Major Trauma and Trauma & Orthopaedic Services
How we respond to major trauma and deliver trauma and orthopaedic services in Ayrshire and Arran has changed.
The Scottish Trauma Network was created in 2017 to establish an integrated trauma care system across Scotland which would improve the delivery of care from pre-hospital intervention through to rehabilitation.
Central to this plan is the creation of four Major Trauma Centres (MTC) to cover the North, East, South East and West of Scotland.
The West of Scotland Major Trauma Centre, based at Queen Elizabeth University Hospital (QEUH) in Glasgow, opened late summer 2021. As part of the implementation of the Scottish Trauma Network, NHS Ayrshire & Arran, has established a dedicated trauma unit in University Hospital Crosshouse.
Following major trauma, rehabilitation is essential to address the physical and psychosocial needs of patients that result from their injuries and experiences. Ayrshire patients are returned to our local hospitals for rehabilitation and benefit from investment in our Douglas Grant Rehab centre.
By concentrating major trauma and trauma cases in the Major Trauma Centres and Trauma Units, we are able to ensure equity of access to those specialist services for trauma patients. This change will enable Boards to develop elective centres of excellence within their local emergency hospitals.
Supported by investment from Scottish Government, a National Treatment Centre for inpatient elective care will be created at University Hospital Ayr. This welcome investment is part of the Scottish Government’s National Elective Centre Programme.
Why have we changed how we respond to major trauma and provide trauma and orthopaedic services?
Evidence shows that by standardising care for trauma patients and reducing additional transfers of injured patients, there can be improved outcomes for patients:
- More people will survive major trauma.
- Trauma patients will receive the best possible care from specialised teams providing emergency access to consultant-led care 24 hours a day, seven days a week.
- Trauma demand is projected to grow 17.5 per cent by 2035, mainly due to our ageing population.
What does it mean for people living in Ayrshire and Arran?
Our ambition is to have the best emergency and planned orthopaedic inpatient services, providing the best outcomes for everyone living in Ayrshire and Arran. We want to be better able to plan and respond more effectively to trauma incidents.
Major Trauma
The majority of major trauma patients are admitted directly to the Major Trauma Centre in Queen Elizabeth University Hospital (QEUH), Glasgow. This is estimated to be around 80 patients from Ayrshire and Arran each year.
Patients who experience a trauma incident more than 45 minutes from QEUH are transferred to University Hospital Crosshouse initially, but may subsequently be transferred to QEUH.
Orthopaedic trauma
Those experiencing a trauma incident in Ayrshire who require an ambulance may be admitted to University Hospital Crosshouse, instead of University Hospital Ayr. This decision will be made by the paramedic team based on the clinical presentation of each patient using a pre-defined ‘triage tool’.
Creating a trauma unit at University Hospital Crosshouse means that trauma patients receive the best care from dedicated multi-disciplinary teams, including dedicated medical, nursing and allied health professional teams. Our clinicians are able to identify how serious an injury is as soon as possible and ensure that detailed investigation is undertaken as soon as the patient arrives at hospital.
For minor injuries, patients who are ambulant (able to walk or move) and require assessment should continue to attend their local hospital – either University Hospitals Ayr or Crosshouse.
Adult elective orthopaedic services
Moving forward, all adult elective inpatient orthopaedic surgery will be undertaken at the National Treatment Centre at University Hospital Ayr. In a similar way to trauma, the development of an elective centre of excellence will mean that we can treat more patients which will in turn reduce waiting times and improve patient experience for all patients.
The National Treatment Centre will be open by 2025 which will offer additional inpatient and daycase capacity for the orthopaedic service.
Day surgery, outpatients and paediatrics
Day surgery and outpatient clinics continue to be provided from both University Hospitals Ayr and Crosshouse. Paediatric (children’s) care continues to be provided from University Hospital Crosshouse.
Emergency Department
University Hospital Ayr is the designated local emergency hospital for South Ayrshire, and University Hospital Crosshouse is the designated local emergency hospital for East and North Ayrshire. Both University Hospitals Ayr and Crosshouse have an emergency department. Patients who are able to attend hospital without needing an ambulance should present to their local emergency department.
Read our patient scenarios and details of the patient flow.
What are the benefits to this way of working?
A more co-ordinated approach to trauma and orthopaedic services ensures that patients experiencing a major trauma or requiring trauma and orthopaedic services receive excellent care from dedicated teams.
Patients admitted to QEUH have immediate access to wide range of specialist services that are not routinely available in Ayrshire and Arran, including neurosurgery and interventional radiology.
Centralising trauma at University Hospital Crosshouse means that we can pool our medical and Allied Health Professional (AHP) resource, so that patients are seen by senior decision makers quickly and receive improved and immediate post-operative rehabilitation.
Developing a centre of elective excellence at University Hospital Ayr will result in increased elective activity. This will, in turn, reduce waiting times for patients, which is particularly important as our services begin to recover after COVID-19. By transferring trauma to University Hospital Crosshouse means that it is less likely that elective theatre activity will be reduced / cancelled owing to impact of emergency orthopaedic care.
If I have to go to the major trauma centre in Glasgow, will I be able to get some of my treatment and recovery care in Ayrshire?
The aim of major trauma care is to provide the initial treatment and coordinated care that people require for serious and life threating injuries to improve survival and minimise the long-term impact on their lives. The initial treatment and care could be from a range of specialities such as orthopaedic, neurology or vascular surgeons and is coordinated by a consultant-led team.
Following initial treatment led by a major trauma team, the major trauma patient will be moved into a dedicated major trauma ward, which will include significantly enhanced rehabilitation. When medically appropriate to do so, patients will be discharged directly home from QEUH. However, there may be instances where it is in the patient’s best interests to be transferred back to a hospital in Ayrshire and Arran.
All of this comes together as part of a network to save lives and give lives back.
Won’t some patients need to travel further for treatment?
We recognise that for some people this could mean more travel. To check if you may be entitled to help with necessary travel costs to and from hospital, see NHS Scotland leaflet HCS1 – A quick guide to help with health costs.
Some people may be entitled to book patient transport from Scottish Ambulance Service. For further information please visit the Scottish Ambulance Service – Support With Appointments website.
Is this change to service just about saving money?
No, this is about saving lives, not saving money. This new and improved approach to trauma and orthopaedic services will ensure that patients have access to specialist services to improve their outcomes and ensure they access the right care in the right place.
Implementation of the Scottish Trauma Network and the National Elective Centre programme have both benefitted from investment from Scottish Government to expand and improve the delivery of these services.
Is this about changing the status of the emergency department at University Hospital Ayr?
No, University Hospital Ayr will continue to be the designated local emergency hospital for the south of the area. Both University Hospitals Ayr and Crosshouse will continue to have an emergency department and patients are encouraged to attend their local emergency department where appropriate for their needs.
Where can I find out more?
If you have any concerns, please speak to your clinician or your family doctor (GP).