Guideline Development

MAJOR TRAUMA EDUCATION PROJECT

The Major Trauma Education Project has been established by the State Trauma System to deliver a trauma-focussed sustainable state-wide educational system for clinical staff (doctors, nurses, paramedics) across Victoria.

The project is managed by Adult Retrieval Victoria within its scope as a state-wide provider of coordinated, systematised clinical advice, retrieval, and information management.

Guidelines have been developed to support awareness of key aspects of the trauma system, early trauma care, specialist trauma management as well as retrieval activation and intervention. The audience for these guidelines and the educational material is primarily clinical staff in non-major trauma service settings; however the guidelines (particularly those which address process) are applicable to the entire system.

Each guideline contains supportive referencing and linkage to relevant materials, implementation support material and is reviewed using the AGREE instrument for assessment of guideline development methodology. The project has commenced a dynamic evaluation process which has already received contact and feedback from over 400 health care workers in Victoria.

ARV Project Team

ARV provides a project coordinator and project support staff to research and develop guidelines and educational material, coordinate consultation and feedback, and build and deploy the web-based components of Trauma Victoria.

Expert Review Group

Initial draft format was prepared through reference to standard authoritative information; evidence based material, as well as publications from peak bodies. The input from expert contributors with extensive experience and knowledge in the field of trauma management was sought in the consultation period. The expert review group consists of representatives involved in trauma care / management in Victoria from both the Metropolitan & Regional/ Rural sectors as well as from specialist sub groups.
  • Health Department of Victoria
  • State Trauma Committee (STC)
  • Major Trauma Services
  • Regional Trauma Service
  • Adult Retrieval Victoria (ARV)
Once the guidelines had been reviewed by the expert sponsor, revisions were made in accordance with their recommendations.

Trauma Education and Guideline Development Group

The guideline development group was chosen by the department of health for the knowledge and expertise they bring to the forefront through their experience in a chosen specialist field. Initially there were two separate groups to include both the trauma education and the trauma guidelines project group; these were eventually merged to include the one group for consistency. The trauma education and guideline development group consists of representatives involved in trauma care / management in Victoria from both the Metropolitan & Regional/ Rural sectors as well as from specialist sub groups to include:

  • Major Trauma Service
  • Metropolitan Trauma Service
  • Regional Trauma Service
  • Primary Care Service
  • Urgent Care Service
  • Adult Retrieval Victoria (ARV)>Health Department of Victoria
  • State Trauma Committee
  • Ambulance Victoria (AV)
  • The group would meet consistently on a monthly basis in order to guide the development of the trauma education project and to review any feedback obtained through the evaluation process.

Consultation with target audience

Draft trauma guideline documents were circulated to health network representatives from each of the Victorian health areas for feedback on content, applicability and readability, with responses collated.

Broad representations from across Victoria in various aspects of the field related to trauma management were chosen to review the guidelines for their usefulness, adaptability and implementation into current practice techniques. Draft guidelines were circulated to all health service types in all health regions of Victoria, reaching at least 20 different healthcare organisations

STC and Expert Steering Group-Trauma Guidelines Project Group representatives were also asked to provide feedback on one or more of the draft trauma management guidelines.

Individuals were not expected to review all of the guidelines but were asked to review guidelines which were of particular interest or where expert clinical knowledge in a given area was existing.  Draft guidelines were accessible for a period of 3-4 weeks and content of the feedback was reviewed on a weekly basis by the ARV Project Team. The project received over 40 individual written feedback responses.

Consensus between current guidelines in use at Major Trauma Services and the TED Project Guidelines was established.

Once the revisions were complete the next step in the process was to distribute the draft guidelines to the STC and to clarify any areas of contention.

State Trauma Committee

The State Trauma Committee (STC) provides advice to the Minister for Health and the Department of Health on the Victorian State Trauma System by identifying systemic issues and exploring opportunities for improvement. The STC is made up of a range of health service experts with proven experience in trauma management and system operations. They have been involved with the development of the guidelines since its inception and will complete the final sign off on the content of the guidelines post revision.

Literature/Evidence of best practice

The guidelines to support trauma services have been designed to maintain awareness of current practices in management of trauma. Essential to this is the sourcing and review of literature utilised and in the enhancement of guideline acceptability.

Integral to the development of an evidence based guideline series is the review of literature in current trauma management by health services. Project staff undertook a rapid structured literature review (RSLR) to identify key publications, reports and papers that should be utilised in the review of guidelines based on the RoTES Report of 1999REF and the development of supportive educational documents for end users.

The RSLR format was utilised for some it its key advantages, namely;

  • Capability to advance short timeframe for research
  • Reduced budget impact to the project
  • Reduced liability on project resources

The inclusion criterion for relevant research information was;

  • a published date from January 2008 to current
  • databases accessed; CINAHL, Medline, OVID, PubMed and Google Scholar

In addition to database explorations, project personnel undertook searching of the reference lists of identified relevant publications to expand the volume of significant documents.

Exclusion criteria were deliberately pliant, in that documents of significance were not excluded purely on date of publication, where significant clinical information was identified in articles which were extensively cited by other authors.

Exclusion criteria included articles that were;

  • not available in full and only available as a summary
  • fee-for-product publications-accessibility was an issue with those agencies which charged a fee to view each review
  • English language summaries of foreign language papers
  • produced only in a language other than English