The South Island Alliance Major Trauma Workstream hosted trauma care specialists from around the South Island for the Trauma South 2019 Conference in Dunedin on 5 September.

The main themes of the conference included sharing learning from the mass casualty response in Christchurch, to progressing trauma system development in New Zealand.

A number of speakers from Christchurch shared their experiences, and explored ways to improve trauma care across New Zealand.

Registrations are now open for Trauma South 2019 – the South Island trauma conference.

Every year in New Zealand, an estimated 1,800 people die from trauma – and mostly before they get to a hospital. For those who survive, their injuries can have a profound and lasting impact on their life. Injured patients stand the best chance of making a good recovery if the trauma system performs well. In support of this, a national database – the Major Trauma Registry – has been established and all DHBs are required to submit their major trauma data.  The northern regions have been leading the way, but the South Island is catching up quickly, with all of the main hospitals now having trauma nurse coordinators in place.

Initially, their role is to gather and record information into the database, as well as help with aspects of patient care.  Ideally, as DHBs devote more resources to improving trauma services, the nurse’s role may extend to include more focus on following patients throughout their recovery – including linking them to social services and other resources. Already, the information being collected in South Island hospitals is giving great insight of the extent of trauma in the region and will lead to improved patient care and more efficient processes within the hospitals.

Below, the seven South Island trauma nurse coordinators discuss their new roles and talk about their vision for trauma care.

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Melissa Evans
Christchurch Trauma Nurse Coordinator, Canterbury DHB

I follow patients from a trauma call (initial presentation in ED) through until discharge, which means sometimes I’m the only constant person a patient sees throughout their admission. I like that this role is so broad. I do the data entry, code patients, trouble shoot, review medical images and blood tests, and work closely with all areas in the hospital – not just medical. I like that I am making a change to how trauma patients are being cared for and some initiatives have crossed over to non-trauma patients as well.Compared with the rest of the world, trauma nurse coordinators are relatively new in New Zealand. I like that we are paving the way for a new service within the DHBs. With the changing face of nursing, the role of a TNC could extend to advanced nursing practice and hopefully trauma nurse practitioners who can work alongside the doctors in managing the care of patients in a holistic way.

Claire Hitchcock
Resuscitation and Trauma Nurse Coordinator, Wairau Hospital and Nelson Hospital, Nelson Marlborough DHB.
My role involves coordinating the care and treatment of people admitted to hospital following any kind of trauma resulting in injury. By ensuring best practice, I strive to improve outcomes, reduce complications and decrease length of stay in hospital.I collect data for the National Trauma Registry and DHB. Whilst it may be impossible to eradicate trauma and injury, it’s my vision to be actively involved in advancing and developing trauma care and promoting best practice in Nelson Marlborough DHB.I am new to this role and have a great opportunity to develop our processes and procedures to make a real difference in trauma care. I am lucky to be part of a team of trauma nurse coordinators around the country, who are passionate about trauma care and research.

Gordon Speed
Trauma Nurse Coordinator, Dunedin Hospital (shared role with Fiona Thomas), Southern DHB
I am new to this role, after many years working in intensive care. The service in Dunedin is also new and we are busy setting up our systems and finding out what is useful. Our first major goal is getting the data collection well organised and gathering useful information.My vision for trauma care is to have a clear and consistent service that improves the outcomes for people who have suffered trauma in our district. This role is a great new challenge and I enjoy starting a new service that can really improve quality for people and hopefully I’ll see the difference that I can make. The trauma nurses are a wonderful group and are being really supportive for our new service – my thanks go out to all of them.

Fiona Thomas
Trauma Nurse Coordinator, Dunedin Hospital, Southern DHB
I’ve recently started this role and with a multitude of ideas and a ton of enthusiasm, I’ve had to take time to learn and prioritise some of these ideas. Building on existing relationships has been important in identifying gaps in the trauma patient’s journey through the hospital system. Emphasis has mainly been on developing efficient systems and processes to collect quality trauma data, as over time, this data will be a vehicle to improve, develop and lead change to meet the needs of trauma patients in the southern district.My vision is to work as part of the trauma service team throughout the hospital, to ensure care for trauma patients follows agreed guidelines, is comprehensive, coordinated and timely. I would also like to ensure a collaborative approach supports the care of trauma patients in our rural regions, especially major trauma patients in their journey to Dunedin Hospital.The amazing work done by fellow trauma nurse coordinators has been inspiring and their kindness in sharing their knowledge and experience has been very much appreciated.  Although we work mostly autonomously, I like how we’re working together as a team to support, share ideas and contribute to trauma care within New Zealand.

Rebecca Coats
Trauma Nurse Coordinator, Invercargill Hospital, Southern DHB
I‘ve been enjoying the challenge of developing this exciting new role within Southland Hospital, which involves data collection, AIS coding, trauma registry data entry, major trauma patient clinical review, chair of the hospital committee meeting, and I am also the promoter and co-presenter of the trauma morbidity and mortality meetings.The trauma nurse coordinator role is in its infancy in the South Island, and our North Island and Australian colleagues have provided support, encouragement and resources to those of us in the south.It’s my vision that the Southern DHB trauma nurse coordinator will be working to full potential, completing all these key role functions in their everyday work, and that this role will be recognised by the DHB as a Clinical Nurse Specialist position, as it is with our North Island colleagues.  The role enables a ‘panoramic view’ of the patient’s trauma journey, from injury site to rehab, thus removing the traditional silo approach to health care.

Lynette Skeats
Trauma Nurse Coordinator, Grey Base Hospital, West Coast DHB
My role is eight hours per week and is predominantly data collection for the national registry. I aim to get accurate and meaningful trauma data from the West Coast. My background is intensive care/high dependency.I also hope to get a trauma committee up and running and from there develop some longer term goals that align with national trauma goals and also reflect how we manage trauma in an isolated rural area.

Megan Stark
Trauma Nurse Coordinator, Timaru Hospital, South Canterbury DHB
I work six hours per week as the Southern Canterbury DHB trauma nurse coordinator.  This is a newly established role and has a varied workload.  I, along with the trauma lead clinician Dr Peter Doran, record and input data on major trauma admissions to Timaru Hospital.We have established a trauma committee looking at our management of trauma admissions. The first major achievement has been setting up a trauma call system and development of local guidelines for procedure management. My vision for trauma care is to ensure all trauma admissions receive high quality, timely, seamless health care and that the data can identify risk areas/populations that may benefit from prevention strategies.

Wendy Davie,Trauma Nurse Coordinator, Canterbury DHB
Ensuring the best outcomes for the patients that come through Christchurch Hospital with any trauma is a key driver of mine in my role. We are a small but strong team who work cohesively to ensure excellent care of trauma patients. My role varies daily from data collection, attending trauma calls, coordinating care through various teams, reviewing patients imaging and test results as well as daily rounds to all major trauma patients in the hospital.I have a background in emergency nursing, as well as experience in strategy, project and programme development, through roles I’ve held with NZ Red Cross and The Cancer Society. As well as a special interest in organisation, process and time management. Being part of the network of Trauma Nurse Coordinator’s here in New Zealand is a privilege at this exciting time in the development of trauma services.

Donna Schrader, Trauma Nurse Coordinator, South Canterbury DHB
I have taken over the role of Trauma Nurse Coordiator in South Canterbury DHB from Megan Stark, who did a great job of establishing this role. Due to the increase in major trauma in South Canterbury the role has been increased to eight hours/week. I also work two 12-hr shifts in ED, which compliments the trauma role.I have been enjoying the challenge of this role and being involved with the Trauma committee, dealing with education of staff, running trauma scenarios, working with SMOs in ED, and especially the support of other TNC (esp Mel in ChCh). My vision is to continue with the high quality of care that is given to trauma patients, and to promote best practice in South Canterbury.

Every year in New Zealand, an estimated 2,000 people are admitted to hospital with major trauma. For those who survive, their injuries can have a profound and lasting impact on their life. A recent event in Southland aims to enhance the quality of care for trauma patients by bringing together health professionals from across the sector to learn, share and discuss new developments and best practice in trauma care.

Almost 80 health professionals from across the sector attended the first ‘Southland Trauma Symposium’ in Invercargill, including representatives from St John, Southland Hospital and Dunedin Hospital, as well as a number from rural hospitals and regions.Presentation topics by keynote speakers and specialists included new developments in trauma, ACC statistics and rehabilitation, patient and family perspectives, as well as trauma complications. Chair of the National Trauma Network, Professor Ian Civil, was one of the speakers.

The symposium, held on 28 November, was focused on educating clinicians to increase their knowledge and provide better care to trauma patients, whether in hospital or at the scene of an accident, says trauma nurse coordinator and organiser of the event, Rebecca Coats. “It’s about understanding how to apply this knowledge in a clinical context, as well as keeping up-to-date in current best practice.“Education is absolutely vital in gaining knowledge – but the symposium was about so much more than that. It was about building relationships, networking with other colleagues and strengthening the bond that exists between primary and tertiary healthcare providers.”

Rebecca says response to the event was overwhelming. “This was the first symposium for Southland and it was a huge success. The speakers were of high calibre and we received extremely positive feedback following the event.  It’s anticipated there will be more planned for 2017 and beyond.” The South Island Major Trauma Workstream supports the initiative and will encourage the symposium model in other South Island districts next year.

Waiting times for patients being transferred between South Island hospitals have been significantly reduced, as part of a regional agreement with St John.The arranged transfer of non-acute patients between hospitals previously relied on the availability of St John ambulances at the time of a request for a patient transfer. Following the new regional agreement, dedicated St John ambulances are available for inter-hospital transfers within agreed scheduled hours for each South Island DHB.

The agreement was facilitated by the South Island Support Services Service Level Alliance – part of the South Island Alliance, a collaboration between the five South Island DHBs.Ambulance journeys can now be planned to tie in with services at receiving hospitals, says Christine Nolan, acting General Manager of Nelson Marlborough DHB. “Prior to this agreement, patients had to queue and wait for an ambulance to become available. Some DHBs had their own agreement with St John, while others had no formal agreement in place for some time.

“Instead of invoicing for every single trip and every patient, we decided to focus on a scheduled 24-hour travel arrangement between hospitals. We knew that with some careful planning, we could provide a service to best meet patients’ needs, as well as reduce travel costs and save time.”

The agreement has already proven to increase efficiencies for both parties, says Christine. “St John is now able to provide staff and vehicles on a dedicated scheduled basis with the benefit to St John of a three year agreement. Patients no longer have to wait, and several vehicles are capable of transporting three patients at a time. As a result, our coordination has improved across the South Island.”

Chrissie Cope, St John Service Change Manager of the South Island says attempting to respond to short notice requests was challenging. “Now, we turn up at a prescribed time and the DHBs have been working internally to improve communication and planning. It’s a win/win all round, with patients firmly at centre.”

During the planning process, the number of anticipated journeys and kilometres St John travelled per annum was calculated, and a fixed cost has been set across the region so the service can maintain the required resources. By having a set annual cost for the service, irregular invoicing and payments have also been eliminated.Rosalie Waghorn, Nurse Manager Clinical Services at Grey Base Hospital for the West Coast DHB, says the new service has been a very positive experience from a nursing and patient point of view.

“Prior to this agreement, we would have to ring St John to see when an ambulance would become available and then call around our nurses to see who could coordinate with that time – it was quite ad hoc. Now, we have an ambulance and a driver here every day at 10am to leave for Christchurch.”

After the service began, three nurses were employed to share the transfer roster to travel with the patients, Rosalie says.  “We decided to train our nurses to become prime responders, to enhance their skills should the patient deteriorate on the trip or if they are called as first responders to any events whilst on the road. We have also developed documentation to allow for better handovers between nursing staff at each end of the transfer.”