Implementation of a nationwide trauma network for the care of severely injured patients

Ruchholtz, Steffen; Lefering, Rolf; Lewan, Ulrike; Debus, Florian; Mand, Carsten; Siebert, H.; Kühne, Christian

doi:10.1097/ta.0000000000000245

Cited by 26 publications

(20 citation statements)

References 18 publications

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“…229 The description for this network included a statement that government policy had been put in place to monitor development, but no outputs have been identified. (b) Studies reporting data on activity within clinical networks for specific conditions such as stroke, 230,231 trauma, 232,233 primary or community care 234,235 and ST elevation myocardial infarction. 236 Most of these studies claimed that clinical networks had improved care by, for example, increasing numbers of patients admitted to specialist facilities, 230,232 receiving thrombolysis for stroke 231 and improving mortality from trauma, 233 but all of them reported current activity and had not made any assessment of differences in care compared with before the network became operational or, therefore, whether the network had improved care.…”

Section: Resultsmentioning

confidence: 99%

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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Section: Resultsmentioning

confidence: 99%

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

View full text Add to dashboard Cite

show abstract

“…Hay escasos estudios en red como ocurre en otros campos de la medicina 15 . Son necesarios trabajos colaborativos para diseminar la investigación dentro de la práctica clínica.…”

Section: Peculiaridades De La Investigación En Traumaunclassified

“…Los programas de advanced trauma life support sistematizan y homogeneizan el tratamiento inicial, teniendo un impacto positivo en el resultado final; por esta razón, se requiere un alto nivel de adherencia a dichos programas para mejorar los resultados 15,26 .…”

Section: Sistemas De Atención Al Trauma Graveunclassified

¿Están cambiando nuestros paradigmas en la enfermedad traumática?

López

2015

Medicina Intensiva

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“…15 Collaborative studies are needed to disseminate research within clinical practice. There are few networked trials, in contrast to the situation found in other areas of Medicine.…”

Section: Peculiarities Of Research In Traumamentioning

confidence: 99%

“…In the United States, the key element is the trauma center, defined by levels and subjected to periodic evaluation. 15,26 Periodic recertification is required, and external audits can be performed.…”

Section: Severe Trauma Care Systemsmentioning

confidence: 99%

Are the paradigms in trauma disease changing?

López

2015

Medicina Intensiva (English Edition)

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Implementation of a nationwide trauma network for the care of severely injured patients

Abstract: Epidemiologic study, level III. Therapeutic/care management study, level IV.

Cited by 26 publications

References 18 publications

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

¿Están cambiando nuestros paradigmas en la enfermedad traumática?

Are the paradigms in trauma disease changing?

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