national trauma care policy could provide. His concluding message
underlined the importance of ensuring the delivery of the full array of
accumulated trauma expertise to the patients who need it when they
ON THE FRONTLINE
Professor Cusack provided Millin Symposium delegates with
insights from the frontline of trauma care. He opened with some
stark statistics, outlining the types of accidents that emergency
departments have to deal with, including falls, road traffi c crashes,
burns and smoke inhalation, assault, industrial accidents, stabbings,
farm accidents and sports injuries. Summing up what trauma care is
all about, he said: "Get the right patient to the right location looked
aft er by the right team."
To achieve that objective, planned and effi cient co-ordination is
vital, he said: "Ireland needs a national trauma system. Audit and the
Emergency Medicine Programme are steps in the right direction but
there is an urgent need for investment to counter the eff ect of years of
neglect. It is also a must that all stakeholders must buy in to the fact
that trauma care is a core specialty."
Citing a comment by Amyas Morse, head of the National Audit
Offi ce in the UK in 2010, Professor Cusack said the comment is sadly,
despite some recent advances, all too relevant to the Irish context
today. Mr Morse stated: "Current services for people who suff er major
trauma are not good enough. Th ere is unacceptable variation, which
means that if you are unlucky enough to have an accident at night or
at the weekend, in many areas you are likely to receive worse quality
of care and are more likely to die. Th e Department of Health and
the NHS must get a grip on coordinating services through trauma
networks, on costs and on information on major trauma care, if they
are to prevent unnecessary deaths."
Echoing these remarks, Professor Cusack concluded by stating it is
time that, here in Ireland, for the sake of patients, we `get a grip' on
the range of challenges to trauma care and deal with them effi ciently
and eff ectively.
MEASURE TO MANAGE
Dr Deasy spoke about the implementation of the major trauma
audit. He began by outlining the formation of the National Offi ce of
Clinical Audit (NOCA), which provides governance and framework
structures for the process. He commented: "Th e importance of the
audit initiative is best encapsulated by William Edwards Deming's
famous quote `you can't manage what you don't measure'."
Th e benefi ts of measurement will be evident as the collection of `key
variables' enables risk-adjusted outcomes to be used to drive quality
improvement, he said. "Medicine is a high cost area with known
variations in processes and outcomes; and poor performance leads
to high additional cost or poor quality of life. Audit will make a key
contribution to managing both cost and performance."
Th e mechanism for the implementation of major trauma audit is
Th e Trauma Audit & Research Network (TARN), which was initially
proposed in 2010 by the National Trauma Audit Committee of
RCSI. TARN will provide a uniform list of fractures and injuries
with indications of inclusions and exclusions for audit purposes.
Th e network's data collection remit encompasses each of the
following phases of trauma treatment: Incident, Pre-Hospital,
EM Department, Imaging, Th eatre, Intensive Care Unit, Ward,
Discharge and Rehabilitation.
A comprehensive swathe of key performance measures will
underpin the TARN reports ranging from patient age, gender and
arrival date/time through to injury measures and Glasgow Outcome
Score. As of October 24, 2013, a total of 13 hospitals had completed
TARN training, Dr Deasy reported. Th ey are Letterkenny, Sligo,
CUH, St Vincent's, Crumlin, Tallaght, Drogheda, Limerick, Mercy,
Naas, Cavan, Beaumont and Temple Street.
TRAUMA CARE REFORM
IRISH AUDIT OF
HSE ICT SUPPORT
An outline of the National Offi ce of Clinical Audit organisational structure.