Section 2. The System

System Organisation and Management

Introduction

The successful redevelopment of trauma services in Victoria will depend on the coordination of what will become a complex integrated service system. A system-wide approach is necessary to provide a central, easily recognised focus for system users, raise the profile of trauma services and enable strategic development of the system over time.

The Taskforce proposes that coordination of trauma services will occur through four arms working cooperatively:

• An overarching Ministerial Emergency and Critical Care Committee (MECCC).
• A State Trauma Committee (STC) acting as a subcommittee of the MECCC and providing a statewide advisory role.
• A collaborative cross-campus MTS Statewide Coordination Unit (MSCU).
• Regional CCECCS undertaking an enhanced integrated role in trauma care coordination.

The functions requiring coordination across the system include:

• Policy and service development
• Performance monitoring and evaluation
• Quality improvement
• Health promotion and public information
• Education and training
• Promotion of data collection
• Monitoring and awareness of research activity
• Liaison with major stakeholders, appropriate agencies and service providers.

Ministerial Emergency and Critical Care Committee

The Taskforce recommends that a MECCC be formed to provide advice to the Minister on the coordination, audit and monitoring, ongoing development and distribution of statewide emergency medical services including, but not limited to, the VSTS (Appendix 14). Through this body, a balance could be achieved between the different components of the emergency systems and an assessment made of the impact of recommendations from the STC on the emergency system as a whole.

State Trauma Committee

The Taskforce proposes that the STC be formed as a specialist subcommittee to the overarching MECCC (Appendix 13). The STC would be expertise-based rather than representation-based. It should, however, include representation from other Ministerial committees and the Department, from rural and metropolitan areas, as well as medical and allied health providers. It should be noted that committees, such as Ministerial Advisory Committees, have no executive power, this being the function of the Minister and his Department. While being responsible to the

MECCC, the Taskforce recommends that such a committee have authority to recommend strategies to facilitate optimum care of trauma patients.

Representation from the regional CCECCS on the STC will provide a crucial rural perspective necessary to integrate the trauma system.

The role of the STC in driving trauma system improvement should be looked at from both a system and a process point of view, that is from both the horizontal as well as the vertical perspective. The STC will be integral to the development of strategic direction in quality, monitoring, education and research.

MTS Statewide Coordination Unit

The Taskforce proposes that the MSCU will be established as a cross-campus collaborative group between the three MTSs (Appendix 15). The MSCU will have a small management executive drawn from the MTSs and the Department and will provide representation to the STC. It will be physically located at a MTS and will report under a service agreement to the Department and on a day-to-day basis to the MTS management executive. The MSCU will function as the implementation arm for trauma system development activities, specifically involving:

• Provision of advice, information and data to inform decision making by the STC.
• Collection and collation of trauma system performance data from Victorian trauma care providers, including the ongoing development of a trauma registry, in collaboration with the Department.
• Collaboration with regional CCECCS regarding education, quality improvement, and research activities.
• Implementation of clinical indicators for monitoring trauma care.
• Coordination of and participation in educational and training programs on a statewide basis to enhance trauma management.
• Coordination of and participation in research activities.
• Development of their role in injury prevention activities.
• Liaison with the Department and other trauma care providers.

Metropolitan and Regional Coordination

Metropolitan

The MTS will be responsible for coordinating the operational delivery of trauma services across the metropolitan area. This will involve identifying and addressing issues relating to the transport, reception and treatment of major trauma cases and involvement in planning changes to MeTS in conjunction with the STC.

Regional

The Taskforce recognises that the regional CCECCS will be essential forums for promoting and implementing the proposed trauma system. These multidisciplinary committees currently play an important role in planning, developing, coordinating, monitoring and advising on emergency and critical care services in rural areas. Regional CCECCS also develop necessary activities, such as education programs, to support these services (Appendix 17).

The regional CCECCS are, therefore, well placed to consider the regional application of the proposed trauma system and its underlying principles relevant to the initial reception, treatment and continuity of care of time critical trauma patients.
Their structure and coverage needs to be explored in relation to the regional RTS located at the base hospitals. A collaborative relationship between both will be necessary and auditing of the regional CCECCS will be an important quality activity.

Figure 2.7: Recommended Organisational Framework for Emergency and Critical Care Services in Victoria: Trauma Services