Every patient who experiences a major trauma in Nova Scotia rapidly moves through a system facilitated by Trauma Nova Scotia. That means whether someone becomes critically ill from an injury in Yarmouth or has a major trauma in Meat Cove, every patient is transported via Life Flight or ambulance to the QEII Health Sciences Centre in Halifax (or the IWK for pediatric patients). The trauma team does everything they can to get the patient lifesaving care as soon as possible.
In October 2022, Trauma Nova Scotia launched the QEII Inpatient Trauma Consult Service, an 18-month pilot project staffed with experienced trauma physicians and nurses to facilitate the care of trauma patients after resuscitation. The implementation of a dedicated trauma consult service is filling a major gap in trauma care at the QEII.
“We have a dedicated team of trauma leaders who work on rotation. A member of the team is always on call 24 hours a day, 365 days a year,” explained Dr. Robert Green, Senior Medical Director of Trauma Nova Scotia. “The trauma leader helps facilitate the care of a trauma patient at any time during the patient’s injury from the initial transport to the time they arrive at the hospital. They meet the patient upon arrival to the QEII work as a multidisciplinary team to resuscitate the patient. After this phase of care, our Trauma Consult team takes the lead.”
Dr. Green works closely with Dan Cashen, Director of Trauma Nova Scotia. Together, they sought to improve and better evaluate patient outcomes and key performance indicators to measure progress and address deficiencies within the health care system that impact patient care.
Major trauma is uniquely different than emergency medicine because it crosses many departments, including surgery, emergency, anesthesiology, critical care, and more. The patients that the Trauma Team Leaders see are in extremely severe condition, such as having been involved in a motor vehicle crash, missing a limb, or have a gunshot wound. Depending on the injury, the trauma patient is admitted to a surgical service that best serves their needs. This means trauma patients can be distributed throughout the hospital.
“One of our trauma team consultants works with the trauma consult nurse and sees the patients every day and facilitates and coordinates the care they need,” said Dr. Green. “It is their primary responsibility to ensure every piece of their care is coordinated including discussing their care with the appropriate specialties in the hospital, mobilizing the patient, discussing care options with family members, and working to get the patient returned to their home hospital as soon as they are ready.”
Prior to the implementation of the QEII Inpatient Trauma Consult Service, the care of admitted trauma patients would be provided by health care providers with varying expertise in trauma care. The new model considers space challenges within the system and also ensures that trauma patients are receiving the appropriate care from health care providers who specialize in trauma medicine and support the patient’s entire care team through their recovery journey.
For the last 20 years, extensive data has been collected on all major trauma patients across the province. Evaluation these variables has formed the cornerstone of how trauma care is now delivered in the province.
“We regularly review our patient data and look at trends and outcomes which help us determine our policies and protocols, while guiding us in our research studies and clinical care.” explained Dr. Green.
Trauma Nova Scotia has launched a longitudinal survey to evaluate the success of the new consult service. Any health care provider, family member, or patient who has connected with the consult team completes the survey to provide feedback on the program. Results are showing the program has been a success and the team is also using this feedback to identify even more ways to improve care.
“As a team, we review the completed surveys on a weekly basis. These surveys show us that we are having an extremely positive impact, and the comments are beneficial to identify opportunities to improve the care we are providing,” explained Cashen. “Our practitioners want feedback so that we can pivot if needed. The positive feedback we collect is gratifying and demonstrates we are making a big difference in the health care system. We are optimistic about the future.”
One of the challenges identified in the surveys is the need to better mobilize patients, a crucial element in the patient’s recovery.
“Capturing that data allows for discussions on where resources need to be allocated.” said Dr. Green.
As a physician who specializes in trauma medicine, Dr. Green works a demanding schedule treating patients with an injury that can lead to prolonged disability or death. The number of major trauma injuries increases 5 per cent per year and 58 per cent of major trauma patients in Nova Scotia are a result of motor vehicle collisions. Dr. Green stresses the importance of having patience while you drive and eliminating distractions, including eating, and using cellphones while driving, and most importantly, not driving while under the influence of drugs or alcohol.
