NSW Trauma Services Model of Care

The document titled Improving the Quality of Trauma Care in NSW: Trauma Services Model of Care (2019) was developed by NSW Agency for Clinical Innovation in consultation with trauma services and the Ministry of Health, in response to unwarranted clinical variation with respect to clinical care and patient outcomes.

There is also an ongoing need for clarity across the NSW health system regarding trauma service structure and performance requirements. Significant variation in models of care exists across trauma centres with most regional trauma services and several major trauma services in NSW not staffed to minimum levels stipulated in the NSW Trauma Plan (2009).  This is particularly important given the increasing volume, age and complexity of trauma patients over the past decade.

Trauma service staff at each designated trauma hospital are required to ensure clinical continuity and coordinated care for severely injured patients, to ensure that care is consistent with established policies and procedures, and to escalate and transfer patients in an appropriate and timely manner. Trauma service clinicians are also required to evaluate their care using quality audits and patient reported outcomes measures.

The NSW Trauma Services Model of Care supports:

• Consistent role descriptions and role delineations across the NSW Trauma System
• An integrated system of care with an emphasis on support provided to networked hospitals, leadership with respect to clinical governance, research and education and supra-LHD functions such as referral networks for paediatric, head injury spinal injury and critical care.
• Capabilities across all service domains including clinical leadership, clinical governance, quality improvement, service structure, and education and research.
• Targeted state-wide quality improvement activities such as the NSW Trauma Outcomes Registry and Quality Evaluation (TORQUE) and the NSW Trauma Death Monitoring and Review programs.
• External accreditation by approved programs such as the Royal Australian College of Surgeons Trauma Verification Program

Objectives

The objectives of the Trauma Services Model of Care include:

1. Clarity and transparency across system around trauma service function and structure
2. Stronger trauma network referral arrangements and support for Regional Trauma Services
3. Reduced unwarranted clinical variation with trauma care delivery and patient outcomes to ensure consistent quality of care is delivered to trauma patients regardless of where they are injured in NSW
4. Develop a more patient focused trauma system in NSW
5. Improve coordination across various clinical networks at ACI and Local Health Districts involved in the ongoing care and rehabilitation of trauma patients

Implementation

• Ongoing collaboration with the Ministry of Health in working towards consideration for the model of care to be included in the LHD Service Level Agreement
• Capability and needs analysis at trauma facilities
• Site visits by ACI and external audits through agencies such as RACS verification
• Rolling information sessions at ITIM trauma education evenings
• Engage with ACI Implementation team to provide guidance and support

Evaluation

The implementation of the model of care will be evaluated through a number of means including:

• Data analysis and reporting including risk adjusted mortality and standardised trauma process indicators.
• ITIM death review monitoring program in collaboration with the Clinical Excellence Commission
• Redevelopment of the NSW Trauma Registry to include patient reported outcome and experience measures

Document

• Improving the Quality of Trauma Care in NSW: Trauma services Model of Care, 2019