True mumblings, from a junior doctor...

Curse of the Trauma Centre

Major Trauma Centres are the pinnacle of modern evidence based care for those unfortunate enough to be involved in significant trauma.
The hospital that contains the MTC is hamstrung (cf Royal London, St Mary's) with constant lack of TU and HDU facilities.
Why is this? It's because trauma is never ending, and you triage up not down, meaning that cases previously treated in a local A&E now end up at the shiny hospital. All well and good if the care and outcome is better provided that someone has remembered to plan appropriately.
Of course, in the UK we have tendered low bids and come up short. Trauma is a disease of the young predominantly. These patients survive horrendous injuries, and in the case of head injuries their bodies function very well. This means of course that they take up beds. For extended periods of time. WHich no one has thought about. The budgets for these MTCs are for a couple of patients in ITU and a few in an HDU setting (<20%). In reality the patients often occupy >50% of the critical care beds at any one time. This leads to elective cancellations, higher patient load elsewhere and speedy step downs. This then leads to worse outcomes all round.
If they had been honest when planning then this would be sorted, as the money would have been utilised to make a proper team and wards and critical care capacity. But obviously no one did "cos it can be done for less than that". Then all the staff pay with their sanity.
51.5167° N, 0.175763° W