Alleviating trauma

Monash University is collecting key data on every patient seriously injured in Victoria - with the aim of helping ambulances and hospitals provide the best care. FIONA PERRY and ALLISON HARDING report.

Traumatic injuries occur every day around Australia and with thousands of seriously injured patients rushed to emergency centres every year, it is vital to know if the healthcare system is working. Which hospitals bear the heaviest loads? How long is it taking patients to get to hospital by ambulance? How quickly are patients who require urgent surgery being operated on?

In 1999, a Ministerial Taskforce on Trauma and Emergency Services recommended that a new system of trauma care be implemented throughout Victoria.

The new system would aim to ensure that patients are taken to the most appropriate hospital for the treatment of their trauma within the shortest time possible.

In order to ascertain the effectiveness of the system and to provide ongoing monitoring of major trauma patients, it was recommended that a state-wide trauma registry be established.

The Victorian Department of Human Services awarded the $1.2 million, three-year contract to establish the Victorian State Trauma Registry (VSTR) to Monash University's Department of Epidemiology and Preventive Medicine. Data collection for the registry began in mid-2001.

As part of its aim to develop and maintain a major trauma reporting and analysis system, the registry will collect data from more than 70 public and selected private Victorian hospitals.

Major trauma patients are those who have injuries that are life-threatening or that require significant and immediate treatment in hospital. It includes, for example, patients who spend three or more days in hospital, patients who have significant injuries to two or more body regions and patients who need urgent surgery.

The registry collects information on major trauma cases only, due to the burden that these injuries place on the health care delivery system.

Associate Professor Carolin Finch The registry is coordinated by the Victorian State Trauma Outcome Registry and Monitoring (VSTORM) group, headed by Monash's Associate Professor Caroline Finch. The project's other chief investigators are Professor John McNeil and Ms Karen Smith, from the Department of Epidemiology and Preventive Medicine, and Professor Peter Cameron from the Royal Melbourne Hospital.

Dr Finch says the registry is the first state trauma monitoring system in Australia to have complete coverage across the whole state.

"All the others are based in generally isolated, metropolitan hospitals," she says. "We have access to all hospitals in the state and are able to make rural, regional and urban comparisons. We will be able to provide a model for the whole of Australia in this respect."

Dr Finch says the registry is unique in that it collects data on every stage of a traumatic injury from when the call is made to the ambulance and actions taken at the scene of the injury to which hospital receives the patient and details of surgery and rehabilitation.

"We plan to follow up all patients three months and 12 months after their injury, checking on their recovery and their satisfaction with the care they received, which is not generally done by overseas trauma registries," she explains.

"Our registry is serving as a model for other trauma systems we are, in a sense, establishing state-of-the-art methodology."

According to Dr Finch, the trauma registry looks at a number of variables to determine whether the trauma care system is working, including whether:

patients arrive at hospitals (via ambulance) within minimum times;
patients are referred promptly to hospitals with appropriate specialists for their type of injury;
the death rate following major trauma has declined over time;
a hospital's major trauma team is activated to deal with a major trauma patient on arrival, and not other staff; and
patients who have an urgent need for surgery are operated on within 24 hours of the injury.

Dr Finch says the trauma registry will make a valuable contribution to government policy and the provision of Victorian health care services.

"The registry will also provide a quality assurance measure of the system, which will inform government policy about the provision of trauma services in the state. It will also allow benchmarking of the performance of the trauma system against national and international standards."

Although it has been operating for only six months and changes to the Victorian State Trauma Service have only been partially implemented, Dr Finch says there are already patterns emerging that suggest the trauma service is working.

"There are patterns of referral of significant cases to one of the big three trauma hospitals in Melbourne The Alfred, the Royal Melbourne Hospital, and the Royal Children's Hospital, from both other metropolitan hospitals and large regional hospitals," she says. "This is what would be expected if the trauma triage guidelines were working."

For information on the Victorian State Trauma Registry, visit www.med.monash.edu.au/epidemiology/units/traumaepi/index.html.

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