Case for change
Clinical evidence supporting the plans was clear – major trauma care in the UK compared poorly with other countries as evidenced by The National Confidential Enquiry into Patient Outcome and Death, noting a lack of appreciation of severity of illness, incorrect clinical decision-making and a lack of experienced evening staff in some hospitals.
Most major trauma patients were taken to their local hospital where they encountered long waiting times and two thirds were then transferred because their local hospital was unable to provide the expert care needed for their often multiple and complex injuries.
The huge success of major trauma centres staffed by specialists dealing with such conditions daily was known from trials in the UK and abroad. The New England Journal of Medicine cited a 25% decrease in death rates among the patients who received such specialist care and in Quebec, Canada the establishment of a trauma system resulted in mortality dropping from 52% to 19%. A study in Florida also found that counties with trauma centres had 50% less road accident deaths.
In London, the Severe Injuries Working Group demonstrated that when patients were transported to the nearest hospital, they had a mortality rate of 12%, whereas when patients were transferred to a more specialised unit, it was 19%. Royal London Hospital had reduced deaths of its most severely injured patients by 28% compared with the national average.
Research on the effectiveness of trauma systems found that for each trauma patient returned to work, there is a five to fifteen fold return on the investment.