Large numbers of patients dying unnecessarily, says report

Large numbers of patients are dying unnecessarily due to delays in setting up a co-ordinated system for treating trauma patients, according to a new report.

One in five patients who suffer major trauma have to be transferred to a second hospital because the first one does not have the services needed to treat their injuries, the report by the National Office of Clinical Audit shows.

This interrupts their care and leads to longer recovery times. Only 60 per cent of major trauma patients are discharged directly home following their time in hospital.

Most major trauma is caused by a low fall of less than 2 metres, the Major Trauma Audit National Report 2017 finds. Older people are particularly vulnerable, with low falls the most common mechanism of injury for patients aged over 45 years, and for children.

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"This report tells us that our homes are dangerous places, especially for older people," commented Dr Conor Deasy, clinical lead for major trauma audit. "We need to address the epidemic of low falls in the home through engineering, medical and societal approaches. We have NCTs to ensure car and road-user safety; should we have something similar for our homes given the burden of injury associated?"

The introduction of a major trauma system in Australia and London has cut the number of deaths among patients by half, the report points out. In the UK overall, there was a 20 per cent fall in death and a dramatic reduction in severe disability.

In Ireland, it is estimated one avoidable death per fortnight occurs in relation to road traffic incidents, while two patients suffer avoidable severe disability each week.

“There is no other disease in the developed world where there are similar gains to be made in terms of saving lives,” the report states.

Contrasting the progress made in cancer, stroke and cardiac care through the creation of co-ordinated systems, it says any delay in introducing a trauma system in Ireland will result in “significant ongoing avoidable loss of life” from major trauma.

At present, major trauma care is delivered in 26 Irish hospitals, but no one hospital has all the necessary trauma services on site, it says. In addition, no hospital has a sufficient throughput of severely injured patients to be considered adequate to maintain the skills of doctors, nurses and other healthcare professionals.

“For patients and their families, the current arrangements for the delivery of trauma care are such that access to specialist care is compromised and transfer to another hospital is often required.

“This interrupts continuity of care and lengthens time to recovery, as care is delivered sequentially rather than concurrently.”

The report says little meaningful progress has been made in rolling out trauma teams to make initial assessment of severely injured patients arriving in hospitals. This has been shown to lead to faster critical intervention times and better patient outcomes.

The age profile of patients suffering major trauma has changed since the 1990s; today’s patients are older, their medical needs are more complex and they have to stay longer in hospital.