Formalised Major Trauma Networks (MTN) are a relatively new service configuration in England and Wales and are still being formalised in Scotland and Norther Ireland.
Currently we are not meeting the standards set out by the RCR guidelines.
This is for a combination of infrastructure and human factors.
Our recommendations are for changes that do not require major building or service changes and should therefore,
be possible to implement.
The configuration and services available in departments does not meet the standards.
Many ED and Radiology departments were built before the MTN were operational and before WBCT became central to the management of SIPs.
Going forward with hospital refurbishments and rebuilds CT scanners and IR suites should be co located in the ED department.
Recommendation: In the meantime it is imperative that departments have robust protocols for transferring patients to the CT scanner and IR.
MRI access for SIPs often requires the patient to be transferred between hospitals.
However,
15% of institutions do not have any access to MRI 24/7.
Recommendation: Departments without access to MRI scanner either local or by transfer,
should approach local institutions with MRI facilities.
FAST scanning when performed is almost exclusively performed by ED physicians.
Currently only 11% of departments perform any audit of this service.
Recommendation. Regular audit of FAST scan results.
The standards for performing WBCT in SIP have not been met with 12% of departments having no written protocol and 22% of departments not performing WBCT.
This may be for a number of reasons including radiologists unaware of guidelines,
CT scanner not set up to perform scan,
radiographers not trained.Recommendation. Training of radiologists and radiographers in WBCT.
The issuing of formal primary survey reports is performed in the minority of departments.
Anecdotally ,
many departments give a verbal report as the patient is being scanned with radiologist and ED physician present.
In many institutions the IT is not available to scan pieces of paper onto the radiology reporting system or give a primary report on the radiology reporting system.
When the reporting radiologist is off site a primary report is even more difficult as the radiologist has to wait for images.
Recommendation. Departments to look at SIP flow through CT and radiologists location in the department and find opportunities to produce a primary report.
Almost half of cases have a final consultant report in 1hour and two thirds in 2 hours.
When trainees reporting scans are taken into account 55% of reports are available within 1 hour and 80% in 2 hours.
This is due to a number of factors including workload,
complicated cases,
ongoing case discussion,
reporting off site.
Recommendation. Departments to look at ways of working to prioritise one consultant to trauma imaging and have a second consultant available if breaching time for reports.
However,
it is recognised that when the reporting consultant is off site the IT infrastructure currently may not be in place to support quicker reporting of major trauma scans.
In regards to interventional radiology all MTCs have on call rotas for major trauma,
with patients from TUs transferred to the MTC for treatment.
Recommendation. Robust pathways for transfer of patients needing IR to MTCs
Currently only a quarter of radiologists reporting major trauma attend a regular major trauma meeting.
Reasons include in TUs not enough SIP to justify a regular meeting.
In MTCs most radiology consultants will be reporting cases and cannot all be available to attend the meeting.
Tele radiology company radiologists do not have this opportunity.
Recommendation. In major trauma centres encouraging consultants to attend meeting where the cases they have reported are being discussed.
Although currently the standards are not being met for this relatively new service there are many opportunities for improvement with training,
pathway development and ways of working.