Ontario Trauma Centres: Minimum Standards
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Ontario Trauma Centres: Minimum Standards
May 2022
Public Information © 2022 Critical Care Services Ontario. All rights reserved. This publication may be reproduced in whole or in part for non-commercial purposes only and on the condition that the original content of the publication or portion of the publication not be altered in any way without the express written permission of Critical Care Services Ontario. To seek this information, please contact: [email protected]
About Critical Care Services Ontario
Established in 2005, Critical Care Services Ontario (CCSO) led the implementation of Ontario’s first Critical Care Strategy and now centrally coordinates and develops integrated system solutions for critical care (Adult, Paediatric and Neonatal) and specialty programs aligned with critical care (Neurosurgery, Trauma and Burns, and the Life or Limb Policy). CCSO’s work is the result of an ongoing collaboration between critical care providers, hospital administrators, partners from the Ministry of Health and other health system leaders.
[email protected] https://ccso.ca/ youtube.com/CriticalCareServicesOntario
ii
Ontario Trauma Centres: Minimum Standards
The Ontario Trauma Centres: Minimum Standards identify minimum standards for the identified designations of trauma centres. They define expectations for adult and paediatric level I, level II, and level III trauma centres regarding their system role, capacity, and capabilities. Understanding roles and capacity of these trauma centres will enable coordination of processes between hospitals, formalize roles and responsibilities, and develop and sustain trauma services within an inclusive Ontario Trauma System. The trauma centres are expected to maintain services as per the Ontario Trauma Centres: Minimum Standards. This document contains thirteen (13) sections and identifies minimum standards for the identified designations of trauma centres. The sections are:
1. Academic and Research 2. Leadership Roles 3. Emergency Preparedness 4. Performance Improvement and Patient Safety 5. System Leadership 6. Pre-Hospital: Protocols and Processes 7. Emergency Department: Processes 8. Emergency Department: Personnel 9. Emergency Department: Equipment 10. Trauma Surgery Capabilities 11. Non-Surgical Trauma Capabilities 12. Inpatient Trauma Services: Protocols and Services 13. Inpatient Trauma Services: Personnel
The following tables show the minimum requirements for Trauma Centres needed in each of the categories for Ontario Trauma Centres.
Ontario Trauma Centres: Minimum Standards • Page 1 of 22
1. Academic and Research
Criteria
a. University affiliation and academic leadership for the trauma training program (fellowship, postgraduate, undergraduate)
b. Trauma research program infrastructure
c. Initiation, participation, and dissemination of trauma research (publications)
d. Offer in-house Advanced Trauma Life Support® (ATLS®) or equivalent program
e. Offer in-house Trauma training courses or equivalent for nurses e.g., Trauma Nursing Core Course (TNCC), Emergency Practice Interventions and Care – Canada (EPICC), Advanced Trauma Care for Nurses (ATCN)
Level I Lead Trauma
Hospital
Mandatory Mandatory Mandatory Mandatory
Mandatory
Level II Lead Trauma
Hospital
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Recommended Recommended Recommended Recommended
Not required Not required Not required Not required
Mandatory Mandatory Mandatory Mandatory
Recommended Recommended Recommended Recommended
Recommended
Not required
Mandatory
Recommended
Ontario Trauma Centres: Minimum Standards • Page 2 of 22
2. Leadership Roles
Criteria
a. A leadership or central role in the provincial or regional trauma system (administrative, planning, clinical programs)
Level I Lead Trauma
Hospital
Mandatory
Level II Lead Trauma
Hospital
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Mandatory
Not required
Mandatory
Mandatory
Ontario Trauma Centres: Minimum Standards • Page 3 of 22
3. Emergency Preparedness
Criteria
a. Liaison role in emergency preparedness (planning, exercising, and education necessary to achieve a state of readiness for disasters and emergencies)
Level I Lead Trauma
Hospital
Mandatory
Level II Lead Trauma
Hospital
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Mandatory
Mandatory
Mandatory
Mandatory
Ontario Trauma Centres: Minimum Standards • Page 4 of 22
4. Performance Improvement and Patient Safety
Criteria
a. Data submission to the Ontario Trauma Registry (OTR)
b. Participation in Ontario Trauma Advisory Committee (OTAC) Performance Improvement Program (quarterly reports)
Level I Lead Trauma
Hospital
Mandatory
Mandatory
Level II Lead Trauma
Hospital
Mandatory
Mandatory
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Mandatory
Mandatory
Mandatory
Mandatory
Mandatory
Mandatory
Ontario Trauma Centres: Minimum Standards • Page 5 of 22
5. System Leadership
Criteria
a. Data analyst support consistent with hospital trauma volumes for mandatory provincial reporting to the Ontario Trauma Registry (OTR)
b. Trauma program positions in place and staffed e.g. trauma medical director, trauma program coordinator, and trauma data analyst
c. Hospital Trauma committee and sub-committees with terms of reference
d. Medical Director for Trauma Services
e. Trauma program manager (or Coordinator)
f. Financial support for leadership roles
g. Demonstrable quality Management activities (quality assurance, improvement initiatives, process and accountability)
Level I Lead Trauma
Hospital Mandatory
Mandatory
Mandatory Mandatory Mandatory Mandatory
Mandatory
Level II Lead Trauma
Hospital
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Mandatory
Mandatory
Mandatory
Mandatory
Mandatory
Mandatory Mandatory Mandatory Mandatory
Mandatory
Mandatory
Mandatory Mandatory Mandatory Mandatory
Mandatory
Mandatory
Mandatory
Mandatory Mandatory Mandatory Mandatory
Mandatory Mandatory Mandatory Mandatory
Mandatory
Mandatory
Ontario Trauma Centres: Minimum Standards • Page 6 of 22
Criteria
h. Dedicated initiatives for injury prevention (e.g. in-hospital education programs, collaboration with public health partners, communication of trauma data with regional partners to drive programming)
i. At least 70% of Trauma Team Leaders (TTL), Emergency Physicians, and ICU Intensivist accepting direct trauma patient transfers complete Advanced Trauma Life Support® (ATLS®) or equivalent education
j. At least 70% of the ED or ICU nurses receiving direct transfer of accountability (ToA) of trauma patients complete trauma training courses or equivalent e.g., Trauma Nursing Core Course (TNCC), Emergency Practice Interventions and Care – Canada (EPICC), Advanced Trauma Care for Nurses (ATCN)
Level I Lead Trauma
Hospital Mandatory
Mandatory
Mandatory
Level II Lead Trauma
Hospital
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Mandatory
Recommended
Mandatory
Mandatory
Mandatory
Recommended
Mandatory
Mandatory
Mandatory
Recommended
Mandatory
Mandatory
Ontario Trauma Centres: Minimum Standards • Page 7 of 22
6. Pre-Hospital: Protocols and Processes
Criteria
a. Field Trauma Triage protocol for recognition and transport of the major trauma patient to the appropriate level of care within the Regional Trauma Network (RTN)
b. Protocols and processes between air (ORNGE) and land Emergency Medical Services (EMS) to ensure 24/7 access to Lead Trauma hospital for major trauma patients
Level I Lead Trauma
Hospital
Mandatory
Mandatory
Level II Lead Trauma
Hospital
Mandatory
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Mandatory
(Centre works with LTH to establish and adopt shared practice guidelines)
Mandatory
Mandatory
Mandatory
Mandatory
(Local helipad access with ambulance transport protocol in place)
Mandatory
Mandatory
Ontario Trauma Centres: Minimum Standards • Page 8 of 22
May 2022
Public Information © 2022 Critical Care Services Ontario. All rights reserved. This publication may be reproduced in whole or in part for non-commercial purposes only and on the condition that the original content of the publication or portion of the publication not be altered in any way without the express written permission of Critical Care Services Ontario. To seek this information, please contact: [email protected]
About Critical Care Services Ontario
Established in 2005, Critical Care Services Ontario (CCSO) led the implementation of Ontario’s first Critical Care Strategy and now centrally coordinates and develops integrated system solutions for critical care (Adult, Paediatric and Neonatal) and specialty programs aligned with critical care (Neurosurgery, Trauma and Burns, and the Life or Limb Policy). CCSO’s work is the result of an ongoing collaboration between critical care providers, hospital administrators, partners from the Ministry of Health and other health system leaders.
[email protected] https://ccso.ca/ youtube.com/CriticalCareServicesOntario
ii
Ontario Trauma Centres: Minimum Standards
The Ontario Trauma Centres: Minimum Standards identify minimum standards for the identified designations of trauma centres. They define expectations for adult and paediatric level I, level II, and level III trauma centres regarding their system role, capacity, and capabilities. Understanding roles and capacity of these trauma centres will enable coordination of processes between hospitals, formalize roles and responsibilities, and develop and sustain trauma services within an inclusive Ontario Trauma System. The trauma centres are expected to maintain services as per the Ontario Trauma Centres: Minimum Standards. This document contains thirteen (13) sections and identifies minimum standards for the identified designations of trauma centres. The sections are:
1. Academic and Research 2. Leadership Roles 3. Emergency Preparedness 4. Performance Improvement and Patient Safety 5. System Leadership 6. Pre-Hospital: Protocols and Processes 7. Emergency Department: Processes 8. Emergency Department: Personnel 9. Emergency Department: Equipment 10. Trauma Surgery Capabilities 11. Non-Surgical Trauma Capabilities 12. Inpatient Trauma Services: Protocols and Services 13. Inpatient Trauma Services: Personnel
The following tables show the minimum requirements for Trauma Centres needed in each of the categories for Ontario Trauma Centres.
Ontario Trauma Centres: Minimum Standards • Page 1 of 22
1. Academic and Research
Criteria
a. University affiliation and academic leadership for the trauma training program (fellowship, postgraduate, undergraduate)
b. Trauma research program infrastructure
c. Initiation, participation, and dissemination of trauma research (publications)
d. Offer in-house Advanced Trauma Life Support® (ATLS®) or equivalent program
e. Offer in-house Trauma training courses or equivalent for nurses e.g., Trauma Nursing Core Course (TNCC), Emergency Practice Interventions and Care – Canada (EPICC), Advanced Trauma Care for Nurses (ATCN)
Level I Lead Trauma
Hospital
Mandatory Mandatory Mandatory Mandatory
Mandatory
Level II Lead Trauma
Hospital
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Recommended Recommended Recommended Recommended
Not required Not required Not required Not required
Mandatory Mandatory Mandatory Mandatory
Recommended Recommended Recommended Recommended
Recommended
Not required
Mandatory
Recommended
Ontario Trauma Centres: Minimum Standards • Page 2 of 22
2. Leadership Roles
Criteria
a. A leadership or central role in the provincial or regional trauma system (administrative, planning, clinical programs)
Level I Lead Trauma
Hospital
Mandatory
Level II Lead Trauma
Hospital
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Mandatory
Not required
Mandatory
Mandatory
Ontario Trauma Centres: Minimum Standards • Page 3 of 22
3. Emergency Preparedness
Criteria
a. Liaison role in emergency preparedness (planning, exercising, and education necessary to achieve a state of readiness for disasters and emergencies)
Level I Lead Trauma
Hospital
Mandatory
Level II Lead Trauma
Hospital
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Mandatory
Mandatory
Mandatory
Mandatory
Ontario Trauma Centres: Minimum Standards • Page 4 of 22
4. Performance Improvement and Patient Safety
Criteria
a. Data submission to the Ontario Trauma Registry (OTR)
b. Participation in Ontario Trauma Advisory Committee (OTAC) Performance Improvement Program (quarterly reports)
Level I Lead Trauma
Hospital
Mandatory
Mandatory
Level II Lead Trauma
Hospital
Mandatory
Mandatory
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Mandatory
Mandatory
Mandatory
Mandatory
Mandatory
Mandatory
Ontario Trauma Centres: Minimum Standards • Page 5 of 22
5. System Leadership
Criteria
a. Data analyst support consistent with hospital trauma volumes for mandatory provincial reporting to the Ontario Trauma Registry (OTR)
b. Trauma program positions in place and staffed e.g. trauma medical director, trauma program coordinator, and trauma data analyst
c. Hospital Trauma committee and sub-committees with terms of reference
d. Medical Director for Trauma Services
e. Trauma program manager (or Coordinator)
f. Financial support for leadership roles
g. Demonstrable quality Management activities (quality assurance, improvement initiatives, process and accountability)
Level I Lead Trauma
Hospital Mandatory
Mandatory
Mandatory Mandatory Mandatory Mandatory
Mandatory
Level II Lead Trauma
Hospital
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Mandatory
Mandatory
Mandatory
Mandatory
Mandatory
Mandatory Mandatory Mandatory Mandatory
Mandatory
Mandatory
Mandatory Mandatory Mandatory Mandatory
Mandatory
Mandatory
Mandatory
Mandatory Mandatory Mandatory Mandatory
Mandatory Mandatory Mandatory Mandatory
Mandatory
Mandatory
Ontario Trauma Centres: Minimum Standards • Page 6 of 22
Criteria
h. Dedicated initiatives for injury prevention (e.g. in-hospital education programs, collaboration with public health partners, communication of trauma data with regional partners to drive programming)
i. At least 70% of Trauma Team Leaders (TTL), Emergency Physicians, and ICU Intensivist accepting direct trauma patient transfers complete Advanced Trauma Life Support® (ATLS®) or equivalent education
j. At least 70% of the ED or ICU nurses receiving direct transfer of accountability (ToA) of trauma patients complete trauma training courses or equivalent e.g., Trauma Nursing Core Course (TNCC), Emergency Practice Interventions and Care – Canada (EPICC), Advanced Trauma Care for Nurses (ATCN)
Level I Lead Trauma
Hospital Mandatory
Mandatory
Mandatory
Level II Lead Trauma
Hospital
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Mandatory
Recommended
Mandatory
Mandatory
Mandatory
Recommended
Mandatory
Mandatory
Mandatory
Recommended
Mandatory
Mandatory
Ontario Trauma Centres: Minimum Standards • Page 7 of 22
6. Pre-Hospital: Protocols and Processes
Criteria
a. Field Trauma Triage protocol for recognition and transport of the major trauma patient to the appropriate level of care within the Regional Trauma Network (RTN)
b. Protocols and processes between air (ORNGE) and land Emergency Medical Services (EMS) to ensure 24/7 access to Lead Trauma hospital for major trauma patients
Level I Lead Trauma
Hospital
Mandatory
Mandatory
Level II Lead Trauma
Hospital
Mandatory
Level III Trauma Centre
Level I Paediatric Lead Trauma Hospital
Level II Paediatric Lead Trauma Hospital
Mandatory
(Centre works with LTH to establish and adopt shared practice guidelines)
Mandatory
Mandatory
Mandatory
Mandatory
(Local helipad access with ambulance transport protocol in place)
Mandatory
Mandatory
Ontario Trauma Centres: Minimum Standards • Page 8 of 22
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