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Critical Care Management of Major Trauma

Developing pathways to improve patient flow and clinical outcomes


Interventional Radiography Ambulance Service (primary transfer) Emergency Department Acute Hospital (secondary transfer) Operating theatre Single specialty level 0-1 care: Community Service/Home CT Multispecialty care level 0-1 care Acute Hospital

J2

Critical Care Level 1-3 care:

NCCU & Trauma Ward

Specialist Hospital

existing specialty wards

Outreach support

Reception, Resuscitation and Emergency Care

Acute Care, Reconstruction and Rehabiltation

Figure 1: MTC patient flows into, through and out from Addenbrookes Hospital, utilizing/adapting NCAG recommendations for MTC patient management but adapted to sit within local organizational structures. Lightly shaded pink boxes indicate areas where NCCU staff provide direct patient care.

Overview of the Project


The aim of my project was to enhance the current critical care facilities at Addenbrookes Hospital for major trauma patients Addenbrookes was designated the Major Trauma Centre for the eastern region from the 1st April 2012. All major trauma is referred to NCCU at Addenbrookes. As demonstrated in Figure 1., NCCU has the potential to be a significant bottleneck to patient flow. A series of pathways are being developed to ensure that these complex patients are managed appropriately whilst simultaneously ensuring that the care of all other patients managed on the NCCU is not impacted, and indeed may be enhanced.

and resource limitation. Implementation has required staff engagement both within the NCCU and from clinicians across a range of specialities. There was a need to ensure nationally defined targets were met. The patients and their families are often very complex and incorporating their needs was central to pathway redesign.

Results
The project remains work in progress with a range of pathways and protocols relating to specific diagnoses e.g. spinal injury, pelvic fractures, end of life care, being modified/developed. The traditional model of 1:1 nursing care has been replaced with a newer model, based on pods allowing greater flexibility in matching levels of care to patient needs. This has become embedded over the period of the project. Extra ward space, staff and equipment have been negotiated and pathways of care based on rehabilitation needs for the patients are being implemented.

Leadership Challenges
The project has challenged and changed traditional models of critical care and local models for trauma care. There have been specific challenges in targeting the most effective interventions for efficiency and cost savings whilst maintaining/improving outcome and patient safety in a climate of reduced spending

Contact Information
Dr Rowan Burnstein Consultant in Anaesthesia and Intensive Care, Clinical Director of Neurocritical Care
rowan.burnstein@addenbrookes.nhs.uk

01223 245151