2014-15ANNUAL REPORTBAY OF PLENTY • LAKES • HAUORA TAIRA-WHITI • TARANAKI • WAIKATO

2

Executive Summary 4

Our People 5

MTS philosophy 5

Our Ethos 5

Our Vision 5

Our Mission 5

Key Objectives 5

Structure and Function 5

Operational model 6

MTS Trauma Research Centre 7

Key regional studies completed or in progress for 2015-16 7

This report 7

Quality Improvement Model 8

Data Qualifications 9

Terminology 9

Disclaimer 9

Demographics and Injury Event 10

Age 10

Major and minor trauma in 5-year age bands: 2014 10

Trauma events in 2014 by domicile in census area units 10

Child trauma events (0-14 years) by domicile in census area units 11

Trauma events in older people (65+) by domicile in census area units 11

Gender 12

Percentage of Trauma Events by Gender 12

Percentage of Trauma Events by Age Group for Males: Expected versus Observed 12

Percentage of Trauma Events by Age Group and MTS Hospital for Females: Expected versus Observed 13

Observed vs. Expected 14

Number of Minor Events by Age Group: Expected versus Observed 14

Number of Major Events by Age Group: Expected versus Observed 14

Severity 15

Number of Trauma Events by Severity, Age Group and Gender 15

Number of Critical Trauma Events (ISS>25) by Age Group and Gender 15

Ethnicity 16

Number of Events by Ethnicity 16

Māori patients: distribution of trauma events by census area unit in 2014 16

Trauma rates for Māori, standardised by population size. 17

Minor trauma, Māori 17

Major trauma, Māori 17

Mechanism 18

Percentage of Minor Trauma Events by Mechanism 18

Percentage of Major Trauma Events by Mechanism 18

TABLE OF CONTENTS

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Type of Injury 18

Percentage of Trauma Events by Severity and Type of Injury 18

Hospital Volumes and Outcomes 19

Number of Trauma Events and Admissions by MTS hospital 19

Events by Month 19

Events by Day of Week 19

Number and percentage of Minor Trauma Events by Day of Week 20

Number and percentage of Major Trauma Events by Day of Week 20

Number of Minor Trauma Events by Day of Week and Mechanism 21

Bed Days 22

Hospital Bed Days by MTS Hospital 22

Trauma Injury Severity Score (TRISS) 23

Number of Events with a TRISS Score Calculated, by Type of Injury and Outcome 23

Number of Events with no TRISS Score Calculated, by Type of Injury and Outcome 23

Injury Severity Score versus Predicted Probability of Survival (TRISS Score) by Outcome 23

Percentage of Trauma Events by Severity and Outcome 23

MTS Process Indicators 24

Pre-hospital intubation if GCS < 9 24

Average time from arrival to index CT scan 24

Mortality rate, by first arrival facility 24

Time from admission to particular surgical procedures 25

MTS Targets to 2018 26

Operational Targets 26

Clinical Targets 26

System Targets 26

Population Targets 26

4

Trauma continues to have a major impact on Midland communities, resulting in 5980 admissions in 2014 and 23,839 hospital bed days. The cost of this to the hospitals alone is estimated at over $43m – the intangible costs to patients and families is enormous.

After 5 years of sustained clinical effort, data collection, and data platform building, Midland Trauma System (MTS) is now entering its output phase wherein we can use our clinical network and the information we have gathered to reduce the burden of trauma on the community, both in prevention, and in improving our responses at the point where prevention fails.

There has been significant progress in the high-level support for MTS in 2015: The MTS business case for 2015-2017 was endorsed by the Midland DHBs, enabling us to optimise our staffing levels and technical data solutions until July 2017; MTS has been given priority status in the Midland RSP, and we have developed and implemented a state-of–the art web-based trauma registry.

The MTS registry is hosting the National Major Trauma Minimum Dataset from DHBs across New Zealand. We are helping other services and systems in New Zealand to get up and running as the Major Trauma Network Clinical Network (MTNCN) develops. MTS now uses ISS > 12 as the threshold for major case definition.

Midland Trauma Guidelines and Matrices are in use and will be continuously assessed and fine-tuned as we track process indicators in the registry. MTS is holding its first symposium in May 2016; titled Understanding Trauma: Bridging the gaps.

As part of our transition into “output” mode we have implemented data visualisation tools to give the MTS teams direct access to their own data in user-friendly formats that can translate directly into knowledge sharing and action. We are developing a relational data warehouse linked with the registry that will have real-time access and data-matching capability. This will provide exciting opportunities for MTS to supply key information to service providers and community health groups that will enable them to accurately target and resolve issues in prevention and care.

The Midland Trauma Research Centre (MTRC) maintains our “Patients First” ethos and will prioritise work to address problems we identify from the registry data, tempered by the needs of our community. The centre will be the touchpoint for a wide range of organisations to access and analyse data.

As always, our most important function is to maintain our consistent contact and support for our trauma patients and families as they move through their clinical journeys. This is our core business, and one that MTS staff perform do with determination, commitment and skill; work that is often unobserved and challenging but remains critically important.

We are pleased to present this year’s annual report for the MTS.

Grant ChristeyDirector of MTS

EXECUTIVE SUMMARY

4

5

Our Ethos

PATIENTS COME FIRSTOur VisionThe burden of trauma on the Midland community will be reduced by our activities.

Our MissionTo lead trauma quality improvement activities across multiple groups and to support others outside Midland to do the same.

Key Objectives• To enable provision of highest quality trauma care focussed on the needs of patients

• To improve patients’ journeys by encouraging collaboration between all trauma care providers

• To develop a trauma quality improvement program based on trauma registry data

• To ensure that stakeholders are informed of MTS activities and progress

• To ensure adequate resourcing and sustainability of MTS

• To engage a wide range groups in a community-focussed research centre

• To enable direct and meaningful access of regional MTS teams to trauma-related information about their own communities

MTS PHILOSOPHY

OUR PEOPLE The Clinical Teams Tairawhiti: Susan Pulman, Ric Cirolli, Steve HudsonTaranaki: Paula Turner, Glenn Farrant, Grant LookerLakes: Cherry Campbell, Ulrike BuehnerBay of Plenty: Katrina O’Leary, Barnaby SmithWaikato: Jenny Dorrian, Ruwan Paranawidana, Grant Christey

The Hub TeamAlaina Campbell, Kristy Medd, Thilini Alwis, Steve Holmes, Carol Munt, Grant Christey

mrts@waikatodhb.health.nz

mts@waikatodhb.health.nz

+64 7 839 8904

5

MTS is a network of specialised, clinical personnel committed to ensuring application of best practice in trauma care across the Midland Region. Clinical staff members perform clinical risk assessment and mitigation, data collection and facilitate local trauma committees to enable quality improvement initiatives. MTS members contribute to national and international bodies engaged in trauma system development and quality improvement

The hub group, based at Waikato DHB, manages the regional database, develops trauma guidelines and transfer protocols, and supports the activities of MTS clinicians and the Midland Trauma Research Centre (see operational model).

MTS has a profile in the Midland Regional Services Plan and isgoverned by a strategic group that has representation from all Midland DHBs across multiple levels.

STRUCTURE AND FUNCTION

6

OPERATIONAL MODEL

7

The MTRC has been established to guide the outputs of the MTS database so that it delivers maximal benefits to the community. It maintains representation from a range of medical and non-medical groups that can help define priorities for research and dissemination of information. The ethos of the centre aligns with that of MTS as a whole: research work will be focussed primarily on the needs of the community. Our Triple Aim strategic plan provides a framework for prioritisation of work.

The centre will develop expertise in data management and advanced analytics to help us answer questions about trauma and will communicate this information in a way that is meaningful and relevant. Academic rigour will be applied to all work so that anything we produce will be of the highest quality. This gives users the confidence that the information they are using to induce positive change is representative and reliable.

Key regional studies completed or in progress for 2015-161. Paediatric Trauma

2. Trauma in Older Persons

3. Trauma by Ethnicity

4. Rural Trauma

5. Traumatic Brain Injury

6. Spinal Injury

7. Paediatric TBI

8. Neurotrauma Transfer Efficiencies

MIDLAND TRAUMA RESEARCH CENTRE

7

Information is presented in two main sections: the first for patient demographics and event information, including infographics; the second representing hospital volumes and outcomes.

THIS REPORT

1. Demographics and Event InformationAge

Gender

Ethnicity

Mechanism

Type of Injury

2. Hospital Volumes and Outcomes Volumes: Events and Admissions

Severity

By Month

By Day of the Week

Hospital Bed Days

ICU Bed Days

Length of Stay

Outcomes: TRISS and Mortality

8

PopulationMonitoringPrevention

Equity

SystemContinuous Service Integration and Optimisation

Cost EffectivenessGovernance

IndividualPatient experience

Quality of CareSafetyTQIP

Registry: the measurement

TraumaRegistry

TQUAL

Clinical teamsAction: Data, collaboration

Guidelines: the standard

iPMReporting

Cost-proResearch

GISKPIs

ACCSystem Analyses

Others Clinical support

QUALITY IMPROVEMENT MODEL

9

TERMINOLOGYTerm DescriptionEvent An event refers to the occurrence of a single injury incident

Admission An admission refers to a period of occupancy of a patient in an inpatient bed excluding Emergency Department

Length of Stay (LOS) The length of stay of a patient is the length of time from admission date to final discharge date.

Severity The Injury Severity Score (ISS) 1, 2 is calculated from Abbreviated Injury Scale (AIS) 3, 4, 5 for single injuries. A score of greater or equal to 13 is reported as a major trauma case, a score of less than 13 is reported as a minor trauma case. AIS is the international standard for injury scoring

Mechanism The mechanism is the means by which injury occurs e.g. road traffic crash (RTC)

Type of Injury Blunt, Penetrating or Burn

Outcome Outcome is alive or dead at eventual discharge

Trauma Injury Severity Score (TRISS)

The TRISS is the predicted probability of survival. This is calculated for major trauma events

Expected Expected calculations are based on population demographics supplied by Statistics New Zealand to District Health Boards

Incidence Incidence rates of injury are calculated as events per 100,000 people per year resulting in hospital admission

Observed Population Demographics

Observed is the analysis based on the data in the MTS registry. The population demographics of the hospital have been used as a comparison

1 Baker SP, O'Neill B, Haddon W, Long WV, The Injury Severity Score: Development and Potential Usefulness, Proceedings, Association for the Advancement of Automotive Medicine 18: 58-74, 197

2 Baker SP, O'Neill B, The Injury Severity Score: An Update, J Trauma 16: 882-885, 1976.3 Rating the severity of Tissue Damage. The Abbreviated Injury Scale, JAMA 215(2):277-280, 1971.4 Petrucelli E, States JD, Hames LN, The Abbreviated Injury Scale: Evolution, Usage and Future Adaptability Accid. Anal.& Prev. 13: 29-35, 1982.5 Champion HR, Copes WS, Sacco WJ, et al. The Major Trauma Outcome Study: Establishing National Norms for Trauma Care, J Trauma 30

(11), 1356-1365, 1990.

Date Range is 1st January to 31st December 2014 (except where multi-year data are presented).

DATA QUALIFICATIONSMTS Hospitals

• These are hospitals that submit trauma data to the MTS registry. They include Waikato, Tauranga, Whakatane, Rotorua and Taranaki Base Hospital.

• Note that both Whakatane and Tauranga hospitals contribute to Bay of Plenty DHB data.

• Gisborne Hospital (Tairawhiti DHB) commenced data collection July 2014 hence some estimates have been made and described in the analysis.

Trauma Events• Events have been used as the measure for patient-

related statistics, such as demographic profiling and assessment of community risk factors for injury.

• Trauma events are grouped to the first MTS hospital the patient was admitted to.

Trauma Admissions• An admission occurs where a patient attends Emergency

Department and then moves on to an inpatient area in the same hospital.

• Admissions are used as a measure of hospital-related statistics, such as average length of stay, and other measures that quantify the impact of a trauma event on a hospital’s resources.

MTS Inclusion Criteria• Admission to an in-hospital bed within 7 days of injury.

MTS Exclusions• Insufficiency fractures: osteoporotic, osteopoenic,

metastatic, pathological. This includes fractured neck of femur, fractured neck of humerus, Colles’ fracture.

• Peri-prosthetic fractures.• Exertional injuries: e.g. tendon rupture not associated

with external force.• Hanging, drowning, asphyxiation, poisoning without

evidence of external force.• Ingested foreign body.• Injury as a direct result of pre-existing medical conditions

e.g. epilepsy, syncope, Parkinson’s, etc.• Injury sustained is out of proportion to the force applied

because of an underlying medical condition.• Those patients admitted to a hospital bed and

discharged for elective surgery follow up will be marked as interval surgery on discharge and not recollected when readmitted; i.e. one event = one trauma number. The registry is for acute admissions only.

• MTS uses ICD10-AM and AIS 2005-08 update.

Disclaimer: for the purpose of this report it is assumed information has been provided to and recorded by MTS accurately and consistently.

10

The primary discriminators in the analyses are Age, Gender, Ethnicity and Mechanism. Severity is determined by Injury Severity Score (ISS). Minor is ISS12. Map densities are in count per 100,000 persons.

Age Detailed analyses of demographic and injury patterns in the Census Area Units (CAUs) enables detailed understanding of groups at risk of injury that may be amenable to prevention.

Major and minor trauma in 5-year age bands: 2014

DEMOGRAPHICS AND INJURY EVENT

13 11 8 25 28 19 11 19 28 14 28 29 24 18 19 16 7 11 5

316

395 371

407 362

312

255 243 257

245 256

217 228

180 164

109 101 89

60

050

100150200250300350400450500

00-0

4

05-0

9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85-8

9

90+

Major Minor

Events69.8 - 87

52.6 -

11

Trauma events in older people (65+) by domicile in census area unitsNote – Map densities are in count per 100,000 older persons.

Child trauma events (0-14 years) by domicile in census area unitsNote – Map densities are in count per 100,000 children.

Events19.4 - 24

14.8 -

12

GENDERPercentage of Trauma Events by Gender

0

20

40

60

80

100

120

140

160

00-0

4

05-0

9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85-8

9

90+

Num

ber o

f tra

uma e

vent

s

Expected Observed

Percentage of Trauma Events by Age Group and MTS Hospital for Males: Expected versus ObservedNote – Bay of Plenty includes Tauranga and Whakatane events.

Major (ISS > 12) Minor (ISS < 13)Arrival Facility Male Female Male FemaleGisborne Hospital 85.7% 14.3% 63.8% 36.3%

Rotorua Hospital 72.7% 27.3% 68.8% 31.2%

Taranaki Base Hospital 77.8% 22.2% 65.3% 34.7%

Tauranga Hospital 62.2% 37.8% 61.5% 38.5%

Waikato Hospital 70.5% 29.5% 63.1% 36.9%

Whakatane Hospital 78.9% 21.1% 55.9% 44.1%

Grand Total 70.3% 29.7% 63.2% 36.8%

Waikato Male (n=1283)

0 10 20 30 40 50 60 70 80 90

100

00-0

4

05-0

9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85-8

9

90+

Num

ber o

f tra

uma e

vent

s

Expected Observed

Bay of Plenty Male (n=990)

0

5

10

15

20

25

30

35

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Num

ber o

f tra

uma e

vent

s

Expected Observed

Taranaki Male (n=309)

0

10

20

30

40

50

60

00-0

4

05-0

9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85-8

9

90+

Num

ber o

f tra

uma e

vent

s

Expected Observed

Lakes Male (n=429)

02468

1012141618

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Num

ber o

f tra

uma e

vent

s

Expected Observed

Tairawhiti Male (n=108)

13

Percentage of Trauma Events by Age Group and MTS Hospital for Females: Expected versus ObservedNote – Bay of Plenty includes Tauranga and Whakatane events.

Gender age-group distribution shows over-representation in males from 15-24 years and in females at extremes of age – 0-9 years and over 70s, particularly in Bay of Plenty and Taranaki.

0 10 20 30 40 50 60 70 80 90

00-0

4

05-0

9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85-8

9

90+

Num

ber o

f tra

uma e

vent

s

Expected Observed

Waikato Female (n=729)

0

10

20

30

40

50

60

00-0

4

05-0

9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85-8

9

90+

Num

ber o

f tra

uma e

vent

s

Expected Observed

Bay of Plenty Female (n=641)

02468

10121416

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Num

ber o

f tra

uma e

vent

s

Expected Observed

Taranaki Female (n=159)

0

5

10

15

20

25

00-0

4

05-0

9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85-8

9

90+

Num

ber o

f tra

uma e

vent

s

Expected Observed

Lakes Female (n=193)

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00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Num

ber o

f tra

uma e

vent

s

Expected Observed

Tairawhiti Female (n=59)

13

14

This is derived from comparison of actual versus expected number of events from the same rate applied to each age group. “Expected” is the same number of trauma events applied equally across population age groups. The gap between the “observed” line and the population size bar shows a higher or lower incidence of trauma in that age group.

OBSERVED VS. EXPECTED

Number of Minor Events by Age Group: Expected versus Observed

050

100150200250300350400450

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Num

ber o

f tra

uma e

vent

s

Expected Observed

Number of Major Events by Age Group: Expected versus Observed

0

5

10

15

20

25

30

35

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Num

ber o

f tra

uma e

vent

s

Expected Observed

Note that for minor events the trauma rate is higher in the 5-34 years ages. For major events there are peaks for 15-24 year-olds, 40-44 year-olds and 55+. There is a major peak in older females >75.

15

SEVERITYNumber of Trauma Events by Severity, Age Group and GenderNote – scales are different.

0

50

100

150

200

250

300

350

400

450

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Minor trauma: ISS < 13

Female Male

0

5

10

15

20

25

30

35

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Major trauma: ISS < 12

Female Male

Minor trauma (ISS12) accounts for 25) shows the same trimodal pattern as major trauma but with lower volumes and fewer patients in the 0-9 age group. This possibly reflects direct referrals to Starship Hospital.

Number of Critical Trauma Events (ISS>25) by Age Group and Gender

0

1

2

3

4

5

6

7

8

9

00-04

05-09

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Severe trauma: ISS > 25

Female Male

16

Events32.7 - 39

26.3 -

17

Trauma rates for Māori, standardised by population sizeColour scale is applied across all DHBs within either Major or Minor trauma categories.Tairawhiti collected data for the latter half of 2014.Rate is expressed as events per 1,000 of population within this ethnic group.

Minor trauma, Māori (Minor trauma: ISS > 13)

Major trauma, Māori (Major trauma: ISS > 12)

N = 17 N = 45 N = 5 N = 18 N = 5 N = 18 N = 1 N = 6 N = 44 N = 123

Bay of Plenty Lakes Tairawhiti Taranaki WaikatoAge group Female Male Female Male Female Male Female Male Female Male

00-04 0.6 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.305-09 0.0 0.3 0.0 0.5 0.0 1.5 0.0 0.0 0.0 0.210-14 0.4 1.0 0.5 0.0 1.7 0.0 0.0 0.0 0.2 0.415-19 0.4 0.7 1.2 1.6 3.8 5.4 0.0 0.0 0.6 1.120-24 1.0 2.7 0.0 0.0 0.0 0.0 0.0 0.0 0.7 1.625-29 0.6 2.8 0.0 1.0 0.0 3.4 0.0 0.0 0.3 1.730-34 0.6 3.0 0.9 0.0 2.9 0.0 0.0 3.5 0.4 1.835-39 0.6 3.6 0.0 0.0 0.0 0.0 0.0 0.0 0.3 1.440-44 0.0 3.4 0.0 3.0 0.0 9.5 1.5 0.0 0.4 2.045-49 0.6 2.1 0.0 2.1 0.0 6.9 0.0 0.0 0.5 1.650-54 0.6 0.7 0.0 3.3 0.0 10.3 0.0 5.3 0.3 2.155-59 2.9 2.5 1.1 2.5 3.3 7.3 0.0 0.0 1.1 1.760-64 0.9 5.3 0.0 0.0 0.0 0.0 0.0 0.0 0.7 2.065-69 0.0 0.0 0.0 5.0 0.0 13.3 0.0 0.0 0.3 0.870-74 0.0 4.1 0.0 3.3 0.0 10.0 0.0 0.0 0.5 2.375-79 2.9 0.0 0.0 0.0 0.0 0.0 0.0 11.1 0.8 1.080-84 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.085-89 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 6.390+ 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

N = 322 N = 628 N = 150 N = 316 N = 39 N = 78 N = 36 N = 110 N = 837 N = 1741

Bay of Plenty Lakes Tairawhiti Taranaki WaikatoAge group Female Male Female Male Female Male Female Male Female Male

00-04 13.7 19.5 13.0 16.5 11.3 4.7 4.1 4.7 10.5 12.905-09 17.4 20.9 15.2 22.3 6.3 13.6 3.3 7.9 11.3 14.110-14 9.5 25.4 5.9 18.4 10.3 15.4 2.7 8.0 6.9 16.215-19 11.0 29.5 8.1 20.3 7.5 18.0 6.0 16.5 7.5 19.920-24 12.1 42.8 8.0 22.2 4.7 28.9 2.7 25.8 6.6 26.625-29 12.8 41.0 4.0 25.5 7.2 27.6 1.4 23.1 6.4 25.730-34 8.6 37.8 9.9 26.5 5.7 18.5 9.8 10.5 7.4 23.235-39 10.3 20.0 3.6 15.9 2.9 27.6 3.2 10.2 5.2 17.240-44 10.6 20.5 5.3 28.0 2.5 9.5 0.0 7.9 6.2 17.545-49 8.6 20.0 4.4 14.4 5.5 6.9 1.8 11.1 5.7 12.950-54 10.8 12.2 10.6 12.1 5.7 13.8 3.5 5.3 6.6 10.955-59 10.8 12.7 6.5 11.4 0.0 3.6 2.2 7.1 5.8 8.060-64 8.5 11.6 7.5 5.2 8.3 0.0 3.2 0.0 5.5 7.965-69 6.8 10.0 6.5 7.5 0.0 6.7 4.0 4.2 5.6 7.870-74 7.5 8.2 2.9 13.3 8.7 10.0 0.0 0.0 4.1 8.075-79 23.5 24.1 0.0 0.0 0.0 16.7 8.3 0.0 7.9 10.280-84 12.0 14.3 0.0 0.0 16.7 0.0 0.0 0.0 4.9 3.785-89 11.1 25.0 0.0 0.0 0.0 0.0 0.0 0.0 3.0 12.590+ 0.0 0.0 0.0 0.0 10.0 0.0 0.0 0.0 25.0 0.0

18

MECHANISMPercentage of Minor Trauma Events by Mechanism

Percentage of Major Trauma Events by Mechanism

Road traffic crash accounts for 52.5% of all major trauma, including 16.5% from motorcycle crashes and 7.2% from heavy transport, peaking in Rotorua. Extreme rates of car and van crashes are seen in Gisborne. High rates of serious assault are seen in Whakatane, Taranaki, Rotorua and Gisborne. Bicycle crash rates are high for both minors and majors in Rotorua. Self-harm peaks in Taranaki. Serious pedestrian injuries peak in Whakatane and Taranaki.

TYPE OF INJURYPercentage of Trauma Events by Severity and Type of Injury

Mechanism Gisborne Rotorua Taranaki Tauranga Waikato Whakatane Grand TotalOther car/van crash 57.1% 18.2% 14.8% 24.3% 34.1% 26.3% 28.8%

Falls 14.3% 12.1% 11.1% 23.0% 17.9% 15.8% 17.7%

Motorcycle crash 14.3% 21.2% 11.1% 10.8% 19.1% 15.8% 16.5%

Heavy vehicle crash 0.0% 15.2% 11.1% 5.4% 5.8% 10.5% 7.2%

Pedestrian accidents 0.0% 0.0% 11.1% 6.8% 6.4% 15.8% 6.6%

Other 0.0% 9.1% 7.4% 10.8% 4.0% 0.0% 6.0%

Assaults 14.3% 12.1% 14.8% 5.4% 1.7% 15.8% 5.7%

Bicycle crash 0.0% 9.1% 7.4% 8.1% 3.5% 0.0% 5.1%

Intentional self-harm 0.0% 0.0% 7.4% 2.7% 2.9% 0.0% 2.7%

Contact with animal/human 0.0% 3.0% 0.0% 1.4% 1.7% 0.0% 1.5%

Air or water events 0.0% 0.0% 3.7% 1.4% 1.2% 0.0% 1.2%

Contact with object/machinery 0.0% 0.0% 0.0% 0.0% 1.7% 0.0% 0.9%

Mechanism Gisborne Rotorua Taranaki Tauranga Waikato Whakatane Grand TotalFalls 35.0% 33.1% 33.8% 43.2% 35.5% 35.2% 37.0%

Other 11.3% 14.1% 21.8% 18.9% 19.0% 16.1% 18.2%

Contact with object/machinery 10.0% 8.7% 8.2% 9.7% 11.6% 6.3% 10.0%

Contact with animal/human 10.0% 6.6% 7.5% 5.5% 8.8% 8.6% 7.5%

Other car/van crash 9.4% 5.1% 5.4% 6.1% 5.9% 8.6% 6.1%

Motorcycle crash 5.6% 6.1% 7.3% 5.3% 6.4% 5.3% 6.0%

Bicycle crash 0.0% 14.3% 7.0% 3.4% 3.5% 4.3% 5.1%

Assaults 8.8% 5.8% 4.8% 4.0% 4.2% 9.5% 4.9%

Heavy vehicle crash 8.8% 4.1% 3.9% 1.9% 3.1% 4.3% 3.2%

Pedestrian accidents 1.3% 1.0% 0.0% 0.8% 0.9% 1.3% 0.8%

Intentional self-harm 0.0% 0.7% 0.2% 0.6% 0.8% 0.3% 0.6%

Air or water events 0.0% 0.5% 0.2% 0.7% 0.5% 0.3% 0.5%

Primary Injury Type Major: ISS > 12 Minor: ISS < 13 Grand TotalBlunt 95.2% 95.8% 95.8%Burn 1.8% 2.6% 2.5%Penetrating 3.0% 1.6% 1.7%

19HOSPITAL VOLUMES AND OUTCOMES

Number of Trauma Events and Admissions by MTS hospital

A single event can result in more than one admission if the patient is transferred between two hospitals. The ratio of admissions to events is 1.22.

Events by Month

2012

1308

622 468

323 167

2536

1434

853 611

366 180

0

500

1000

1500

2000

2500

3000

Waikato Tauranga Rotorua Taranaki Whakatane Gisborne

Events Admissions

9%

8%

9% 9% 8%

7%

8% 7% 8%

9% 9% 10%

050

100150200250300350400450500

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Waikato Tauranga Rotorua Taranaki Whakatane

Events by Day of the Week

12% 13% 14%

12%

14%

19%

16%

0100200300400500600700800900

1000

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Waikato Tauranga Rotorua Taranaki Whakatane Gisborne

20

Number and percentage of Minor Trauma Events by Day of Week

Number and percentage of Major Trauma Events by Day of Week

Arrival Facility Monday Tuesday Wednesday Thursday Friday Saturday Sunday Grand Total

Even

ts

Waikato 240 218 259 241 241 338 302 1839

Tauranga 159 170 163 146 185 229 182 1234

Rotorua 60 79 79 64 83 115 109 589

Taranaki 49 46 58 57 65 95 71 441

Whakatane 35 45 40 31 47 56 50 304

Gisborne 22 18 24 16 32 29 19 160

Perc

ent

Waikato 13.1% 11.9% 14.1% 13.1% 13.1% 18.4% 16.4% 100.0%

Tauranga 12.9% 13.8% 13.2% 11.8% 15.0% 18.6% 14.7% 100.0%

Rotorua 10.2% 13.4% 13.4% 10.9% 14.1% 19.5% 18.5% 100.0%

Taranaki 11.1% 10.4% 13.2% 12.9% 14.7% 21.5% 16.1% 100.0%

Whakatane 11.5% 14.8% 13.2% 10.2% 15.5% 18.4% 16.4% 100.0%

Gisborne 13.8% 11.3% 15.0% 10.0% 20.0% 18.1% 11.9% 100.0%

Total Events 565 576 623 555 653 862 733 4567Total Percent 12.4% 12.6% 13.6% 12.2% 14.3% 18.9% 16.0% 100.0%

Arrival Facility Monday Tuesday Wednesday Thursday Friday Saturday Sunday Grand Total

Even

ts

Waikato 18 24 18 17 26 37 33 173

Tauranga 9 8 19 6 9 11 12 74

Rotorua 4 3 6 5 1 8 6 33

Taranaki 4 6 1 4 9 3 27

Whakatane 2 1 4 1 2 9 19

Gisborne 1 1 1 3 1 7

Perc

ent

Waikato 10.4% 13.9% 10.4% 9.8% 15.0% 21.4% 19.1% 100.0%

Tauranga 12.2% 10.8% 25.7% 8.1% 12.2% 14.9% 16.2% 100.0%

Rotorua 12.1% 9.1% 18.2% 15.2% 3.0% 24.2% 18.2% 100.0%

Taranaki 14.8% 22.2% 0.0% 3.7% 14.8% 33.3% 11.1% 100.0%

Whakatane 10.5% 5.3% 21.1% 5.3% 0.0% 10.5% 47.4% 100.0%

Gisborne 0.0% 14.3% 14.3% 14.3% 0.0% 42.9% 14.3% 100.0%

Total Events 37 43 48 31 40 70 64 333Total Percent 11.1% 12.9% 14.4% 9.3% 12.0% 21.0% 19.2% 100.0%

21

Number of Minor Trauma Events by Day of Week and MechanismThe colour scale emphasises the peak occurrence by weekday of each event mechanism.

Mechanism Monday Tuesday Wednesday Thursday Friday Saturday Sunday Grand Total

Even

ts

Falls 210 224 236 216 266 294 246 1692Other 112 104 123 106 131 126 127 829Contact with object/machinery

74 60 60 63 54 71 73 455

Contact with animal/human

40 38 36 34 43 105 47 343

Other car/van crash 20 36 49 48 42 46 37 278Motorcycle crash 29 21 28 20 22 74 81 275Bicycle crash 23 29 36 21 34 46 46 235Assaults 18 26 30 26 32 55 37 224Heavy vehicle crash 24 23 18 13 19 29 22 148Pedestrian accidents 7 4 1 5 5 9 7 38Intentional self-harm 5 9 4 2 1 2 4 27Air or water events 3 2 2 1 4 5 6 23

Perc

ent

Falls 37.2% 38.9% 37.9% 38.9% 40.7% 34.1% 33.6% 37.0%Other 19.8% 18.1% 19.7% 19.1% 20.1% 14.6% 17.3% 18.2%Contact with object/machinery

13.1% 10.4% 9.6% 11.4% 8.3% 8.2% 10.0% 10.0%

Contact with animal/human

7.1% 6.6% 5.8% 6.1% 6.6% 12.2% 6.4% 7.5%

Other car/van crash 3.5% 6.3% 7.9% 8.6% 6.4% 5.3% 5.0% 6.1%Motorcycle crash 5.1% 3.6% 4.5% 3.6% 3.4% 8.6% 11.1% 6.0%Bicycle crash 4.1% 5.0% 5.8% 3.8% 5.2% 5.3% 6.3% 5.1%Assaults 3.2% 4.5% 4.8% 4.7% 4.9% 6.4% 5.0% 4.9%Heavy vehicle crash 4.2% 4.0% 2.9% 2.3% 2.9% 3.4% 3.0% 3.2%Pedestrian accidents 1.2% 0.7% 0.2% 0.9% 0.8% 1.0% 1.0% 0.8%Intentional self-harm 0.9% 1.6% 0.6% 0.4% 0.2% 0.2% 0.5% 0.6%Air or water events 0.5% 0.3% 0.3% 0.2% 0.6% 0.6% 0.8% 0.5%

22

BED DAYS

Hospital Bed Days by MTS Hospital

In 2014, 23,839 hospital bed days were utilised by MTS trauma patients, with 937 of these being ICU bed days. This equates to an average of 65 trauma patients in a MTS hospital on any given day.

Average length of stay overall is 4.9 days.

The cost of trauma hospitalisations at Waikato Hospital in 2014 was over $23 million. This includes medical and nursing care, intensive care, operating theatre costs, x-rays, CT scans, laboratory tests, physio- and occupational therapy, social work – all of the elements of trauma care in a tertiary centre.

Arrival Facility MinorISS < 13Major

ISS 13 - 25SevereISS > 25

Avg Pts/day

MinorISS < 13

MajorISS 13 - 25

SevereISS > 25

Waikato Hospital 8893 1788 1388 33 2 7.5 14

Tauranga Hospital 5135 615 293 17 2 5.5 7

Rotorua Hospital 2063 205 52 6 2 4 1

Taranaki Base Hospital 1832 174 58 6 2 6 6

Whakatane Hospital 716 28 50 2 1 1 1

Gisborne Hospital 511 35 3 2 2 4 1

Grand Total 19150 2845 1844 65 2 6 10Average LOS: 3.6 8.9 17.9

23

Number of Events with no TRISS Score Calculated, by Type of Injury and Outcome

Injury Severity Score versus Predicted Probability of Survival (TRISS Score) by OutcomeThe scatter plot shows a correlation between TRISS score and ISS. A lower ISS indicates a higher probability of survival; however, there are some outliers present in the data.

The graph has been divided into quadrants to group ISS into major (ISS >12) and severe (ISS >25) and probability of survival into expected versus unexpected survival. Those deceased patients placed in the upper left hand corner died with relatively minor injuries.

0

0.2

0.4

0.6

0.8

1

1.2

0 10 20 30 40 50 60 70 80

Pred

icted

Pro

babi

lity o

f Sur

vival

ISS Survived Died

Percentage of Trauma Events by Severity and Outcome

TRAUMA INJURY SEVERITY SCORE

Number of Events with a TRISS Score Calculated, by Type of Injury and Outcome

The Trauma Injury Severity Score (TRISS) score determines the probability of survival of a trauma patient. TRISS is calculated from a combination of the patient age, the severity and type of trauma, and the Revised Trauma Score (RTS). RTS is calculated from the Glasgow Coma Scale, systolic blood pressure and respiratory rate.

Of the 4,900 trauma events in 2014, 327 were major trauma with blunt or penetrating injuries, therefore meeting the criteria for a TRISS score.

Of these 327 events, 76% (249) had adequate information for a TRISS score to be calculated.

Outcome Blunt Penetrating PercentSurvived 222 5 91%

Died 20 2 9%

Grand Total 242 7

Outcome Blunt Penetrating PercentSurvived 71 2 94%

Died 4 1 6%

Grand Total 75 3

Values Severity Survived Died Grand TotalCases Minor (ISS < 13) 4559 8 4567

Major (ISS > 12) 305 28 333Percent Minor (ISS < 13) 99.82% 0.18% 100.00%

Major (ISS > 12) 91.59% 8.41% 100.00%Total Cases 4864 36 4900Total Percent 99.27% 0.73% 100.00%

24

MTS PROCESS INDICATORSThe MTS trauma guidelines contain process indicators that are collected in the registry and analysed. Thresholds and values that mark best practice can be applied to some process indicators to quantitatively assess performance and outcomes from system change. The cycle of guidelines, registry and analysis forms our evidence-based quality improvement loop.

This table assesses process indicators over the same period as the analyses throughout this document. Key Intervals have been assigned so that numbers are representative of process completion (completed or not) or efficiency (time taken).

Pre-hospital intubation if GCS < 9

0%

10%

20%

30%

40%

50%

2012 2013 2014

% Intubated

Average time from arrival to index CT scan(Reduced time is an improvement)

Mortality rate, by first arrival facilityNote – the death may not have occurred in the facility of first arrival.

First facility 2012 2013 2014Gisborne 1.20%

Rotorua 0.46% 0.85% 0.32%

Taranaki 0.57% 0.63% 0.43%

Tauranga 0.58% 1.16% 1.15%

Waikato 0.84% 0.49% 0.55%

Whakatane 0.66% 0.58% 1.24%

2012 2013 2014Gisborne 0:48

Rotorua 4:14 5:10 3:19

Taranaki 5:02 1:59 2:20

Tauranga 3:42 4:17 4:38

Waikato 4:53 2:24 2:39

Whakatane 1:56 1:38 1:25

n = 150 (2 = "n/a")

2012 2013 2014

No 47 38 34

Yes 5 10 14

% Intubated 11% 26% 41%

0.00%

0.50%

1.00%

1.50%

2.00%

2012 2013 2014

Gisborne Rotorua Taranaki Tauranga Waikato Whakatane

0:00

1:12

2:24

3:36

4:48

6:00

2012 2013 2014

Gisborne Rotorua Taranaki Tauranga Waikato Whakatane

25

Time in hours from first admission to particular surgical proceduresData shown as hours. Number of operations shown in parentheses.

2012 2013 2014Spinal fracture fixation Tauranga 69.7 (3) 68.0 (7) 65.0 (1)

Waikato 70.8 (39) 75.8 (27) 51.9 (52)

Craniectomy Waikato 21.8 (4) 5.7 (6) 10.2 (6)Fixation of tibial fracture Gisborne 39.0 (1) 38.9 (11)

Taranaki 51.7 (26) 35.1 (22) 27.7 (21)

Tauranga 46.0 (39) 33.7 (49) 32.9 (47)

Waikato 45.0 (88) 56.4 (69) 37.1 (90)

Whakatane 8.1 (8) 12.1 (10) 82.0 (3)* * Whakatane average distorted by one case with a 10-day delayTrauma laparotomy Taranaki 3.0 (1) 4.0 (1)

Tauranga 5.0 (3) 3.0 (2) 1.0 (1)

Waikato 19.2 (5) 8.0 (6) 9.5 (6)

Whakatane 2.0 (1)

2626

Operational Targets• All Midland DHBs entering data via web-based registry

• Midland Trauma Research Centre operational by end 2016

• TQual relational data warehouse operational by end 2016

• All Midland DHBs to receive quarterly updates of their trauma data as Qlik Sense files by June 2016

Clinical Targets • Reduce mortality in severely injured (ISS >12) from 8.4% (2014)

to 7.0% (world best practice is 10%)

• Compliance to clinical exsanguination algorithms >90%

• In-hospital early deaths by exsanguination 95% data-capture of patients admitted to Midland Hospitals as a result of trauma

System TargetsNote: trauma LOS calculation is the total bed-days per trauma event across hospitals.

• Reduce overall LOS from 4.9 (2014) to 4.5 days (approximately 1800 bed days p.a.)

• Reduce LOS in severely injured from 24 (2014) to 21 days

• Produce quantitative evidence to inform optimal inter-hospital vehicle, staff and resource utilisation

Population Targets• Predominant at-risk community groups identified from

incidence studies

• Identification of equity and access discrepancies Midland trauma population completed by December 2016

• Functional linkage developed with regional and local injury prevention agencies

MTS TARGETS TO 2018

2727