L. Bubb1, L. Pritchard2, S. Stibbards1, L. Potter2

1Alder Hey Children's NHS Foundation Trust, UK

2North West and North Wales Paediatric Transport Service (NWTS), Warrington, UK


Trauma is one of the leading causes of death in children, up to 30% of these deaths are potentially preventable by optimising initial resuscitation and early access to specialist interventions1.  To facilitate this the North West Children’s Trauma Network published the network guideline ‘Children’s Major Trauma Pathway’ in 2015.  The North West and North Wales Paediatric Transport Service (NWTS) is a specialist service commissioned to transfer critically unwell children from across the North West to regional paediatric intensive care units.  Although the service is not commissioned to perform time critical transfers, including those related to major trauma, NWTS are still involved in many trauma transfers as a source of transfer advice and to facilitate discussions between local hospitals and Trauma Team Leaders (TTLs) in the two regional children’s major trauma centres.


A 2019 audit of referral and advice calls to NWTS for paediatric major trauma patients identified that all areas of the regional Children’s major Trauma Pathway were adhered to in only 17% of cases.

Strategy for change

A dual-strategy education approach was required to raise awareness of the pathway, using both in-house teaching sessions for staff within the NWTS team and an outreach teaching programme to the district general hospitals within the North West Children’s Trauma Network.  Prompts to involve a TTL were included on paperwork used within the NWTS service and a trauma quick reference guide was produced by NWTS, in collaboration with the trauma Network, for local hospitals to access and support them during a trauma transfer.

Measure of improvement

Trauma referral cases were re-audited in 2021 (trauma referrals 01/01/2020 – 31/12/2020) and 2023 (trauma referrals 01/01/2021-31/12/23) and compared to the original 2019 data.

Lessons learnt

  • Lack of familiarity with the trauma pathway is likely to have contributed to the poor compliance initially, reflected by the improvements seen with the ensuing educational programmes.
  • It can be challenging to refer to complex policies and pathways in the context of an acutely unwell patient, this was addressed using the quick reference guide and prompts embedded in documentation forms.
  • Some of the initial improvements were not sustained following the first re-audit, highlighting the need for periodic reassessment of any project to allow refinement and targeted interventions.
  • Staff turnover within the NHS necessitates repeating educational interventions over time.


Message for others

Quick reference guides can be hugely beneficial for infrequently occurring, high acuity clinical situations, including paediatric trauma, improving compliance with unfamiliar clinical pathways during a stressful clinical situation.


  1. Cullen, PM. Paediatric trauma, CEACCP, 2012, 12:3, pp157-161.
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