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NHS “black hole” for patients with major trauma injuries

17 September 2008

The NHS is failing to deal with some of the UK’s most severely injured patients because local NHS targets designed to speed up routine operations are leaving emergency patients stuck in the wrong hospital. The resulting delays in transfer to specialist centres and late operations is a result of poorly co-ordinated care and a lack of proper regionalised trauma services, said orthopaedic surgeons at their annual Congress today (Thursday 18th Sept).

At their Annual Congress this week, the British Orthopaedic Association (BOA) set out the minimum standards needed in order to manage cases of pelvic and hip socket (acetabular) fracture. Patients with pelvis fractures, predominantly young people with multiple injuries caused by road traffic accidents, need prompt treatment in hospitals with specialist units but are frequently denied access.

Patients are systematically harmed as the key targets for hospitals are that local patients are out of A&E within four hours and that planned elective surgery cases are not cancelled. This can mean that hospitals with specialist trauma teams cannot accept transferred patients with serious injuries or risk breaking their targets. This causes trauma patients to remain marooned in an inappropriate hospital and suffer poor care and long delays in receiving an operation

Mismanaged pelvic injuries can lead to death from haemorrhage and commonly results in major disability, while delayed surgery of fractures of the pelvic hip socket leads to avoidable osteoarthritis, hip damage and artificial joint replacement. Figures show that with prompt surgery, within 5-7 days, 80% of patients with the most complex fractures can recover with excellent results, avoiding disability. Less than 50% can expect the same results after 10 days and almost no one after 3 weeks. Yet these delays are commonplace in the NHS, with hospitals reporting an average of between 10 and 20 days.

Wasted bed days, more complex surgery and slower rehabilitation is costly to the NHS, compounding the increased societal costs of greater disability and loss of employment.

The British Orthopaedic Association (BOA) and The Royal College of Surgeons have repeatedly called for the creation of a regional trauma network, where patients with complex, multiple injuries can be treated quickly.

Professor Chris Moran, consultant trauma and orthopaedic surgeon, said:

“The current system does not work. What these patients require is immediate transfer to a trauma unit where they can be treated by a specialist team. But this is not happening: patients are frequently denied access because the units are already full and are instead stuck on hidden waiting lists until a bed becomes free. These patients are not a priority as units are under no obligation to take on emergency cases from another hospital. In the future, a trauma network should ensure that the specialist hospital takes responsibility for these patients immediately.”

Mr John Black, President of the Royal College of Surgeons, said:

We have been calling for a review of trauma services in the UK for many years. Evidence has been available since the mid 90s that shows that the treatment of pelvic and acetabular injuries was, and still is, inadequate. In the wake of Lord Darzi’s comprehensive review of the health service, I would urge the Department of Health to make a review of trauma services an urgent priority.


Notes to Editors:

  1. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit www.rcseng.ac.uk
  2. If you have any queries please contact: Matthew Worrall – Email: mworrall@rcseng.ac.uk; T: 020 7869 6047 Elaine Towell – Email: etowell@rcseng.ac.uk; T: 020 7869 6045 Out-of-hours: 07966 486 832