Christchurch Hospital’s specialist trauma service made no difference in first year - report

Christchurch Hospital, the largest trauma centre in the South Island, established a specialist trauma admitting service in January 2022. Photo / George Heard

A “minimally resourced” specialist trauma service at Christchurch Hospital failed to make any difference for patients in its first year, because of poor staffing and limited operating hours, new research has found.

Christchurch Hospital, the largest trauma centre in the South Island, established a specialist trauma admitting service in January 2022.

Internationally, such services have been shown to improve survival rates and recovery for patients admitted to hospital after major trauma.

However, the Otago University study, published in The New Zealand Medical Journal on Friday, which involved nearly 800 patients, found “no measurable improvement” in major trauma outcomes for those admitted in its first year of operation, compared with those admitted the year before.

The authors, including surgeons, said “resourcing limitations have undermined the potential impact of this service”.

“The Christchurch TAS was launched without adequate funding, resulting in significant staffing shortfalls, including limited trauma surgeon involvement (fewer than four hours per week), no dedicated house officer and restricted operational hours (Monday to Friday only),” it said.

“As a result, trauma patients admitted over the weekend were initially managed by the on-call surgical teams before being handed over to the TAS on Monday, potentially leading to delays or inconsistencies in tertiary survey completion.

“This has meant that patients admitted over weekends are initially managed by on-call teams before being transferred to the TAS, introducing delays and potential inconsistencies in care.”

Because of staffing shortages, there were periods when the service was not functioning at all, which probably diluted its impact, the report noted.

“An example of this is when there was a lack of registrar cover, and so the entire service was closed over the Christmas and New Year period in 2023/2024.”

Another limitation was “inconsistent or missing data”, which may have affected the accuracy of outcome measures and “masked potential areas of improvement”, researchers said.

Findings disappointing

One of the study’s authors, surgeon Dr Chris Wakeman, told Morning Report the team coordinates trauma patient treatment, who require complex treatment that crosses over specialists.

“In a big tertiary hospital like Christchurch we have very good but very specialised neurosurgeons, orthopaedic surgeons, but they’re not used to looking after the whole body. They’re looking after their brain, their fracture, or for me as a general colorectal surgeon, a fractured spleen, but they’re not used to looking at the whole package.

“So things get missed, things get delayed, operations occur out of order. We do know that a specialist coordinated service can coordinate and run things better.”

He said as someone who helped set up the team, the study’s findings were disappointing.

“We’ve had to close the trauma admitting service this year a number of times, sometimes for a whole week at a time, because there’s been no junior staff.

“We had to go back to the old-fashioned system where if you had a fractured head, abdomen, leg, but the head was the most important thing, then you’d go under the neurosurgeons, because we were closed.”

Wakeman said the team has the worst nurse to patient ratio in the country.

Injury is the leading cause of death in New Zealand for those under the age of 35, and the second most common reason for hospitalisation.

Although most New Zealand hospitals have dedicated trauma assessment teams (including staff from emergency medicine, general surgery, anaesthetics and nursing), only two of the country’s seven tertiary hospitals provide ongoing inpatient trauma-specific care through dedicated trauma admission teams.

Health NZ has been approached for comment.

– RNZ