Sir, – I write in response to the expression of dismay by a number of neurosurgeons at Beaumont Hospital (Letters, May 4th) in relation to the recent decision to designate Dublin's Mater hospital rather than their own hospital as Dublin's major trauma centre.
International studies have consistently shown that concentrating the care of severely injured patients in dedicated major trauma centres is associated with improved access to care, reduced length of stay and demonstrably better outcomes for patients. As your letter writers note, at present no single Dublin hospital has all the acute specialties required in a major trauma centre. Instead, several key trauma specialties are spread across Dublin in different hospitals. As a result, during 2014-2019, 31 per cent of adult trauma patients were transferred at least once to another hospital as the receiving hospital could not provide the totality of care required. The designation of the Mater hospital as a major trauma centre followed a rigorous process. It included a public consultation on the designation process during which all stakeholders had the opportunity to contribute; each Dublin hospital group made submissions to an independent assessment panel; the panel visited all potential Dublin hospitals and met with clinical leaders and hospital managers; the panel requested subject experts to be available to them and consulted with a leading neurosurgeon specialising in neurotrauma at a major trauma centre in another jurisdiction as part of its deliberations. It was at the end of this very comprehensive process that it advised the HSE on the hospitals to be designated as the major trauma centre and Dublin trauma units.
The recommendation of the panel was approved by the board of the HSE and was accepted by Government. The advice of the panel took into account the totality of what was required to develop a major trauma centre in Dublin so that it could support the trauma system for Ireland. It is estimated that the trauma system will reduce the likelihood of death from trauma by 20 per cent.
The assertion that the HSE intends to establish a “mini-neurosurgical centre” at the Mater Hospital is not correct. The plan is for the National Office of Trauma Services to collaborate with the National Neurosurgical Centre (at Beaumont and Temple Street) to develop a system that best serves patients requiring trauma and other neurosurgical care.
Many models for the delivery of trauma neurosurgery in trauma centres exist around the world, and lessons from these, but most importantly from the incumbents who currently deliver the service, will inform the model that best suits Dublin. Meetings have taken place and will continue between the HSE and interested representatives of the National Neurosurgical Centre, and it is disappointing that the efforts to collaborate on the part of the HSE Trauma Office have not previously been referenced.
The trauma system decided upon will deliver better outcomes for patients. Delivering high-quality care requires a highly functioning team working together collaboratively in the interests of patients. The HSE’s Trauma Office will always strive to foster a spirit of co-operation in the knowledge that this is what will save lives and prevent disability. – Yours, etc,
KEITH SYNNOTT,
Consultant Orthopaedic
and Spine Surgeon,
National Spinal
Injuries Unit,
National Clinical Lead
for Trauma Services,
HSE National Office
for Trauma Services,
Dublin 8.