The reconfiguration of clinical services report provides new insights into the drivers of reconfiguration and the underpinning evidence. It builds on a major analysis, commissioned by the National Institute for Health Research (NIHR), of reviews of service reconfigurations conducted by the National Clinical Advisory Team (NCAT).
This page summarises the report's findings on the reconfiguration of trauma services.
Proposals reviewed by NCAT
- Region-wide initiatives, centralising trauma services into designated major trauma centres and creating trauma networks linking local hospitals to the centre.
- Centralising trauma onto one site within multi-site trusts. In one case, this involved the separation of trauma from elective orthopaedic services.
Key drivers of trauma service reconfiguration
National policy and safety were the primary drivers of this type of reconfiguration.
Context and relevant policy
- The National Audit Office (NAO) estimates that major trauma occurs 20,000 times in England each year.
- In 2010, the NHS Clinical Advisory Group on trauma published evidence-based advice for designing and implementing trauma networks across England. The recommendations are summarised below.
- Regional trauma networks went live across England in April 2012 and, from April 2013, major trauma services have been commissioned by NHS England. The service specification set out in the standard contract draws heavily on the Clinical Advisory Group’s work.
The current evidence base
Formalised systems of trauma care, in which care for the most complex patients is centralised into a small number of trauma centres, improves patient outcomes. Trauma centres need 24/7 access to fully staffed theatres and diagnostics, including CT, MRI and pathology. They also need comprehensive critical care and neurosurgical support.
Relevant college and other guidance
In 2007, the Royal College of Surgeons of England recommended that, as a minimum, major trauma centres should admit more than 250 critically injured patients a year. But in subsequent guidance, it suggested a minimum of between 400 and 600 cases and serving a population of 2–3 million.
In the United States, the American College of Surgeons (2012) requires hospitals seeking accreditation as a major trauma centre to admit more than 240 cases a year.
Key recommendations from NHS Clinical Advisory Group on trauma report
- Each region needs to identify and designate at least one hospital to act as a major trauma centre, supported and linked via a trauma network to local trauma units.
- All patients identified as major trauma (using a trauma triage tool) should be taken to a major trauma centre.
- Those who are within 45 minutes’ travel time from the centre should be taken there directly, bypassing other units. Patients further than 45 minutes’ travel time from the centre should be stabilised first in their local trauma unit.
- A trained trauma team should be present 24 hours a day for the immediate reception of the patient. The trauma team leader should be a consultant in the major trauma centre and, in the trauma unit, there should be at least ST4 or equivalent competency who will attend within 30 minutes by a consultant.
- Emergency trauma surgery should be performed by a consultant surgeon with appropriate skills and experience.
- All patients requiring acute intervention for haemorrhage control must be in a definitive management area (operating room or intervention suite) within 60 minutes.