Date created: | Last Updated:

Category: Project

Description: New South Wales Ambulance Aeromedical Operations maintains an electronic quality assurance (QI) database to guide audit, research projects and QI activities. As this service does not maintain an ongoing clinical relationship with patients after hand-over we are not allowed to routinely access clinical information from hospital events. This severely limits the ability of our quality assurance activities or research projects to learn from the patient's journey beyond our immediate clinical care. For example, our patients who receive pre-hospital blood may be at risk of inappropriate blood product ratios if they begin a Major Trauma Centre massive transfusion protocol that begins with additional pack red blood cells. Currently we are no able to easily investigate this. Similarly, the NSW trauma system operates as a series of networks that identify and manage patients who have, or potentially have, a serious injury. Annually more than 900 trauma patients require referral and transfer to a designated trauma service (1). Although vital, transfer delays the time until definitive care can be provided. In 2015, for half of patients, the time to definitive care exceeded eleven hours. (1) Delays of this magnitude are considerable and may have a direct impact on patient outcomes. Recently, a trend towards unwarranted clinical variation in the identification, referral and transfer of major trauma patients has emerged across major, regional and paediatric trauma services (2, 3). Prehospital under-triage of major trauma, especially in over 60 year olds, is also of concern (4). This projects represents two activities we wish to conduct to understand NSW trauma patients through data-linkage. Both these studies have separate protocols attached as appendices to this application. In brief, our triage study will utilise Ambulance NSW data as the top-line in the data-linkage. This project seeks to understand the triage and disposition of NSW trauma patients, linking their initial presentation, the accuracy of their triage and destination hospital, with their outcomes. Our second project will use the dataset from the triage study to investigate a subset of patients who receive prehospital blood. We will match them to patients who do not receive prehospital blood but still receive a massive transfusion, in order to investigate the ratio of blood products received and clinical outcomes. References 1. NSW Institute of Trauma and Injury Management. Major Trauma in NSW 2015. Sydney: NSW Agency for Clinical Innovation, 2016 2. NSW Institute of Trauma and Injury Management. Trauma Patient Outcome Evaluation: Qualitative Report. Sydney: NSW Agency for Clinical Innovation, 2016 3. Clinical Excellence Commission Patient Safety report – Retrieval and Inter-hospital transfer 2013 4. NSW Institute of Trauma and Injury Management. Summary of a linked data analysis of the NSW trauma system. Sydney: NSW Agency for Clinical Innovation, 2018