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Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
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Cambridge Polytrauma Pathway: Are we making appropriately guided decisions?

William Wynell-Mayow1, Borna Guevel1, Benjamin Quansah1

  • 1Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge CB2 0QQ, UK.

Injury
|August 7, 2016
PubMed
Summary

Implementing the Cambridge Polytrauma Pathway improved early appropriate care for major trauma patients. Key improvements included better recording of lactate and fibrinogen levels, enhancing patient management in orthopaedic polytrauma cases.

Keywords:
Early appropriate careMajor trauma centreMultidisciplinary teamOrthopaedicsPolytrauma

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Area of Science:

  • Trauma Surgery
  • Orthopaedic Surgery
  • Critical Care Medicine

Background:

  • Major trauma care requires timely and coordinated multidisciplinary interventions.
  • Existing care pathways may not fully optimize Early Appropriate Care (EAC) for complex orthopaedic polytrauma.
  • Addenbrooke's Hospital serves as a Major Trauma Centre for the East of England Trauma Network.

Purpose of the Study:

  • To devise and implement the Cambridge Polytrauma Pathway to enhance Early Appropriate Care for orthopaedic polytrauma patients.
  • To audit the pathway's impact on key performance indicators, including diagnostic imaging, laboratory monitoring, and surgical intervention timing.
  • To assess the feasibility of introducing outcome scoring systems like GOS-E or EQ-5D for future evaluation.

Main Methods:

  • Development of the Cambridge Polytrauma Pathway based on NCEPOD guidelines, literature review, and expert consultation.
  • Initial audit of 59 orthopaedic polytrauma patients (2013-2013) followed by pathway implementation.
  • Re-audit of 15 patients (2014-2015) to evaluate pathway effectiveness, comparing pre- and post-implementation data.

Main Results:

  • Significant improvements in the recording of lactate and fibrinogen levels on admission and preoperatively (p<0.000 to p=0.015).
  • Time to full body trauma CT scan remained unchanged (median 0.53h), indicating consistent diagnostic throughput.
  • Reduction in out-of-hours definitive orthopaedic interventions from 8 to zero, with decisions shifted to daytime multidisciplinary meetings.

Conclusions:

  • The Cambridge Polytrauma Pathway successfully improved adherence to Early Appropriate Care principles in orthopaedic polytrauma.
  • Enhanced monitoring of key biochemical markers and a shift towards daytime multidisciplinary decision-making were key achievements.
  • The pathway is anticipated to improve patient outcomes, with recommendations for standardized outcome assessment using GOS-E or EQ-5D.