Ensuring trauma care is delivered effectively and consistently

NICE has launched a suite of guidelines to ensure that trauma services are delivered effectively and consistently.

The guidelines cover fractures, complex fractures, spinal injury assessment, major trauma and trauma services.

Trauma cases result in around 5,400 deaths each year in England, and are the most common cause of death in patients under 40 in the UK.

In 2010, a report from the National Audit Office found inadequacies in the level of trauma care delivered in the country. Following this, a number of regional trauma networks were developed, led by doctors, nurses, and allied health professionals. The aim of these networks was to ensure patients are taken to the right hospital for them and to get the treatment they need.

These trauma networks have been fundamental in helping to reduce variation across England, and they have been estimated to save an extra 600 lives every year.

NICE’s latest suite of guidelines aim to support these current systems and further reduce variation in trauma care.

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Improving the governance of patient safety in emergency care: a systematic review of interventions

Hesselink et al. BMJ Open 2016 6:e009837

Objectives To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility.

Methods PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings.

Results Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively.

Conclusions Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base.

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