Enhancing patient outcomes and quality assurance following trauma
On initial presentation to the Emergency Department it is important for clinicians to prioritise potentially time critical and life threatening injuries. Therefore, patients may be intubated, taken to CT or to theatre promptly. Consequently, less severe or minor injuries may not be recognised during the initial assessment and could be identified later in the patient’s care.
The Tertiary Survey in Major Trauma care is a comprehensive ‘head to toe’ patient evaluation. Its purpose is to identify and document injuries or medical complications that may have been missed during earlier assessments, ensuring no harm is overlooked as the patient’s care progresses
This should be completed when the patient is fully alert and orientated to ensure that no injuries have been missed prior to discharge. NMTR requirements stipulate this must be completed or considered (and documented as such) within 24hrs of admission. This enables the MTC to meet quality assurance measures and best practice tariff, meeting national Major Trauma standards.
It is the responsibility of the consultant host team, to ensure all Major Trauma patients meet this measure. This can be completed by a nominated clinician if required and is available in all ward areas. The survey should include:
- Review the medical records.
- Review imaging and laboratory tests.
- Complete a ‘head to toe’ physical assessment.
- Document findings.
If a new injury is suspected, further studies or imaging should be obtained.
The completed tertiary survey should be filed as part of the patient’s hospital record and data feedback sent to the National Major Trauma Registry.
Rehabilitation Guidelines
NICE guidelines NG211 Rehabilitation after traumatic injury
Rehabilitation after traumatic injury (nice.org.uk)
British Orthopaedic Association Standards for Trauma
rehabilitation and communication with trauma patients.pdf (boa.ac.uk)
Resources for patients
Headway - Charity to support patients and their loved ones, employers following head injury www.headway.org.uk
Support for families / patients who have been through critical care Home - ICUsteps
Spinal Injuries Association - A fulfilled life for everyone affected by spinal cord injury - SIA
Specialist rehabilitation units
A small proportion of patients may require more extensive and specialist rehabilitation after Major Trauma to meet there needs. Please feel free to discuss with our Key Worker or Rehabilitation Consultant if these options have been raised with you.
Within our network we have the following partners:
Brain Injury Rehabilitation Unit Frenchay | Neurological Rehabilitation | Active Care Group
Salisbury Spinal Injury Rehabilitation Spinal Treatment Centre (salisbury.nhs.uk)
The Dean Neurological Centre The Dean - Elysium Healthcare
Somerset Neurological Rehabilitation Centre Somerset Neurological Rehabilitation Centre | Somerset NHS Trust (somersetft.nhs.uk)