University Hospital Wishaw (UHW) was identified as a STAG mortality outlier for 2017 – 2019 inclusive.

As a result, a high-level multidisciplinary mortality review process of all trauma deaths was conducted. This is now established as an essential part of the UHW Major Trauma annual clinical governance process.

These annual mortality reviews identified three key areas for quality improvement initiatives due to the excess mortality demonstrated:

• Frailty
• Chest wall trauma (including rib fractures)
• Cervical spine injuries not for surgical fixation

The quality improvement initiatives commenced during 2021 and coincided with the employment of the NHS Lanarkshire Major Trauma Coordinator who has driven them forward. The projects were supported by an extensive education programme for medical, nursing and AHP staff as well as continued ward support.

These interventions have led to significant improvements in mortality in both patient groups,

• Cervical spine injury mortality has reduced from approximately 14% to approximately 3% consistently.
• Rib fracture mortality has followed a similar pattern and reduced from approximately 8% to approximately 4%.

It is highly encouraging that in the STAG 2024 Annual Report, UHW were no longer Scottish mortality outliers for 2021 – 2023 inclusive. This sustained improvement in mortality demonstrated the case for an additional Major Trauma Coordinator to allow expansion of the service.