"Current services for people who suffer
major trauma are not good enough. There 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. The
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."
Amyas Morse, head of the National Audit Office, 5 February
2010
There is unacceptable variation in major trauma care in England
depending upon where and when people are treated, according to a
National Audit Office report published today. Care for patients who
have suffered major trauma, for example following a road accident
or a fall, has not significantly improved in the last 20 years
despite numerous reports identifying poor practice, and services
are not being delivered efficiently or effectively.
Survival rates vary significantly from hospital to hospital,
with a range from five unexpected survivors to eight unexpected
deaths per 100 trauma patients, reflecting the variable quality of
care. The NAO estimates that 450 to 600 lives could be saved each
year in England if major trauma care was managed more
effectively.
For best outcomes care should be led by consultants experienced
in major trauma; but major trauma is most likely to occur at night
and at weekends, when consultants are not normally in the emergency
department. Only one hospital has 24-hour consultant care, seven
days a week.
Major trauma care is not coordinated and there are no formal
arrangements for taking patients directly for specialist treatment
or transferring them between hospitals. CT scanning is very
important for major trauma patients; however, a significant number
of patients that need a scan do not receive one. Not enough
patients who need a critical care bed are given one.
Access to rehabilitation services, which can improve patients’
recovery, quality of life and reduce the length of hospital stay,
varies across the country and patients are not always receiving the
care that they need. The costs of major trauma care are not well
understood. The estimated annual lost economic output from deaths
and serious injuries from major trauma is between £3.3 billion and
£3.7 billion.
Collecting information on care is essential for monitoring and
improving services, but only 60 per cent of hospitals delivering
major trauma care contribute to the Trauma Audit and Research
Network (TARN). The performance of the 40 per cent of hospitals
that do not submit data to TARN cannot be measured.
Publication details:
HC: 213, 2009-10
ISBN: 9780102963472