PEER REVIEW VISIT REPORT (MULTI-DISCIPLINARY TEAM)

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PEER REVIEW VISIT REPORT for Royal Preston Hospital - Network Organisation Measures (published: 5th June 2014) Page: 1/3

PEER REVIEW VISIT REPORT

(MULTI-DISCIPLINARY TEAM)

Regional Trauma Network RMTN

Trauma Centre Royal Preston Hospital

Trauma Service

Royal Preston Hospital

Network Organisation Measures (T13-1C-1) - 2013/14

Peer Review Visit Date 27th February 2014

Compliance

NETWORK ORGANISATION MEASURES

Self Assessment

%

(0/0) Peer Review

100.0%

(8/8) Zonal Statement

Completed By Marie Cummins

Job Title Programme Manager

Date Completed 12/03/14

Agreed By (Clinical Lead/Quality Director) Julia Hill

Date Agreed 28.5.14

Key Themes

Network Governance Measures

The Lancashire and South Cumbria (L&SC) Trauma Network covers a geographical area from Barrow in the north to Chorley in the south and Burnley in the east to Blackpool in the west. Tourists influx into areas such as Blackpool and the Lake District. The estimated population is about 1.6 million. It consists of a Major Trauma Centres (Royal Preston Hospital, Lancashire Teaching Hospitals), four Trauma Units (Blackpool Victoria Hospital, Royal Blackburn Hospital, Furness General Hospital and Lancaster Royal Infirmary), Pre Hospital providers are North West Ambulance Service (NWAS), North West Air Ambulance and Great North Air Ambulance. The network is recognised as an Operational Delivery Network (ODN).

Overall the Lancashire and South Cumbria (L&SC) Trauma Network has made good progress which needs to be congratulated. It continues to strive for improved outcomes and equity of access to specialist care.

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PEER REVIEW VISIT REPORT for Royal Preston Hospital - Network Organisation Measures (published: 5th June 2014) Page: 2/3

Good Practice

Good Practice/Significant Achievements

1. There is good evidence of collaborative working.

2. There is a valuable recognition of separating the roles of the MTC lead and Network lead. 3. An escalation policy is in place for ISS>15 patients in TU's that are not transferred to the MTC.

4. An exceptional executive 'buy-in' of major trauma is recognised and the importance to drive forward the five year plan.

Concerns and Recommendations

Immediate Risks Identified?

Not Identified

Immediate Risks

Immediate Risks Resolved?

Not Applicable

Immediate Risks Resolution

Serious Concerns Identified?

Not Identified

Serious Concerns

Serious Concerns Resolved?

Not Applicable

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PEER REVIEW VISIT REPORT for Royal Preston Hospital - Network Organisation Measures (published: 5th June 2014) Page: 3/3 Concerns

1. There remains a low TARN data completeness and submission from the TU's and this needs to be driven more, it is acknowledged that an action plan has been agreed to assist with this. 2. The review panel recommend that the roles of the Major Trauma Centre and Network lead are specific and separate.

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PEER REVIEW VISIT REPORT for Royal Preston Hospital - Pre-Hospital Measures (published: 5th June 2014) Page: 1/3

PEER REVIEW VISIT REPORT

Trauma Service

Royal Preston Hospital Pre-Hospital Measures (T13-2A-1) - 2013/14

Compliance PRE-HOSPITAL MEASURES Self Assessment

%

90.0%

Key Themes

Pre-Hospital Measures

The Lancashire and South Cumbria (L&SC) Trauma Network covers the geography from

Barrow in the north to Chorley in the south and Burnley in the east to Blackpool in the west. The North West Ambulance Service (NWAS) provide cover for L&SC, which includes support from North West Air Ambulance and Great North Air Ambulance.

North West Ambulance Service (NWAS) use a Major Trauma Pathfinder Triage Tool which identifies major trauma and allows for bypass to a Major Trauma Centre (MTC) within 45 minutes.

NWAS have created a Trauma Cell alongside the Air Ambulance Desk; the Trauma Cell is staffed by Advanced Paramedics. The Advanced paramedic notifies the appropriate MTC that a patient has been taken to a Trauma Unit (TU) and the Ambulance Service facilitates a 'Trauma Blue' transfer to the MTC if required.

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PEER REVIEW VISIT REPORT for Royal Preston Hospital - Pre-Hospital Measures (published: 5th June 2014) Page: 2/3

pre-alerts are co-ordinated through the Trauma Cell which enables Clinician to Clinician communication.

Good Practice

1. Secondary transfers are robust and the process is well embedded.

Not Identified

Immediate Risks

Not Applicable

Not Identified

Not Applicable

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PEER REVIEW VISIT REPORT for Royal Preston Hospital - Pre-Hospital Measures (published: 5th June 2014) Page: 3/3 Concerns

1. North West Ambulance Service (NWAS) has successfully commissioned a MERIT service to fulfil the civil contingencies act to provide medical advice to major incidents and mass casualties and staff are currently being recruited. There remains a gap in providing an Enhanced Care team to deliver direct medical care on scene with no plans to develop this service.

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PEER REVIEW VISIT REPORT for Royal Preston Hospital - Reception and Resuscitation Measures (published: 5th June 2014) Page: 1/3

PEER REVIEW VISIT REPORT

Trauma Service

Royal Preston Hospital

Reception and Resuscitation Measures (T13-2B-1) - 2013/14

Compliance

RECEPTION AND RESUSCITATION MEASURES

Self Assessment

%

91.7%

Key Themes RECEPTION

The Major Trauma Centre (MTC) has a Trauma Team Activation protocol. For each call three to four Consultants arrive within working hours which is very good practice.

The Trauma Team Leader is not on site 24/7.

RADIOLOGY

The CT scanner is currently not co-located with the Emergency Department, however the MTC is going through a redevelopment and the new location will improve the transfer of patients following major trauma much more readily and an improvement demonstrated by the major trauma dashboard is expected. All scans are reported by a Consultant within 12 hours. The current commissioning surrounding the regional vascular service has not been agreed

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which means that at the moment an â€˜out of hoursâ€™ Interventional Radiology service is shared with Wigan and Bolton.

SURGERY

There is 24/7 access to a fully staffed emergency theatre. The principles of Damage Control surgery have been rolled out.

INTENSIVE CARE

The Intensive Care Unit at the MTC comprises of a mix of level 3 and 2 beds. Bed modelling in relation to neurosurgical patients is taking place at the moment, because of the potential

increase to capacity.

The unit submits to ICNARC (Intensive Care National Audit & Research Centre).

PAIN MANAGEMENT

A comprehensive acute pain service, with a Consultant lead is in place at the MTC.

TRANSFUSION

A massive transfusion protocol is in place at the MTC and Pre-hospital providers are able to activate the protocol.

Good Practice

1. The Trauma Team Activation Protocol supports three to four Consultants which attend needs to be applauded.

Not Identified

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Not Applicable

Identified

1. The absence of a 24/7 Consultant Trauma Team Leader was felt by the panel to be a serious concern which needed to be examined.

Not Resolved

Serious Concerns Resolution

Concerns

1. CT scanner is not co-located, but the redevelopment will address this concern.

2. The uncertainty regarding the vascular reconfiguration is creating a â€˜blockerâ€™ to the further progression of the MTC and network and this requires a speedy agreement in order to enable the MTC to push forward their development plans for major trauma

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PEER REVIEW VISIT REPORT for Royal Preston Hospital - Definitive Care Measures (published: 5th June 2014) Page: 1/3

PEER REVIEW VISIT REPORT

Trauma Service

Royal Preston Hospital Definitive Care Measures (T13-2C-1) - 2013/14

Compliance

DEFINITIVE CARE MEASURES

Self Assessment

%

82.4%

Key Themes

Definitive Care Measures

Availability of all specialities required to provide definitive care following major trauma are available at the Lancashire and South Cumbria (L&SC) Trauma Network.

Overall responsibility for major trauma patients is the Emergency Department Trauma Team Leader.

A business case has been submitted to develop a 12 bedded dedicated trauma ward at the Major Trauma Centre (MTC) and it's activity and performance will be reviewed at the next peer review. It is expected that major trauma patients will be admitted under the care of the

Orthopaedic Consultants and the multidisciplinary input into the major trauma service will be appraised at the next peer review. Pelvic fracture surgery is currently undertaken by the regional team, which may require the patient to be transferred for surgical intervention and plans are in place to appoint a local pelvic surgeon, working with the regional service to provide on site surgical care. The role of a Major Trauma Network Nurse has been established and tertiary surveys are carried out.

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The orthopaedic registrars are not resident; a recently carried out audit shows that the

orthopaedic registrar always arrives when called within the specified 30 mins. If a patient has sustained an isolated cardiothoracic injury the patient will be transferred straight to Blackpool which is the regional cardiothoracic centre. However, a patient who has suffered polytrauma will be admitted to the MTC and the cardiothoracic surgeons will operate at the MTC. Patients with spinal cord injury are admitted to either a neurosurgical ward or an orthopaedic ward and after stabilisation they are then transferred under the care of the spinal team.

The MTC is the designated regional burns unit.

Good Practice

1. The progression of the Major Trauma ward needs to be commended. 2. Dedicated Orthopaedic Consultant delievered care is to be applauded. 3. The role of the Major Trauma Network Nurse (MTNN) is to be congratulated.

Not Identified

Immediate Risks

Not Applicable

Not Identified

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Not Applicable

Concerns

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PEER REVIEW VISIT REPORT for Royal Preston Hospital - Rehabilitation Measures (published: 5th June 2014) Page: 1/2

PEER REVIEW VISIT REPORT

Trauma Service

Royal Preston Hospital Rehabilitation Measures (T13-2D-1) - 2013/14

Compliance REHABILITATION MEASURES Self Assessment

%

85.7%

Key Themes

Rehabilitation Measures

Trauma Rehabilitation is supported from a commissioning perspective and â€˜activity based commissioningâ€™ has been used in order to increase the capacity of trauma rehabilitation services.

A Medical Director for Rehabilitation Medicine and a Clinical Lead has been appointed. The Rehabilitation Prescription is completed by the Rehabilitation Co-ordinator and all in-patients have an identified key worker.

Good Practice

1. Increase in the rehabilitation services being provided. 2. The Rehabilitation Prescription is fully embedded.

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PEER REVIEW VISIT REPORT for Royal Preston Hospital - Rehabilitation Measures (published: 5th June 2014) Page: 2/2

Not Identified

Immediate Risks

Not Applicable

Not Identified

Not Applicable