Summary
Blood loss remains a leading cause of death in trauma patients. However, advances in trauma systems and care mean that many haemorrhage deaths are now considered potentially avoidable if critical bleeding is recognised early and patients are moved quickly through treatment processes to surgery to control the bleeding. Internationally, standardisation of critical bleeding protocols has shown promising reductions in mortality. In Aotearoa New Zealand, a multi-agency partnership sought to reduce mortality and morbidity in critically haemorrhaging trauma patients by revising massive transfusion protocols to meet current best-practice trauma care, implementing a nationally agreed best-practice guideline and adapting this national guideline to work within the varying levels of our health care system.
The critical haemorrhage project’s aspirational goal is to achieve zero in-hospital deaths from trauma-related critical haemorrhage, and the overall project aim is to eliminate avoidable deaths from trauma-related critical haemorrhage and related multiple organ failure by 2025.
In early 2019, Te Tāhū Hauora Health Quality & Safety Commission (Te Tāhū Hauora) was contracted by the Accident Compensation Corporation (ACC) to support the National Trauma Network (the Network) to carry out quality improvement work within identified areas of need. The first priority was improving trauma care for critically bleeding patients, and the critical haemorrhage project commenced in January 2020. The three agencies worked in partnership with the New Zealand Blood Service, the Australian and New Zealand Massive Transfusion Registry, ambulance services and the-then district health boards with the aim of reducing mortality and complications in critically haemorrhaging trauma patients. They did this by:
- supporting hospitals to review and update existing massive transfusion protocols to meet current best-practice trauma care
- developing a national best-practice critical bleeding bundle of care for ambulance services and hospitals to adjust to their local context and implement
- developing associated national critical bleeding best-practice guidance.
The goal of this work is to support Aotearoa New Zealand health care providers with early recognition of and appropriate action for trauma-related critical haemorrhage across ambulance services, emergency departments, perioperative teams and intensive care units.
Dr Kerry Gunn was appointed clinical lead for the project. Kerry is an anaesthetist with a special interest in coagulopathy and massive haemorrhage management. He chaired the Auckland Blood Transfusion Committee and is a member of the steering committee for the Patient Blood Management Committee of the National Blood Authority (Australia) and the Australasian Massive Transfusion Registry. He is also a member of the Te Tāhū Hauora Perioperative Mortality Review Committee.
If you have any questions, please contact: help@majortrauma.nz
January–July 2020 (scoping phase)
- Case for change
- Current state analysis
- Stakeholder engagement
March–December 2020 (national guideline)
- Expert reference group
- Project measures
- Sector consultation
- Guideline publication
November 2020–September 2021 (implementation)
- National presentations
- Targeted site visits
- Social media strategy
- Development of additional resources
October 2021–June 2023 (monitoring)
- 12-month site survey
- 24-month site survey
Background
In early 2019, Te Tāhū Hauora Health Quality & Safety Commission (Te Tāhū Hauora) was contracted by the Accident Compensation Corporation (ACC) to support the National Trauma Network (the Network) to carry out quality improvement work within identified areas of need. The first priority was improving trauma care for critically bleeding patients, and the critical haemorrhage project commenced in January 2020. The three agencies worked in partnership with the New Zealand Blood Service, the Australian and New Zealand Massive Transfusion Registry, ambulance services and the-then district health boards with the aim of reducing mortality and complications in critically haemorrhaging trauma patients. They did this by:
- supporting hospitals to review and update existing massive transfusion protocols to meet current best-practice trauma care
- developing a national best-practice critical bleeding bundle of care for ambulance services and hospitals to adjust to their local context and implement
- developing associated national critical bleeding best-practice guidance.
The goal of this work is to support Aotearoa New Zealand health care providers with early recognition of and appropriate action for trauma-related critical haemorrhage across ambulance services, emergency departments, perioperative teams and intensive care units.
Dr Kerry Gunn was appointed clinical lead for the project. Kerry is an anaesthetist with a special interest in coagulopathy and massive haemorrhage management. He chaired the Auckland Blood Transfusion Committee and is a member of the steering committee for the Patient Blood Management Committee of the National Blood Authority (Australia) and the Australasian Massive Transfusion Registry. He is also a member of the Te Tāhū Hauora Perioperative Mortality Review Committee.
If you have any questions, please contact: help@majortrauma.nz
Timeline
January–July 2020 (scoping phase)
- Case for change
- Current state analysis
- Stakeholder engagement
March–December 2020 (national guideline)
- Expert reference group
- Project measures
- Sector consultation
- Guideline publication
November 2020–September 2021 (implementation)
- National presentations
- Targeted site visits
- Social media strategy
- Development of additional resources
October 2021–June 2023 (monitoring)
- 12-month site survey
- 24-month site survey