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Ryall: Major trauma national clinical network speech

Tony Ryall

4 JUNE, 2014

Major trauma national clinical network speech

Thank you for inviting me to the meeting today. It is my pleasure to be here to express my support to the Network and to hear how your work is progressing.

I would like to begin by acknowledging: Associate Professor Ian Civil, as the Clinical Leader of the Network for his contribution to and leadership of the Network and its work; the Network members and associated people for their time and commitment to the development and advancement of the different aspects of a good trauma system in New Zealand; and the various DHBs and service providers around the country for permitting their staff to support and implement the Network’s work.

It is good to see the level of collaboration and inputs attributed to improving trauma services in New Zealand.

I am pleased to see that this Network provides a forum for the relevant groups of people, including our trans-Tasman colleague, Dr Oran Rigby, from the New South Wales Institute of Trauma to share learning and experience, and to continue to collaborate and develop work on this.

As we know, in most developed countries such as New Zealand, trauma is the leading cause of death in the first 45 years of life. The development and implementation of integrated high quality major trauma services are an important aspect of providing comprehensive effective and safe health services across New Zealand, and will save lives.

We need frontline personnel, pre-hospital and rehabilitation partners, and service management to work closely together to contribute to a positive journey for patients who are injured.

We have seen evidence of the positive gains an integrated trauma system can bring through examples from the Midland Region Trauma System. I am encouraged by the proactive approach that the Network has taken over the last two years in promoting best practice to the rest of the country.

The Network is now beginning its third year of operation. I have been advised that good progress has been made to deliver on its key objectives, and a number of important tasks have been completed to lay the basis for improving the outcome of patients suffering major trauma in New Zealand.

The areas which I would particularly like to recognise are:

• The completion of a capacity and capability report which confirms that many of the necessary elements of major trauma services exist. The system now needs priority actions to focus on integration and on delivering quality trauma care; the revision and implementation of the national “Guidelines for a Structured Approach to the Provision of Optimal Trauma Care” ensures that injured patients throughout New Zealand are managed appropriately wherever they receive their care

• Agreement of a minimum dataset in preparation for a national major trauma registry so that consistent baseline data can be collected to inform ongoing guideline development and quality improvement

• Publication of trauma incidence and mortality rates on the Health Quality and Safety Commission Atlas of Healthcare Variation helps prompt debate within the sector over the quality of trauma service and highlighted areas DHBs can improve on.

• Contribution to the Spinal Cord Impairment Action Plan and the development of the National Helicopter Dispatch Protocols will allow the principles of “right place, right time” to be achieved when patients suffer major trauma. I am pleased to announce that the Spinal Cord Impairment Action Plan has now been finalised. I look forward to the implementation of the agreed actions in the plan.

• Development of a research proposal relating to pre-hospital trauma mortality will allow the Network to appreciate the burden of pre-hospital mortality and guide development of systems that increase the chance that severely injured patients will arrive at hospital alive.

• Supporting the implementation of regional hub and spoke models and engaging with regional hub hospitals in the provision of regional educational fora. These fora are important for the national network and regional networks to provide ongoing professional support and clinical advice to the relevant DHBs. They are also a good way to facilitate cross-disciplinary learning and planning for an integrated trauma care system.

• The work with ACC around rehabilitation pathways for major trauma patients including running a rehabilitation workshop in conjunction with ACC to promote a patient-centred service. This workshop, which some of you participated in, focused on how trauma care and rehabilitation services can be better linked, and identified that coordination of services and early engagement of rehabilitation professionals in the patient’s journey is an important element to the success of the patient’s care;

• And supporting DHBs as they contribute to regional plans for major trauma services and data collection. In particular, sharing experiences and knowledge around developing good governance structures, decision making processes, the importance of dedicated trauma service personnel to provide specialised clinical advice, and to collect customised trauma data. All of these will improve management and outcomes for trauma patients.

These activities are essential in laying the basis for a comprehensive and patient-centred trauma system and ultimately improving outcomes for patients and to ensure consistent application of best practice trauma care to patients across New Zealand.

I am aware that quality improvement, data and guidelines have been the key areas of focus in the Network’s work programme. These areas are interlinked to the extent that guidelines drive quality improvement, data allows identification of areas for improvement, and data is required to monitor what improvement has occurred.

This government has a clear focus on regional planning and integration in a hub and spoke model to ensure DHBs and all service providers work effectively together so that there is reduced duplication and wastage of resources. Establishing a clear pathway and strong governance for the regional trauma systems is essential to achieve that.

Already I have seen some commitment from DHBs and regions through the draft 2014/15 regional services plans illustrating how they are going to progress with establishing governance, coordinator support and mechanism in collecting the appropriate data. I look forward to seeing some tangible actions implemented.

New Zealand’s journey to improve trauma care and the outcomes after severe injury is not happening in isolation. Our colleagues in Australia have shown the way in this regard. More recently the National Health Service in the United Kingdom has instituted a trauma system led by Professor Keith Willett that is closely modelled on the Victorian system. By learning from the evidence available in other similar countries, as you are doing today, the Network will be able to move more quickly to proven, evidence-based models of trauma care. This will greatly benefit patients suffering severe injury in New Zealand.

Once again, it has been my pleasure to be here, I am confident that your dedication and collective effort will continue to drive improvement to the New Zealand’s trauma services and outcomes towards international best practice.

I look forward to seeing progress of the work and evidence of how the Network’s work contributes to improving the health outcomes and experience of trauma patients and their families.

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