British Orthopaedic Association Standards for Trauma

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The Journal of Bone and Joint Surgery. British volumeVol. 91-B, No. 8 EditorialsFree AccessBritish Orthopaedic Association Standards for TraumaK. Willett, D. Marsh, C. Moran, P. Giannoudis, M. BircherK. WillettProfessor of Orthopaedic Trauma SurgeryJohn Radcliffe Hospital, University of Oxford, Headley Way, Oxford OX3 9DU, UK.Search for more papers by this author, D. MarshProfessor of Orthopaedic SurgeryRoyal National Orthopaedic Hospital, University College, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.Search for more papers by this author, C. MoranProfessor of Trauma SurgeryQueen’s Medical Centre, Nottingham University, Derby Road, Nottingham NG7 2UH, UK.Search for more papers by this author, P. GiannoudisProfessor of Orthopaedic and Trauma SurgeryLeeds General Infirmary, University of Leeds, Great George Street, Leeds LS1 3EX, UK.Search for more papers by this author, M. BircherConsultant Trauma and Orthopaedic SurgeonSt George’s Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK.Search for more papers by this authorPublished Online:1 Aug 2009https://doi.org/10.1302/0301-620X.91B8.22715AboutSectionsView articleSupplemental MaterialPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail View articleIn Britain, as in many other developed countries, care of the injured patient continues to have a lower priority than elective surgery. Whether this is a result of less favourable levels of funding or government obsession with waiting times for elective surgery, the situation has remained unchanged for many years, only intermittently securing headlines or space in a political party manifesto. Also, the unpredictable timing and the challenging range of conditions and complications, result in trauma ranking low in the declared interests of many in the profession. The vast majority of trauma patients have musculoskeletal injuries. The surgery of trauma excites most trainee orthopaedic surgeons but with seniority, specialisation and remoteness from the primary presentation, confidence and competence wane. It is common for older surgeons to seek withdrawal from the on-call rota for trauma. However, it remains the absolute responsibility of the profession to provide the best available care and to maintain standards for these patients.There have been several reports1,2 on the management of trauma in the United Kingdom during the last 20 years, often with good media coverage and considerable public interest, but they have resulted in little change. They have contained a multidisciplinary professional consensus as to the configuration of a trauma service and the care of specific injuries. Recent reports (2007) focusing on trauma care for the seriously injured3 (NCEPOD) and patients with fragility fractures4 (BOA and BGS), have prompted government support for the suggested service changes. For the seriously injured, the lack of a regional system of trauma care creates significant delays in treatment which compromise both surgery and outcomes. For the older person with a fragility fracture, often with complex medical disorders, surgery and rehabilitation are unnecessarily delayed. Multidisciplinary care and secondary prevention are deficient. It falls to the specialist professional bodies to define appropriate standards of care to protect patients. It is against such standards that we can audit individual cases and the performance of orthopaedic units. Providing the best care for our patients remains our prime responsibility. We should appreciate, not fear, the power of audit to effect change and welcome the publication of comparisons with professionally derived standards. Prompted by the Health Care Commission, in 2007 TARN (Trauma Audit and Research Network) secured approval for the publication of data on survival rates and performance as measured against the recommendations of the RCSoE/ BOA 2000 report2 ( www.tarn.ac.uk). Similar support is anticipated for the National Hip Fracture Database relating to the first British Orthopaedic Association standards for Trauma (BOAST) publication on hip fractures.In response to this need for further progress, the BOA has formed a Trauma Group with a specific remit to develop professional standards of care. The group, working with other representative professional bodies, will publish a series of standards for trauma care derived from research evidence, specialist opinion and contemporary wisdom. This is a progression of the proposal presented in the BOA and RCSoE report2 (2000) defining standards of audit for certain index trauma diagnoses to allow monitoring within a local and regional structure. Each BOAST will be a succinct one-page document listing a number of contemporary standards, supported by online references. They are intended to indicate the level of care that should be achievable for most patients in the United Kingdom. As published, they will be circulated to all active members of the BOA, allied specialist groups, hospital units and relevant authorities. A ‘no-blame’ review culture will be promoted. Units will be encouraged to audit local practice against the BOAST. If a case falls outside these standards then the causes should be determined and, if necessary, changes in practice adopted.The first in the series of BOASTs is ‘Hip Fracture in the Older Patient’. This has recently been published and the supporting Blue Book,4 ‘The Care of Patients with fragility Fracture’, has been produced in collaboration with the British Geriatric Society. Each BOAST will be published on the JBJS(B)5 and BOA website;6 and on those of other specialty groups relevant to that BOAST. Future BOASTs will cover Spinal Clearance in the Unconscious Trauma Patient, Pelvic and Acetabular Fractures, Open Fractures, Unstable Spinal Injuries, Vascular Injuries associated with Fractures and Dislocations, Peripheral Nerve and Brachial Plexus Injuries and Implant-Related Sepsis in Fracture Surgery.Supplementary materialFurther information on this subject is available with the electronic version of this article on our website at www.jbjs.org.ukNo benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.References1 No authors listed. Report of the working party on the management of patients with major injury. Royal College of Surgeons of England, London. 1988. Google Scholar2 No authors listed. Better care for the severely injured: a report from The Royal College of Surgeons of England and British Orthopaedic Association 2000 ISBN 0 902166 18 2. http://www.boa.ac.uk/site/showpublications.aspx?id=59 (date last accessed 29 April 2009). Google Scholar3 No authors listed. Trauma: who cares?: a report of the National Confidential Enquiry into outcome and death. 2007. www.ncepod.org.uk (date last accessed 28 April 2009). Google Scholar4 No authors listed. The care of patients with fragility fractures: a report from the British Orthopaedic Association and British Geriatrics Society. 2007. www.boa.ac.uk/site/showpublications (date last accessed 28 April 2009). Google Scholar5 No authors listed. The Journal of Bone and Joint Surgery [Br]. http://www.jbjs.org.uk Google Scholar6 No authors listed. British Orthopaedic Association. http://www.boa.ac.uk Google ScholarFiguresReferencesRelatedDetailsCited byWhat is the impact of a fast-track pathway on length of stay for adult patients with a hip fracture? 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