quality specialist care, and accordingly an MTC is usually the optimal destination for a patient with major trauma.

Regional trauma networks were set up to ensure trauma care is delivered efficiently and effectively. The NHS Operating Framework for England 2011 – 2012 reiterated a commitment to ensure the implementation of regional trauma networks across England. Regions started implementing trauma systems in 2011/12 and have a commitment to ongoing delivery and implementation. The NHS standard contract for major trauma services sets out the minimum service required to provide care for major trauma patients who are delivered to a major trauma centre.

The scope of this guidance was not to evaluate the service configuration of trauma networks but to address service delivery issues that stakeholders have identified as needing further clarification in the trauma networks.

The key service areas are:

  • Access to services
  • Appropriate destination
  • Continuity of care
  • Documentation and transfer of information
  • Audit
  • Provision of information.
Copyright © National Clinical Guideline Centre, 2016.
Bookshelf ID: NBK367717

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