2015/16 Annual Report - Fraser Health · P a g e | 2 Fraser Health Trauma Network 2015/16 Annual...

2015/16 Annual Report

Fraser Health Trauma Network September 2016

2016 Awarded “Distinction

in Trauma Services”

P a g e | 2

Fraser Health Trauma Network


Directors’ Message We, the Medical Director and the Operations Director for the Fraser Health Trauma

Network are pleased to present the Network’s 2015/16 annual report. We are

honoured to be associated with such high calibre and dedicated health professionals

across our region, who selflessly deliver high quality health care to the

traumatically injured patients and their families. Our trauma service delivery

encompasses prehospital, acute inpatient care, rehabilitation, community

reintegration, and injury prevention. Our services entail education on traumatic

injury as well as academic research for advancement of the public’s health.

Validation of Fraser Health’s exceptional Trauma Services came in May 2016 with

Accreditation Canada bestowing Fraser Health with the highest award of Trauma

Distinction for Trauma Services, making us the second in Canada to achieve such

an honour. We demonstrated high quality regional trauma services through

showcasing our innovation and excellence in quality care delivery, education,

research, and injury prevention.

We are dedicated to providing quality and safe health care to all injured patients

and their loved ones. Delivering state-of-the-art health care practices that are

driven by performance improvement process and facilitated by data analysis is our

mission. Our goal is to evaluate and improve the trauma patient population’s

outcomes by focusing on patient-centred care along with continuous quality

improvement of our processes and internal structures.

This report is part of our commitment to quality care for traumatically injured

patients. Your feedback is most welcome.

Yours sincerely,

Chris Windle Director, Clinical Operations, Royal Columbian Hospital, Fraser Health Trauma Network

Dr. Iain MacPhail Medical Director, Fraser Health Trauma Network

P a g e | 3



Executive Summary Trauma is an injury to human tissues and organs resulting from the transfer of

energy from the environment. Injuries result when the energy exceeds the body’s

resilience to tolerate. A trauma system is an organized and coordinated effort in

a defined geographical area that delivers the full range of trauma care to all injured

individuals and is integrated with the local, regional, and provincial health care

system.

The Fraser Health region has a population of 1.7 million people and stretches from

Burnaby to Boston Bar. Fraser Health is the largest and fastest growing health care

region in British Columbia (37% of the population). Fraser Health’s Trauma Network

was established in 2002. Since its inception, the Trauma Network leadership has

been dedicated to providing quality and safe health care to all injured. The Fraser

Health Trauma Network consists of one level I, one level III, seven level IV, and

three level V designated acute care centres working together with provincial

partners such as Trauma Services B.C., B.C. Emergency Health Services, and other

health authorities to serve traumatically injured patients.

Fraser Health’s Trauma Network was recently awarded Distinction in Trauma

Services by Accreditation Canada and is one of the only two health regions in

Canada to have this distinction.

The purpose of this document is to report on the performance of Fraser Health’s

Trauma Network, especially its level I and level III designated sites, Royal

Columbian Hospital and Abbotsford Regional Hospital respectively. A summary of

statistics of injuries in the 2015/16 fiscal year, and other activities of the Network

including trauma education, injury prevention, and outpatient services are also

reported.

Photo credit: A view of the Fraser valley by TJ Watt. http://www.tjwatt.com/.

Used with permission.

http://www.tjwatt.com/

P a g e | 4



Table of Contents Directors’ Message ......................................................................................... 2

Executive Summary ....................................................................................... 3

List of Tables ................................................................................................. 6

List of Figures ................................................................................................ 6

Overview ...................................................................................................... 7

Traumatic Injuries ....................................................................................... 7

Trauma Systems ......................................................................................... 7

Fraser Health Trauma Network ........................................................................ 7

Fraser Health Trauma Network Structure ....................................................... 8

Geographic Distribution of Fraser Health Sites and their Trauma Level

Designations ............................................................................................. 10

Trauma Team ........................................................................................... 10

Quaternary Services .................................................................................. 11

Personnel ................................................................................................. 11

Partners ................................................................................................... 12

Organizational Chart .................................................................................. 13

Accreditation Distinction ............................................................................... 14

Characteristics of Injuries in Fraser Health in the 2015/16 Fiscal Year ................. 15

Inclusion and Exclusion criteria ................................................................... 15

Injuries by Severity ................................................................................... 15

Injuries by Sex ......................................................................................... 16

Injuries by Day of the Week and Month of the Year ....................................... 17

Injuries by month of the year................................................................... 17

Injuries by day of the week ..................................................................... 18

Motivations for Injury ................................................................................ 19

Types of Injury ......................................................................................... 21

Mechanisms of Injury ................................................................................ 23

Work-related Injuries ................................................................................. 24

Trauma Performance Indicators ..................................................................... 25

Median Length of Stay at Acute Care ........................................................... 25

P a g e | 5



Discharge from Acute Care to Rehabilitation: Average Wait times .................... 26

Tracheal Intubation ................................................................................... 27

Trauma Team Activation ............................................................................ 28

Trauma Mortality within 30 Days of Admission .............................................. 29

Time to Definitive Trauma Care ................................................................... 30

Presence of Ambulance Report on Record ..................................................... 30

Complications ........................................................................................... 31

Discharge Dispositions from RCH and ARH .................................................... 33

Other Activities ............................................................................................ 34

Outpatient Trauma Clinics .......................................................................... 34

Trauma Education ..................................................................................... 34

Trauma Grand Rounds ............................................................................ 34

Lower Mainland Trauma Symposium ......................................................... 35

Advanced Trauma Life Support (ATLS) ...................................................... 35

Trauma Nursing Core Course (TNCC) ........................................................ 35

Trauma Simulation Training Program ........................................................ 36

Infographic for the Public ........................................................................ 36

Clinical Practice Guidelines ....................................................................... 39

Medical Residents ................................................................................... 39

Emergency Preparedness ........................................................................... 40

Injury Prevention ...................................................................................... 40

Looking Forward .......................................................................................... 42

Data Sharing ............................................................................................ 42

Evaluation and Quality Improvement ........................................................... 42

Research .................................................................................................. 42

Trauma Association of Canada Conference ................................................... 42

Contact ....................................................................................................... 42

References .................................................................................................. 43

Appendix. B.C. Trauma Registry’s Inclusion and Exclusion Criteria ..................... 44

P a g e | 6



List of Tables Table 1. Total number of trauma patients who expired in the hospital within 30 days

of admission ................................................................................................ 29

Table 2. 2015/16 Fraser Health trauma mortalities within 30 days of admission

cross-tabulated by age and ISS ..................................................................... 29

Table 3. Time to definitive trauma care in 2015/16, median minutes. ................. 30

Table 4. Percentages of complications including mortalities at RCH in 2015/16 .... 31

Table 5. Percentages of complications including mortalities at ARH in 2015/16 .... 32

Table 6. Titles and presenters of 2015/16’s monthly Trauma Grand Rounds ........ 34

List of Figures Figure 1. Geographic distribution and trauma level designation of Fraser Health

Trauma Network’s acute care sites. ................................................................ 10

Figure 2. Fraser Health Trauma Network Organizational Chart ........................... 13

Figure 3. Numbers of patients by Injury Severity Score in 2015/16 .................... 16

Figure 4. Injuries in Fraser Health in 2015/16, separated by sex ........................ 16

Figure 5. Numbers of overall injuries and severe injuries per month in 2015/16 ... 17

Figure 6. Numbers of overall injuries and severe injuries per days of the week in

2015/16 ..................................................................................................... 18

Figure 7. Overall motivations for injury in 2015/16 ........................................... 19

Figure 8. Motivations for injury among men in 2015/16 separated by age ........... 20

Figure 9. Motivations for injury among women in 2015/16, separated by age ...... 20

Figure 10. Overall types of injuries in 2015/16................................................. 21

Figure 11. Types of injury among men in 2015/16, separated by age ................. 22

Figure 12. Types of injury among women in 2015/16, separated by age ............. 22

Figure 13. Percentages of different mechanisms of injuries in 2015/16 among men

and women ................................................................................................. 23

Figure 14. Mechanisms of work-related injuries in 2015/16 fiscal year ................ 24

Figure 15. Median hospital length of stay for severely injured trauma patients in

2015/16 ..................................................................................................... 25

Figure 16. Average monthly wait times for admission from acute care to a

rehabilitation facility – 2015/16 ..................................................................... 26

Figure 17. Number of tracheal intubations for eligible patients in 2015/16 ........... 27

Figure 18. Numbers of Trauma Team Activations in 2015/16 ............................. 28

Figure 19. Presence of Ambulance Report on Record for admitted trauma patients in

2015/16 ..................................................................................................... 30

Figure 20. Discharge dispositions of trauma patients in 2015/16 fiscal year ......... 33

Figure 21. Concussion awareness campaign in sports and recreation centres at

South Surrey and White Rock. ....................................................................... 41

P a g e | 7



Overview

Traumatic Injuries Trauma is an injury to human tissues and organs resulting from the transfer of

energy from the environment. Injuries result when the energy exceeds the body’s

resilience to tolerate.

Injury is the leading cause of death for British Columbians aged 1-44. In 2010

alone, 2009 British Columbians died of an injury and close to 35,000 were

hospitalized (BCIRPU, 2015a). Within the Fraser Health region, the combined direct

and indirect costs of injuries were estimated to be $1.2 billion (BCIRPU, 2015b).

Trauma Systems A trauma system is an organized and coordinated effort in a defined

geographical area that delivers the full range of trauma care to all injured

individuals and is integrated with the local, regional, and provincial health care

system. It encompasses prehospital care, acute care, rehabilitation and community

care, education, prevention, research and continuous quality improvement. The

system’s key components include standardization of care, data capture, continuous

quality improvement feedback loops, and the physical and human capacity of the

network to provide quality clinical care. Maximizing these components improves

outcomes and efficiencies and decreases patient complications.

Fraser Health Trauma Network The Fraser Health region has a population of 1.7 million people and stretches from

Burnaby to Boston Bar. Fraser Health is the largest and fastest growing health care

region in British Columbia (37% of the population). Approximately 50% of all

population growth to 2020 in B.C. is estimated to occur within Fraser Health (B.C.

Stats Population Estimates).

Fraser Health serves all populations of trauma patients in both urban and rural

settings. Acute care facilities in Fraser Health ably care for single system trauma

patients, most of whom have musculoskeletal injuries. The Network’s aim is serve

all traumatically injured patients. The focus of Fraser Health’s Trauma Network is on

the care of the multiply injured, those at the extremes of age, and patients with

complex single system injuries. These patients represent less than 10% of all

admissions for trauma related cases in the region.

P a g e | 8



Fraser Health’s Trauma Network was established in 2002. Since its inception, the

Trauma Network leadership has been dedicated to providing quality and safe health

care to all injured.

Vision: To provincially and nationally excel in trauma clinical care, quality

improvement, trauma education, research and knowledge advancement, and injury

prevention.

Mission: To deliver state-of-the-art health care practices driven by performance

improvement processes and facilitated by data analysis and review of best practices

at all levels of care delivery.

Goal: To deliver the best trauma patient care; ensure optimal, equitable and

accessible care for all persons sustaining trauma; prevent needless deaths and

disabilities from trauma; contain costs while enhancing efficiency; implement

quality and performance improvement initiatives throughout the system; ensure

that acute care facilities have appropriate resources to meet the needs of the

injured; and decrease the incidence and severity of trauma.

Fraser Health Trauma Network Structure In Fraser Health, there are twelve facilities that provide acute care in the region,

covering both high density areas within urban centres and sparsely populated rural

areas.

Royal Columbian Hospital (RCH) – Level I Trauma Designation

RCH serves as the designated lead Trauma Centre for Fraser Health. It functions

both as the referral centre for complex trauma patients throughout the region and a

resource for severely multiply injured patients from around the province.

This site is especially distinguished for providing:

A leadership role in the provincial trauma system

A central role in the regional trauma system

Majority of tertiary, major trauma care in the system

Complex and unique (quaternary) trauma services for the province (i.e.

obstetrical trauma)

Fraser Health’s referral site for interventional cardiology, interventional

radiology and neurosurgery

Fraser Health’s non-refusal site for major traumatic injuries

Academic leadership including trauma training and research programs

P a g e | 9



Abbotsford Regional Hospital and Cancer Centre (ARH) – Level III Trauma

Designation

A Level III Trauma Centre is required in jurisdictions without immediate access to

Level I (i.e. RCH) or Level II centres (Fraser Health does not have a level II centre).

ARH has a central role in the local community and is a crucial component of Fraser

Health’s regional trauma system for both adult and pediatric trauma. ARH often

receives a moderate to large caseload of major and minor traumas but secondarily

transfers major trauma patients in need of more complex services to RCH. Transfer

agreements and policies are in place to facilitate and expedite this process.

Burnaby Hospital (BH), Chilliwack General Hospital (CGH), Eagle Ridge

Hospital (ERH), Langley Memorial Hospital (LMH), Peace Arch Hospital

(PAH), Ridge Meadows Hospital (RMH), Surrey Memorial Hospital (SMH) –

Level IV Trauma Designation

Level IV hospitals exist in urban settings with a major trauma centre nearby. These

sites receive and provide definitive care for a potentially high volume of secondary

level trauma caseload from within Fraser Health. B.C. Ambulance Services has

prehospital trauma bypass protocols (i.e. Prehospital Trauma Destination Decision

Guideline) that ensure severely injured patients are directly transferred to a centre

that can meet their complex needs.

Delta Hospital (DH), Fraser Canyon Hospital (FCH), Mission Memorial

Hospital (MMH) – Level V Trauma Designation

The Level V acute care facilities exist in rural settings. The Level V facilities receive

all adult or pediatric trauma patients within their catchment area. Those that are

multiply injured, are at the extremes of age and/or have complex single system

injuries requiring admission to hospital are rapidly transferred to RCH or ARH

following stabilization.

P a g e | 10



Geographic Distribution of Fraser Health Sites and their Trauma Level

Designations

Figure 1. Geographic distribution and trauma level designation of Fraser Health

Trauma Network’s acute care sites.

Trauma Team The Trauma Team consists of a group of health care providers proficient at

attending a patient who has suffered severe injuries, such as multiple fractures.

The Trauma Team’s care for such patients is not limited to initial resuscitation, but

also includes ongoing care during stay at the hospital and follow-up after discharge.

The Trauma Team generally consists of emergency medicine physicians, trauma

general surgeons, anesthesiologists, registered nurses, social workers, physical and

occupational therapists, respiratory therapists, and radiologists. Both RCH and ARH

have 24/7 Trauma Team coverage. In 2006, the Fraser Health Trauma Network

hired the first Trauma Nurse Practitioner in B.C. to provide care for the injured

patient population and their families.

P a g e | 11



Quaternary Services RCH provides quaternary services to pregnant trauma patients and pelvic fracture

patients. This means that RCH has highly advanced and specialized equipment and

expertise for providing service for these injuries.

Personnel Regional

Dr. Iain MacPhail, Medical Director, Fraser Health Trauma Network

Chris Windle, Director, Clinical Operations, Royal Columbian Hospital, Fraser

Health Trauma Network

Lisa Constable, Clinical Nurse Specialist, Fraser Health Trauma Network

Cynthia Thurston, Trauma Coordinator, Fraser Health Trauma Network

Joanna Szpakowski, Trauma Registry Analyst

Kasra Hassani, Research Assistant, Emergency and Trauma

Royal Columbia Hospital (RCH) – Level I

Dr. Joe Haegert, Chief Trauma Services

Kathleen Fyvie, Nurse Practitioner, Trauma Services

Karli Gamble, Trauma Registry Analyst

Abbotsford Regional Hospital and Cancer Centre (ARH) – Level III

Dr. Dave Dhat, Chief Trauma Services

Anne Pott, Trauma Registry Analyst

P a g e | 12



Partners Trauma Services B.C. (TSBC) provides strategic leadership and helps with

collaboration of the regional trauma programs and integration of provincial

programs and services.

B.C. Trauma Registry, a part of TSBC, works closely with the Fraser Health

Trauma Network and provides statistics and reports of traumatic injuries.

B.C. Emergency Health Services (BC EHS) provides out-of-hospital and inter-

hospital patient transfer services.

B.C. Ambulance Services (BCAS) out-of-hospital operating wing of B.C.

EHS, provides ground and air ambulance services to trauma patients.

B.C. Patient Transfer Network (BC PTN) coordinates and operates inter-

facility transfer of patients within the province

Health Emergency Management B.C. (HEMBC) provides expertise, education,

tools, and support for the B.C. health authorities to effectively mitigate, prepare for,

respond to, and recover from the impacts of emergency events; ensuring the

continuity of health services.

Vancouver Coastal Health (VCH) is Fraser Health’s neighbouring regional health

authority. VCH and Fraser Health share quaternary trauma services in managing

severe pelvic fractures. Both organizations work together in medical education,

injury prevention, and research.

B.C. Children’s Hospital (BCCH) is the provincial quaternary and non-refusal site

for severely injured pediatric trauma patients.

Fraser Health Trauma Network partners with many colleges and universities in the

province and across Canada for education of medical residents, nurses, and other

health care workers. University of British Columbia (UBC), Simon Fraser

University (SFU), University of Victoria (UVIC) and B.C. Institute of

Technology (BCIT) are some examples of our education partners.

Fraser Health’s Department of Population and Public Health (Fraser Health

PPH), Fraser Health Unintentional Injury Prevention Priority Area

Committee (Fraser Health UIP PAC), B.C. Injury Research and Prevention

Unit (BCIRPU), and B.C. Injury Prevention Alliance (BC IPA) are the Fraser

Health Trauma Network’s partners for regional and provincial injury prevention

projects and campaigns.

P a g e | 13



Organizational Chart

Figure 2. Fraser Health Trauma Network Organizational Chart

P a g e | 14



Accreditation Distinction In June 2016, the Fraser Health Trauma Network was awarded Trauma

Distinction by Accreditation Canada, making it one of only two health

authorities in Canada to receive this award. This Distinction came after a week-long

evaluation of the Trauma Network by two evaluators from Accreditation Canada.

Trauma Distinction recognizes trauma systems or networks that demonstrate

clinical excellence and an outstanding commitment to leadership in trauma care.

Fraser Health Trauma Network will continue to improve its service according to the

needs of its communities, the health authority’s strategic plans, and the

recommendations of Accreditation Canada.

2016 Awarded “Distinction

in Trauma Services”

P a g e | 15



Characteristics of Injuries in Fraser Health in the

2015/16 Fiscal Year The following section provides summary statistics of injuries in the Fraser Health

region in 2015/16. Statistics for factors such as severity, motivation, mechanism,

and types of injury are reported. The source for all the reported data is the B.C.

Trauma Registry.

Inclusion and Exclusion criteria The details of B.C. Trauma Registry’s inclusion and exclusion criteria for injury data

recorded in the 2015/16 fiscal year have been provided in the Appendix. For further

details, please contact the B.C. Trauma Registry provincial office.

Injuries by Severity The chart below shows percentages of injuries with different Injury Severity Scores

(ISS). ISS is calculated based on the number and severity of injuries and ranges

from 1 to 75, with higher ISS score meaning higher severity of injury. Injuries with

the score below 12 are generally considered mild injuries. RCH received a higher

number of injured patients, since it is a level I site.

Patients whose ISS score is “not specified” are patients who have expired shortly

after arrival at the emergency department; exact details of their injuries needed for

calculating the ISS score have not been documented.

P a g e | 16



Figure 3. Numbers of patients by Injury Severity Score in 2015/16

Injuries by Sex The pie chart below shows the proportions of men and women who were admitted

for a traumatic injury to RCH or ARH in the 2015/16 fiscal year. As can be seen,

men were injured more often than women.

Figure 4. Injuries in Fraser Health in 2015/16, separated by sex

262

363

127

222

170

3

0

50

100

150

200

250

300

350

400

Nu

mb

er

of

Inju

ries

Injuries by Injury Severity Score (ISS) - RCH (level I)

179

166

44

40

58

8

0

50

100

150

200

250

300

350

400

Nu

mb

er

of

Inju

ries

Injuries by Injury Severity Score (ISS) - ARH (level III)

Men, 64%

Women, 36%

Percentages of injuries by sex

Total number = 1642

P a g e | 17



Injuries by Day of the Week and Month of the Year

Injuries by month of the year The chart below shows the overall numbers of injuries as well as severe injuries

(identified by Injury Severity Score, ISS of 12 and higher), in each month of the

2015/16 fiscal year for both RCH and ARH combined. ISS is calculated based on the

number and severity of injuries and ranges from 1 to 75, with higher ISS score

meaning higher severity of injury. Injuries with the score below 12 are generally

considered mild injuries while those at 12 and above are considered severe.

Both numbers for overall injuries and severe injuries followed a similar pattern over

time with highest numbers in June and lowest numbers in March.

Figure 5. Numbers of overall injuries and severe injuries per month in 2015/16

130

155

171

129

162

139 151

137

122 124

98

89

51

65 74

52

59 53

71 59

51

55

35

29

0

20

40

60

80

100

120

140

160

180

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

Nu

mb

er

of

inju

ries p

er

mo

nth

Months of the 2015/16 fiscal year

All ISS

ISS ≥ 12

Total number = 1642

Total number = 672

P a g e | 18



Injuries by day of the week The chart below shows the overall numbers of injuries as well as severe injuries

(identified by Injury Severity Score, ISS of 12 or higher), by days of the week, in

2015/16, for both RCH and ARH combined. ISS is calculated based on the number

and severity of injuries and ranges from 1 to 75, with higher ISS score meaning

higher severity of injury. Injuries with the score below 12 are generally considered

mild injuries while those at 12 and above are considered severe.

Injuries occurred more frequently on weekends. Both overall and severe injuries

had their highest numbers on Fridays.

Figure 6. Numbers of overall injuries and severe injuries per days of the week in

2015/16

221 198

228 231

259 259

246

97

85

100

92

108

91 99

0

50

100

150

200

250

300

Mon Tue Wed Thu Fri Sat Sun

Nu

mb

er

of

inju

rie

s

Days of the week

All ISS

ISS ≥ 12

Total Number = 1642

Total Number = 672

P a g e | 19



Motivations for Injury The pie chart below shows the motivations for injuries for patients at RCH and ARH

combined. As can be seen in the chart, the majority of injuries were un-intentional.

Intentional injuries (self-inflicted or third-party) made up about only 10% of all

injuries in Fraser Health in 2015/16.

Figure 7. Overall motivations for injury in 2015/16

Charts below show the breakdown in injury intentions by age and sex. Intentional

injuries among men and women were more common in the 16-64 age group and

more common in men compared to women.

Intentional - Self-inflicted,

2.4%

Intentional - Third Party,

8.1%

Unintentional, 89.0%

Unknown, 0.5%

Motivations for injury - Percentages

Total number = 1642

P a g e | 20



Figure 8. Motivations for injury among men in 2015/16 separated by age

Figure 9. Motivations for injury among women in 2015/16, separated by age

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-15 16-64 65+Ag

e g

rou

p-s

ep

ara

ted

perc

en

tag

es

Age (years)

Motivations for injury in men

Unintentional

Intentional - Third Party

Intentional - Self-inflicted

Unknown

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-15 16-64 65+

Ag

e g

rou

p-s

ep

ara

ted

perc

en

tag

es

Age (years)

Motivations for injury in women

Unintentional

Intentional - Third Party

Intentional - Self-inflicted

Unknown

Total number = 1056

222=1222211116116

661161083

Total number = 586

P a g e | 21



Types of Injury

The pie chart below shows the types of injuries for patients at RCH and ARH

combined. Majority of injuries in 2015/16 were blunt traumas: injuries that result

from a blunt force such as a fall or a motor vehicle collision. Other types of injuries,

including penetrating traumas (such as cuts and gunshot wounds), thermal injuries

(such as burns), and asphyxial traumas (such as drowning) together made up 10%

of the injuries.

Figure 10. Overall types of injuries in 2015/16

The charts below break down types of injury by sex and age group. Penetrating

traumas were most common in the 16-64 age group in both men and women and

overall more common in men. Although a small number, thermal traumas occurred

mostly in the 0-15 age group in both sexes.

Asphyxial, 1%

Blunt, 90%

Penetrating, 8%

Thermal, 1%

Types of injury - Percentages

Total number = 1642

P a g e | 22



Figure 11. Types of injury among men in 2015/16, separated by age

Figure 12. Types of injury among women in 2015/16, separated by age

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-15 16-64 65+

Ag

e g

rou

p-s

ep

ara

ted

perc

en

tag

es

Age (years)

Types of injury among men

Thermal

Penetrating

Blunt

Asphyxial

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0-15 16-64 65+Ag

e g

rou

p-s

ep

ara

ted

perc

en

tag

es

Age (years)

Types of injury among women

Thermal

Penetrating

Blunt

Asphyxial

Total number = 1056

Total number = 586

P a g e | 23



Mechanisms of Injury The chart below shows the percentages of different mechanisms of injury for

patients at RCH and ARH combined. Falls (including same-level falls and falls from

height) followed by motor vehicle collisions constitute the most common

mechanisms of injury for both men and women.

Other categories for mechanisms of injury include cuts and stabs, pedestrian

(person on foot injured by a vehicle), bicycle conveyance (person injured while

riding bicycle), assault (person injured by blunt object or manual force), firearm,

pedestrian conveyance (person injured while using a non-motorized vehicle such as

skateboard or wheelchair, not bicycle), thermal (such as a burn), and asphyxial

(such as drowning).

Figure 13. Percentages of different mechanisms of injuries in 2015/16 among men

and women

0.9%

0.9%

2.2%

2.9%

0.0%

0.5%

2.9%

4.9%

9.9%

1.9%

16.9%

56.1%

0.6%

0.9%

2.6%

2.8%

3.4%

4.1%

4.5%

6.1%

6.6%

8.0%

17.7%

42.8%

0% 10% 20% 30% 40% 50% 60%

Asphyxial

Thermal

Pedestrian Conveyance

Other / Unknown Vehicle

Firearm

Assault

Bicycle Conveyance

Crush / Other Blunt Injury

Pedestrian

Cuts / Stabs

Motor Vehicle Collisions

Falls

Mechanisms of injury among men and women - percentages

Men, total number = 1056

Women, total number = 586

P a g e | 24



Work-related Injuries The chart below shows the percentages of categories of injuries that occurred

during work. Falls and other blunt injuries were the most common work-related

injuries in Fraser Health (RCH and ARH combined) during 2015/16.

Figure 14. Mechanisms of work-related injuries in 2015/16 fiscal year

For further detail about the statistics of injuries please contact us or the B.C.

Trauma Registry office.

1.1%

1.1%

2.1%

7.4%

8.4%

20.0%

60.0%

0% 10% 20% 30% 40% 50% 60%

Assault

Firearm

Cut / Stab

Motor Vehicle Collision

Pedestrian

Crush / Other Blunt Injury

Falls

Mechanisms of work-related injuries - percentages

Mechanisms of work-related injuries

Total number = 95

P a g e | 25



Trauma Performance Indicators The following section reports on the performance and activities of Fraser Health’s

Trauma Network, focusing mainly on RCH as the region’s level I trauma centre and

ARH as the level III trauma centre.

Median Length of Stay at Acute Care The charts below show the monthly median lengths of stay at RCH and ARH in

2015/16 for patients with an Injury Severity Score (ISS) 12 or higher who didn’t

die in the hospital. ISS is calculated based on the number and severity of injuries

and ranges from 1 to 75. An ISS of below 12 is considered a minor traumatic

injury. Medians show the middle number in a series of numbers and are thus less

sensitive to high dispersion, which normally skews averages.

Figure 15. Median hospital length of stay for severely injured trauma patients in

2015/16

9.0

6.0

7.0

10.0 9.5

7.5

11.0 10.0 9.0

13.0

18.0

8.0

0

5

10

15

20


Days

Median lengths of stay at RCH (level I) - ISS ≥ 12

1.0

4.0

4.5

3.0 2.0

8.0

3.5

9.5

8.0

2.0

8.0

9.0

0

5

10

15

20


Days

Median lengths of stay at ARH (level III) - ISS ≥ 12

P a g e | 26



Discharge from Acute Care to Rehabilitation: Average Wait times Charts below show average wait time for discharge from acute care to a

rehabilitation facility, separately for RCH and ARH.

Figure 16. Average monthly wait times for admission from acute care to a

rehabilitation facility – 2015/16

5.0

2.4

4.4

9.6

0

2

4

6

8

10

12

Ap

r-J

un

Ju

l-S

ep

Oct-

Dec

Ja

n-M

ar

Days

Average wait times for rehab at RCH (level I)

0.0

5.0

3.0

2.0

0

2

4

6

8

10

12

Ap

r-J

un

Ju

l-S

ep

Oct-

Dec

Ja

n-M

ar

Days

Average wait times for rehab at ARH (level III)

P a g e | 27



Tracheal Intubation Patients who experience a reduced level of consciousness (Glasgow Coma Scale <

9) should be intubated. Intubation is the placement of a flexible plastic tube into

the trachea (windpipe) to maintain an open airway or to administer certain drugs.

The charts below show the number of eligible (reduced consciousness) patients who

were intubated in the emergency department in 2015/16.

As RCH is a level I trauma centre, it receives severely injured patients more often

and thus has a higher number of intubations.

Figure 17. Number of tracheal intubations for eligible patients in 2015/16

9 8

17

14

0

2

4

6

8

10

12

14

16

18

Apr-Jun Jul-Sep Oct-Dec Jan-Mar

Tracheal intubations at RCH (level I)

4

0

5

2 0

2

4

6

8

10

12

14

16

18


Tracheal intubations at ARH (level III)

P a g e | 28



Trauma Team Activation The Trauma Team consists of a group of health care providers proficient at

attending a patient who has suffered severe injuries, such as multiple fractures.

The Trauma Team’s care for such patients is not limited to initial resuscitation, but

also includes ongoing care during stay at the hospital and follow-up after discharge.

The Trauma Team generally consists of emergency medicine physicians, trauma

general surgeons, anesthesiologists, registered nurses, social workers, physical and

occupational therapists, respiratory therapists, and radiologists. Both RCH and ARH

have 24/7 Trauma Team coverage. In 2006, the Fraser Health Trauma Network

hired the first Trauma Nurse Practitioner in B.C. to provide care for the injured

patient population and their families.

RCH and ARH have 24/7 on call Trauma Teams who are activated when severely

injured patients arrive at the hospital. The charts below show the number of

Trauma Team Activations, the number of times the Trauma Team was called to

come in and attend a patient, in 2015/16. As RCH is a level I trauma centre, it

receives severely injured patients more often and thus has a higher number of

Trauma Team Activations.

Figure 18. Numbers of Trauma Team Activations in 2015/16

42

58

45 43

0

10

20

30

40

50

60


Numbers of Trauma Team Activations at RCH (level I)

9

3 2 4

0

10

20

30

40

50

60


Numbers of Trauma Team Activations at ARH (level III)

P a g e | 29



Trauma Mortality within 30 Days of Admission The table below shows the total number of trauma patients who expired within 30

days of admission to the hospital in 2015/16.

As RCH is a level I trauma centre, it receives severely injured patients more often

and thus has a higher number of mortalities.

Table 1. Total number of trauma patients who expired in the hospital within 30

days of admission

Site Period

(2015/16 fiscal)

RCH 94

ARH 26

The table below cross-tabulates trauma mortality within 30 days of admission by

Injury Severity Score (ISS) and age. ISS is calculated based on number and

severity of injuries and ranges from 1 to 75. As can be seen, mortality rates

increase with increasing age and ISS. Injuries with ISS below 12 are considered

mild (not leading to mortality) and are thus excluded from the table.

Table 2. 2015/16 Fraser Health trauma mortalities within 30 days of admission

cross-tabulated by age and ISS

Trauma Mortality by age and ISS

[Percentages]

Age

≤64 65-74 ≥75 All ages

ISS

13-15 1% 0% 3% 4%

16-24 4% 1% 6% 11%

25-75 35% 14% 35% 85%

All ISS 41% 15% 44% 100%

P a g e | 30



Time to Definitive Trauma Care This indicator provides the median number of minutes taken from the arrival of B.C.

Ambulance Services at the injury scene until the arrival at the definitive trauma

care centre. Medians show the middle number in a series of numbers and are thus

less sensitive to high dispersion, which normally skews averages.

Table 3. Time to definitive trauma care in 2015/16, median minutes.

Median Time to Definitive

Trauma Care (minutes)

Period


RCH and ARH combined 38 40 43 37.5

Presence of Ambulance Report on Record This indicator measures the percentage of patients who had their ambulance report

present on their chart at the time of analysis.

Figure 19. Presence of Ambulance Report on Record for admitted trauma patients

in 2015/16

94.0

%

96.5

%

98.0

%

96.5

%

95.0

%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Presence of Ambulance Report on Record

RCH (level I) - Percentages

100.0

%

100.0

%

100.0

%

89.7

%

100.0

%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Presence of Ambulance Report on Record

ARH (level III) - Percentages

P a g e | 31



Complications The tables below show the rates of a narrowed list of complication rates for trauma

patients admitted to RCH and ARH during 2015/16. Data includes all patients

regardless of Injury Severity Score and Length of Stay. Patients may develop more

than one complication.

Table 4. Percentages of complications including mortalities at RCH in 2015/16

RCH

Type of complication Percentage

No complication 81.3%

Mortality 8.2%

Pneumonia 4.0%

Systemic Sepsis 2.6%

Bleeding 2.5%

Urinary Tract Infection 2.2%

Drug or Alcohol Withdrawal Syndrome 1.7%

Deep Venous Thrombosis DVT/Thrombophlebitis 1.0%

Pulmonary Embolism 1.0%

Deep Surgical Site Infection 0.3%

P a g e | 32



Table 5. Percentages of complications including mortalities at ARH in 2015/16

ARH

Type of complication Percentage

No complication 81.3%

Mortality 5.0%

Urinary Tract Infection 2.0%

Pneumonia 1.0%

Drug or Alcohol Withdrawal Syndrome 1.0%

Systemic Sepsis 1.0%

Pulmonary Embolism 0.4%

Bleeding 0.2%

The mortality rates reported in the tables above do not match the number of

mortalities presented on page 29 in the report. That is because the numbers on

page 28 include solely mortalities that occurred within 30 days of admission to the

hospital, while the tables in this section count in all mortalities.

For further details, please contact the Fraser Health Trauma Network or the B.C.

Trauma Registry provincial office.

P a g e | 33



Discharge Dispositions from RCH and ARH The majority of the trauma patients were discharged home from RCH or ARH. The

second most common discharge disposition was an acute care facility (closer to the

patient’s place of residence), and a rehabilitation facility.

Figure 20. Discharge dispositions of trauma patients in 2015/16 fiscal year

0.1%

0.3%

0.8%

1.1%

1.2%

1.3%

2.0%

3.3%

8.2%

9.5%

13.2%

58.9%

0% 10% 20% 30% 40% 50% 60% 70%

Ministry of Children and Family…

Hospital/Palliative Care

Special Rehab Facility

Nursing Home

Mental Health and Substance Use Facility

Other

Against Medical Advice

Home with Support Services

Expired

General Rehab Facility

Acute Care Facility

Home

Discharge Dispositions - from RCH (level I)

0.2%

0.6%

1.6%

2.0%

4.0%

4.4%

5.1%

5.3%

13.3%

63.4%

0% 10% 20% 30% 40% 50% 60% 70%

Mental Health and Substance Use Facility

Other

Against Medical Advice

Nursing Home

Hospital/Palliative Care

General Rehab Facility

Home with Support Services

Expired

Acute Care Facility

Home

Discharge Dispositions - from ARH (level III)

Total number = 1147

Total number = 495

P a g e | 34



Other Activities

Outpatient Trauma Clinics To provide patient-centred care and implement quality and performance

improvement initiatives, the Fraser Health Trauma Network established Regional

Outpatient Clinics operating from both RCH and ARH. Established in 2014 and

operating one half-day per week, these clinics provide follow-up support to patients

in Fraser Health who have sustained a traumatic injury, specifically to patients who

were admitted to Trauma Service in either RCH or ARH or to patients who visited

the Emergency Department for a traumatic injury in the Fraser East region. The

Trauma Service is a specialized service that provides and oversees the care of

patients with multiple injuries. Since their inception in 2014 until the end of 2015,

these clinics offered services to close to 400 patients.

The performance of these clinics has been monitored using both clinical and

administrative indicators, as well as patient satisfaction surveys. A quality

improvement manuscript describing the performance of the clinics is currently

under preparation for publication in a peer-reviewed journal.

Trauma Education

Trauma Grand Rounds The Trauma Network has been hosting monthly Trauma Grand Rounds since 2003.

Below are the topics of the lectures that were given in 2015:

Table 6. Titles and presenters of 2015/16’s monthly Trauma Grand Rounds

Month Topic Presenter(s)

Jan

The Airway Tamers: RCH Airway Database

Results & Response to Observed

Complications

Dr. Laura Duggan,

Anesthesiologist / Dr.

Brian Deady, Emerg

Physician

Feb New Options in Peripheral Nerve Brachial

Plexus Reconstruction

Dr. Sean Bristol, Plastic

Surgeon

P a g e | 35



Apr Penetrating Aortic Injuries Dr. Joe Haegert

May Interesting Trauma Cases Dr. N Aspinal / J Haegert

Jun Fraser Health Massive Transfusion Protocol Dr. Doug Morrison

Sep Trauma Resuscitation Perils & Pitfalls Dr. Joe Haegert

Oct Heirlooms in DVT Prophylaxis & Guidelines

for Change Dr. Ben Tuyp, Resident

Nov Beyond the Surge: The Intra-Hospital

Response to a Mass Casualty Event Dr. Tim Sveinbjornson

Dec Pan-American View of Trauma 2015 Dr. Michelle Goecke

Jan Rib Fixation and Update Dr. James Bond

Feb Management of the Open Abdomen after a

Trauma Laporatomy Dr. Sue Sidhu

Lower Mainland Trauma Symposium The Fraser Health Trauma Network and the regional Trauma Network of Vancouver

Coastal Health hosted a one-day trauma symposium on November 30th, 2015. The

event was sponsored by Trauma Services B.C. and Provincial Health Services

Authority.

Advanced Trauma Life Support (ATLS) Advanced Trauma Life Support is a systematic, concise approach to the care of a

trauma patient developed by the American College of Surgeons Committee on

Trauma. The Fraser Health Trauma Coordinator coordinates Advanced Trauma Life

Support courses. Fraser Health offers four to six courses annually. All courses are

based out of RCH.

Trauma Nursing Core Course (TNCC) All Registered Nurses in Fraser Health who provide trauma care are offered the

Trauma Nursing Core Course and are expected to maintain it in order to work in the

trauma rooms across Fraser Health. The Trauma Nursing Core Course is funded

regionally and is offered multiple times each year as two-day workshops.

P a g e | 36



Trauma Simulation Training Program The Fraser Health Trauma Network has organized two simulation trainings to date

(head/abdominal trauma, and obstetrical trauma), that were instructed by Dr. Joe

Haegert. Each session was followed by a standardized debriefing. The simulations

took place in the RCH trauma room and included registered nurses, respiratory

therapists, unit clerks, emergency physicians and residents. Simulation sessions for

both RCH and ARH have been planned to take place annually.

Infographic for the Public The infographic below was produced and placed on Fraser Health website as well as

Fraser Health social media outlets (Twitter, Facebook) to educate the public about

trauma and traumatic injuries. The infographic can be accessed on Fraser Health

website as well: http://www.fraserhealth.ca/health-info/health-topics/trauma/.

http://www.fraserhealth.ca/health-info/health-topics/trauma/

P a g e | 37



P a g e | 38



P a g e | 39



Clinical Practice Guidelines Clinical Practice Guidelines (CPGs) are "statements that include recommendations

intended to optimize patient care that are informed by a systematic review of

evidence and an assessment of the benefits and harms of alternative care options."

(IOM, 2011)

The following Clinical Practice Guidelines have been developed and approved in

2015/16 by the Fraser Health Trauma Network in partnership with our neighbouring

Trauma Programs such as Vancouver Coastal Health and B.C. Children’s Hospital.

They are available to all Fraser Health staff on the Fraser Health intranet:

Adult burns

Blunt thoracic aortic injury BTAI

Blunt traumatic arrest

Cervical spine injury

Deep vein thrombosis prophylaxis

Indications for consideration of trauma referral to HAU at RCH and ARH

Indications for CTA arch to COW in blunt trauma to rule out BCVI

Obstetrical trauma

Pediatric burn

Pediatric burn resuscitation – nursing

Pediatric burn resuscitation – Initial 48 hours.

Pediatric severe burn – Critical care orders

Pelvic fracture, unstable patient

Penetrating extremity trauma

Penetrating neck trauma

Penetrating traumatic arrest

Referral process for isolated C-spice or head injury

Rib fracture

Start adult triage algorithm

Start pediatric triage algorithm

Trauma Team activations and consults

Trauma team activation criteria – RCH and ARH

Trauma airway guideline

Medical Residents The Fraser Health Trauma Network is regularly engaged in training and education of

residents in Family Medicine and Emergency Medicine. These include class lectures,

trauma conferences, and on-site trainings.

P a g e | 40



Emergency Preparedness In partnership with Health Emergency Management B.C. (HEM BC), Fraser Health

has developed a disaster/mass casualty plan known as Health Incident Command

System (HICS). Available for staff access on the Fraser Health intranet, the plan

includes mass casualty response structure, functional plans for each site, forms,

signage, job action sheets, and functional area objectives.

Injury Prevention The Fraser Health Trauma Network is a member of the Fraser Health Unintentional

Injury Prevention Priority Area Committee (UIP PAC) and the B.C. Injury Prevision

Alliance (BC IPA). The UIP PAC’s focus in 2015 was raising awareness against

concussions, especially in sports. Below is a list of the committee’s activities in

2015/16:

Created concussion surveys using online Fraser Health My Health, My

Community tool. Pre-survey of concussion awareness (N = 1551), followed

by a three month Preventable.ca concussion poster campaign and a post-

survey (N = 1359) on concussion awareness & preventable concussion

messaging.

Conducted a “physician concussion awareness” survey, reached 29

physicians in 9 municipalities in Fraser Health.

Partnered with Community against Preventable Injuries (Preventable.ca) ,

the City of Surrey and the City of White Rock

o Preventable Poster Campaign reached 25 venues in 17 municipalities

in Fraser Health via Fraser Health Environmental Health Officers

o Poster campaign was followed up with a survey of community centre

leadership. 56% response rate with venue managers for Preventable

poster campaign survey (N = 10/18)

o Received a grant of $13,950 from the Peace Arch Hospital and

Community Health Foundation to promote Preventable’s Concussion

Awareness Campaign in South Surrey / White Rock. Hired contract

coordinator to install Preventable’s Concussion Awareness media in

five locations in the region and conduct evaluation.

Published six articles on Concussion and Child Safety for Fraser Health’s

Healthier You magazine, external news blog, Twitter and Facebook.

Storyboard for “Concussion” unintentional injury prevention digital signage

video

Revision of Fraser Health website for concussion info

http://www.fraserhealth.ca/concussion/

http://www.fraserhealth.ca/concussion/

P a g e | 41



Fraser Health Concussion Resource Network meetings began as a

subcommittee of UIP PAC - November 2015

The UIP PAC’s activities in the first quarter of 2016 were as follows:

Hired contract coordinator and evaluator to run an enhanced evaluation of

the concussion awareness campaign in South Surrey / White Rock, including

surveys, interviews, and focus groups.

Hired consultant to assist in 3-5 year strategic planning for prevention of

alcohol-related injuries.

Figure 21. Concussion awareness campaign in sports and recreation centres at

South Surrey and White Rock.

P a g e | 42



Looking Forward The Trauma Network is working on further improving its performance to provide the

best service and to implement Accreditation Canada’s recommendations.

Data Sharing The Fraser Health Trauma Network commits to more frequent use and reporting of

relevant data to all its stakeholders, including regional level IV and level V sites as

well as the general public. This report is the first effort in fulfilling this commitment.

Evaluation and Quality Improvement The Fraser Health Trauma Network commits to continuous quality improvement of

its service according to the recommendations of Accreditation Canada, as well as

other relevant standards of patient care.

Research The Trauma Network hired a part-time research assistant in the spring of 2016. The

research assistant aims to facilitate research projects that address the needs and

interests of the Fraser Health clinical team as well as its medical residents. For

inquiries please contact us.

Trauma Association of Canada Conference Trauma Association of Canada’s (TAC) next Annual Scientific Meeting & Conference

will take place in Vancouver on February 22-24, 2017. The Fraser Health Trauma

Network is part of the organizational committee for the conference and will actively

participate in its design and implementation. We also welcome members and

affiliates of the Network to attend the conference, and submit abstracts to present

posters and oral presentations. For more information please visit:

http://www.traumacanada.org/

Contact Please direct enquiries to:

[email protected]

Kasra Hassani

Research Assistant,


http://www.traumacanada.org/

mailto:[email protected]

P a g e | 43



References B.C. Injury Research and Prevention Unit (BCIRPU), 2015a, B.C. Casebook for

Injury Prevention, http://www.injuryresearch.bc.ca/wp-

content/uploads/2015/08/BCIRPU-Casebook-2015.pdf

B.C. Injury Research and Prevention Unit (BCIRPU), 2015b, Economic Burden of

Injury in British Columbia, http://www.injuryresearch.bc.ca/wp-

content/uploads/2015/08/BCIRPU-EB-2015.pdf

B.C. Stats Population Projects,

http://www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/PopulationProjectio

ns.aspx

Institute of Medicine, (2011), Clinical Practice Guidelines we can trust, Brief Report

http://www.injuryresearch.bc.ca/wp-content/uploads/2015/08/BCIRPU-Casebook-2015.pdf

http://www.injuryresearch.bc.ca/wp-content/uploads/2015/08/BCIRPU-Casebook-2015.pdf

http://www.injuryresearch.bc.ca/wp-content/uploads/2015/08/BCIRPU-EB-2015.pdf

http://www.injuryresearch.bc.ca/wp-content/uploads/2015/08/BCIRPU-EB-2015.pdf

http://www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/PopulationProjections.aspx

http://www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/PopulationProjections.aspx

P a g e | 44



Appendix. B.C. Trauma Registry’s Inclusion and Exclusion Criteria Below are patient inclusion and exclusion criteria from the B.C. Trauma Registry’s

records. All data presented in this report was acquired from the B.C. Trauma

Registry. For enquiries about the inclusion and exclusion criteria please contact the

B.C. Trauma Registry office.

P a g e | 45



2015/16 Annual Report - Fraser Health · P a g e | 2 Fraser Health Trauma Network 2015/16 Annual...

Documents

Transcript of 2015/16 Annual Report - Fraser Health · P a g e | 2 Fraser Health Trauma Network 2015/16 Annual...