Consultant Nurse (CN) roles were introduced in the United Kingdom (UK) in 1999 to enhance clinical leadership and patient care by keeping senior nurses focused on clinical practice. Defined by the Royal College of Emergency Medicine (RCEM) and Royal College of Nursing (RCN) [1], CNs are clinical experts in emergency nursing who lead on policy, research, education, and advancing practice. UK workforce standards mandate that every Emergency Department (ED) employs at least one CN at a senior pay, with additional roles in sub-specialties like paediatric emergency care. In practice these roles are undertaken by both nurses and allied health professionals. While the roles share the core functions of clinical practice, leadership, education, and research, their implementation varies. Policy initiatives such as workforce plans and a consultant-level practice capability framework have aimed to standardise and expand these roles. However, role configuration, pay, and qualifications continue to vary. Despite some evidence of positive impacts on clinical outcomes, the evidence base is limited, and inconsistent role definitions and integration into workforce planning have hindered implementation. Aim/Methods This study aimed to identify consultant nurse/practitioners in United Kingdom emergency care and describe their roles in EDs. A cross-sectional survey was developed, peer-reviewed, and distributed via professional networks, snowball sampling, and social media. Survey was administered via REDCap and was open June-August 2024. Results Thirty-seven survey responses were analysed, gathering data on demographics, confidence levels, and time spent in each domain. Consultant nurses/practitioners spent most time in expert clinical practice and least in research and innovation, reflecting lower confidence in research and fewer grant applications or publications. Respondents collectively had 299 years of experience, indicating a highly skilled workforce. Conclusion This study offers the first updated demographic review of consultant nurse and practitioner roles in UK emergency care since 2005, revealing workforce shortfalls and role variation. Despite a skilled workforce, reasons for under-recruitment remain unclear. The findings highlight the need for further research to guide workforce planning and optimise consultant-level practice in emergency care.

Objectives To explore barriers and facilitators to implementing the ROWTATE vocational rehabilitation intervention and identify lessons for future service delivery. Design Qualitative interview implementation study embedded within the development and evaluation of a complex health intervention, guided by the UK Medical Research Council framework. Setting National Health Service (NHS) major trauma services in England. The ROWTATE intervention included early vocational assessment lasting up to 12 months, case management, employer engagement and coordinated multidisciplinary support between occupational therapists and clinical psychologists. The intervention was delivered via hybrid models following COVID-19 adaptations. Participants Purposively sampled stakeholders including patients, therapists, mentors, employers, carers, commissioners and primary care practitioners. Methods 80 semistructured interviews were conducted remotely between March 2023 and June 2025 using topic guides informed by the Consolidated Framework for Implementation Research and the Theoretical Framework of Acceptability. Data were analysed using framework coding followed by reflexive thematic analysis to generate cross-cutting themes and implementation-focused recommendations. Results Implementation was shaped by six cross-cutting themes that acted as both barriers and facilitators depending on context. Stakeholders highlighted the importance of addressing diverse patient needs and outcomes through early, personalised support and case management. Remote delivery improved accessibility and flexibility but was most effective when combined with face-to-face contact to strengthen relationships and contextual understanding. Multidisciplinary occupational therapy and clinical psychology collaboration enabled holistic care, though required structured processes to overcome communication challenges. Mentoring provided essential professional development and mitigated isolation in remote roles, while employer engagement facilitated workplace adjustments and retention but was constrained by patients’ reluctance to involve employers and by variable occupational health provision. Strategic buy-in from commissioners and clinical leaders was critical, with emphasis on robust outcome data and economic evidence to support sustainability. Conclusions Findings inform strategies for embedding vocational rehabilitation within integrated care models and identify core components that should be protected to support implementation when scaling hybrid delivery (eg, mentoring and structured multidisciplinary team processes). The study also outlines scalable approaches to hybrid service delivery, workforce development and employer engagement, offering transferable lessons for health systems seeking to reduce economic inactivity and address post-trauma inequalities. Trial registration number ISRCTN43115471 .

BACKGROUND:Trauma coordinators (TCs) play a key role in managing patients with complex injuries, coordinating care across multiple specialties. This study aimed to investigate the current role functions of TCs in the UK, compare them to findings from 2015, and explore differences between TCs in Major Trauma Centres (MTCs) and Trauma Units (TUs). METHODS:A UK-wide cross-sectional survey was conducted using an online questionnaire. Participants included trauma coordinators from MTCs and TUs. Data on role functions, clinical activities, and professional background were analyzed using descriptive statistics. RESULTS:There were 153 responses from TCs from 22 of the 27 trauma networks in the UK. Respondents reported 54 different role titles. Nurses comprised 65 % of the respondents, with 45 % holding a master's qualification. Clinical activities accounted for 51 % of the role, an increase from 39 % in 2015. Data entry and research responsibilities decreased. Advanced or autonomous practice was reported by 19 % of respondents, with more TCs from TUs engaging in independent prescribing. CONCLUSION:The role of TCs has evolved since 2015, with increasing clinical responsibilities and more professionals working at advanced practice levels. However, there remains considerable variation in role titles and functions, reflecting the need for standardization and further research on the impact of TC roles on patient outcomes.

AIM:To examine burnout levels, nurse perceptions of the work environment, job satisfaction, intention to stay and quality of care for nurses working in emergency departments before and following a planned change to nurse staffing levels. DESIGN:A pre-post observational design. METHODS:A systematic approach (Nursing Hours per Patient Presentation) was introduced to determine nurse staffing levels based on patient presentations resulting in adjustments to nurse staffing. Data on burnout, the work environment, intention to stay, job satisfaction and quality of care were collected from three emergency departments prior to and following the adjustments to nurse staffing. RESULTS:An adjustment to nurse staffing levels was made to all three emergency departments. Mean emotional exhaustion scores were significantly lower, and quality of work environment scores and levels of job satisfaction were significantly higher for nurses following staffing adjustments. There was an increase to the proportion of nurses who perceived an improvement in quality of care delivered. In general, the results indicated improvements in outcomes following adjustments to nurse staffing levels. CONCLUSION:A more holistic organisational approach is required to address staffing in emergency departments. Initiatives that involve frontline nurses in resource planning facilitating a bottom-up approach to allow for improved work environments would be beneficial. IMPACT:This study addressed a planned change to nurse staffing levels in emergency departments and staff outcomes pre and post changes to staffing levels. This study highlighted that staffing an emergency department, based on nursing hours per patient presentation, was associated with improvements in staff outcomes. The research will impact on nurses working in emergency departments as outcomes from this research were used to develop a Framework for Safe Nurse Staffing and Skill Mix in Emergency Care Settings. REPORTING METHOD:STROBE and SQUIRE checklist. PATIENT OR PUBLIC CONTRIBUTION:No Patient or Public Contribution.

BackgroundThe relationship between nurse staffing, skill-mix and quality of care has been well-established in medical and surgical settings, however, there is relatively limited evidence of this relationship in emergency departments. Those that have been published identified that lower nurse staffing levels in emergency departments are generally associated with worse outcomes with the conclusion that the evidence in emergency settings was, at best, weak.MethodsWe searched thirteen electronic databases for potentially eligible papers published in English up to December 2023. Studies were included if they reported on patient outcomes associated with nurse staffing within emergency departments. Observational, cross-sectional, prospective, retrospective, interrupted time-series designs, difference-in-difference, randomised control trials or quasi-experimental studies and controlled before and after studies study designs were considered for inclusion. Team members independently screened titles and abstracts. Data was synthesised using a narrative approach.ResultsWe identified 16 papers for inclusion; the majority of the studies (n = 10/16) were observational. The evidence reviewed identified that poorer staffing levels within emergency departments are associated with increased patient wait times, a higher proportion of patients who leave without being seen and an increased length of stay. Lower levels of nurse staffing are also associated with an increase in time to medications and therapeutic interventions, and increased risk of cardiac arrest within the emergency department.ConclusionOverall, there remains limited high-quality empirical evidence addressing the association between emergency department nurse staffing and patient outcomes. However, it is evident that lower levels of nurse staffing are associated with adverse events that can result in delays to the provision of care and serious outcomes for patients. There is a need for longitudinal studies coupled with research that considers the relationship with skill-mix, other staffing grades and patient outcomes as well as a wider range of geographical settings.Tweetable abstractLower levels of nurse staffing in emergency departments are associated with delays in patients receiving treatments and poor quality care including an increase in leaving without being seen, delay in accessing treatments and medications and cardiac arrest.

Abstract Background Moderately severe or major trauma (injury severity score (ISS) > 8) is common, often resulting in physical and psychological problems and leading to difficulties in returning to work. Vocational rehabilitation (VR) can improve return to work/education in some injuries (e.g. traumatic brain and spinal cord injury), but evidence is lacking for other moderately severe or major trauma. Methods ROWTATE is an individually randomised controlled multicentre pragmatic trial of early VR and psychological support in trauma patients. It includes an internal pilot, economic evaluation, a process evaluation and an implementation study. Participants will be screened for eligibility and recruited within 12 weeks of admission to eight major trauma centres in England. A total of 722 participants with ISS > 8 will be randomised 1:1 to VR and psychological support (where needed, following psychological screening) plus usual care or to usual care alone. The ROWTATE VR intervention will be provided within 2 weeks of study recruitment by occupational therapists and where needed, by clinical psychologists. It will be individually tailored and provided for ≤ 12 months, dependent on participant need. Baseline assessment will collect data on demographics, injury details, work/education status, cognitive impairment, anxiety, depression, post-traumatic distress, disability, recovery expectations, financial stress and health-related quality of life. Participants will be followed up by postal/telephone/online questionnaires at 3, 6 and 12 months post-randomisation. The primary objective is to establish whether the ROWTATE VR intervention plus usual care is more effective than usual care alone for improving participants’ self-reported return to work/education for at least 80% of pre-injury hours at 12 months post-randomisation. Secondary outcomes include other work outcomes (e.g. hours of work/education, time to return to work/education, sickness absence), depression, anxiety, post-traumatic distress, work self-efficacy, financial stress, purpose in life, health-related quality of life and healthcare/personal resource use. The process evaluation and implementation study will be described elsewhere. Discussion This trial will provide robust evidence regarding a VR intervention for a major trauma population. Evidence of a clinically and cost-effective VR intervention will be important for commissioners and providers to enable adoption of VR services for this large and important group of patients within the NHS. Trial registration ISRCTN: 43115471. Registered 27/07/2021.

Background Pre-injury frailty is associated with adverse in-hospital outcomes in older trauma patients, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older frail patients at six months after Major Trauma Centre (MTC) admission. Methods This was a multi-centre study of patients aged ≥ 65 years admitted to five MTCs. Data were collected via questionnaire at hospital discharge and six months later. The primary outcome was patient-reported HRQoL at follow up using Euroqol EQ5D-5 L visual analogue scale (VAS). Secondary outcomes included health status according to EQ5D dimensions and care requirements at follow up. Multivariable linear regression analysis was conducted to evaluate the association between predictor variables and EQ-5D-5 L VAS at follow up. Results Fifty-four patients died in the follow up period, of which two-third (64%) had been categorised as frail pre-injury, compared to 21 (16%) of the 133 survivors. There was no difference in self-reported HRQoL between frail and not-frail patients at discharge (Mean EQ-VAS: Frail 55.8 vs. Not-frail 64.1, p = 0.137) however at follow-up HRQoL had improved for the not-frail group but deteriorated for frail patients (Mean EQ-VAS: Frail: 50.0 vs. Not-frail: 65.8, p = 0.009). There was a two-fold increase in poor quality of life at six months (VAS ≤ 50) for frail patients (Frail: 65% vs. Not-frail: 30% p < 0.009). Frailty (β-13.741 [95% CI -25.377, 2.105], p = 0.02), increased age (β -1.064 [95% CI [-1.705, -0.423] p = 0.00) and non-home discharge (β -12.017 [95% CI [118.403, 207.203], p = 0.04) were associated with worse HRQoL at follow up. Requirements for professional carers increased five-fold in frail patients at follow-up (Frail: 25% vs. Not-frail: 4%, p = 0.01). Conclusions Frailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. Pre-injury frailty is a predictor of poor longer-term HRQoL after trauma and recognition should enable early specialist pathways and discharge planning.

BackgroundFrailty is known to be a predictor of poor recovery following trauma and there is evidence that providing early frailty specific care can improve functional and health outcomes. Accurate assessment of frailty is key to its early identification and subsequent provision of specialist care. The aim of this study was to determine the feasibility and acceptability of different frailty screening tools to nurses administering them in the ED in patients admitted following traumatic injury.MethodsPatients aged 65 and over attending the Emergency Department of five major trauma centres following injury participated in the study between June 2019 and March 2020. Patients were assessed using the clinical frailty scale (CFS), Program of Research to Integrate Services for the Maintenance of Autonomy 7 (PRIMSA7), and the Trauma Specific Frailty Index (TSFI). Nurses were asked to rank ease of use and to state their preference for each of the tools from best to worst. If the tool was not able to be completed fully then free text responses were enabled to identify reasons. Accuracy of the tool in identifying if the patient was frail or not was determined by comparison with frailty determined by a geriatrician.ResultsData were analysed from 372 patients. Completion rates for each of the tools varied, with highest degree of compliance using the CFS (98.9%). TSFI was least likely to be completed with “lack of available information to complete questions” as the most cited reason. Nurses showed a clear preference for the CFS with 57.3% ranking this as first choice (PRISMA-7 32.16%; TSFI 10.54%). Both PRISMA-7 and CFS were both rated highly as ‘extremely easy to complete’ (PRISMA-7 58.5%, CFS 59.61%).ConclusionOur results suggest that nurses from five centres preferred to use the CFS to assess frailty in ED major trauma patients.

Abstract Background Frailty is associated with adverse in-hospital outcomes after major trauma in older people, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older patients at six months after major trauma centre (MTC) admission. Methods This was a multi-centre study of patients aged ≥65 years admitted to five MTCs. Data were collected via questionnaire at hospital discharge and six months later. The primary outcome was patient-reported HRQoL at follow up using Euroqol EQ5D-5L visual analogue scale (VAS). Secondary outcomes included health status according to EQ5D dimensions and care requirements at follow up. Multivariable linear regression analysis was conducted to evaluate the association between predictor variables and EQ-5D-5L VAS at follow up. Results Fifty-four patients died in the follow up period, of which two-third (64%) had been categorised as frail pre-injury, compared to 21 (16%) of the 133 survivors. There was no difference in self-reported HRQoL between frail and not-frail patients at discharge (Mean EQ-VAS: Frail 55.8 vs. Not-frail 64.1, p=0.137) however at follow-up HRQoL had improved for the not-frail group but deteriorated for frail patients (Mean EQ-VAS: Frail: 50.0 vs. Not-frail: 65.8, p=0.009). There was a two-fold increase in poor quality of life at six months (VAS ≤50) for frail patients (Frail: 65% vs. Not-frail: 30% p<0.009). Frailty (β-13.741 [95% CI -25.377, 2.105], p=0.02), increased age (β -1.064 [95% CI [-1.705, -0.423] p=0.00) and non-home discharge (β -12.017 [95% CI [118.403, 207.203], p=0.04) were associated with worse HRQoL at follow up. Requirements for professional carers increased five-fold in frail patients at follow-up (Frail: 25% vs. Not-frail: 4%, p=0.01). Conclusions Frailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. For older trauma patients frailty is a predictor of poor longer-term HRQoL after injury should enable early specialist review and discharge planning.

Background: Diagnosis of major trauma in the older person is increasingly recognised as clinically challenging with recent reports finding that older patients sustaining major trauma are commonly under-recognised and subsequently are not receiving gold standard major trauma care. This paper is a service evaluation of the pro-cesses of major trauma (ISS > 15) care for patients > 65 years presenting to a UK major trauma centre.Aim: To identify modifiable factors within the patient journey that might inform future service improvement initiatives.Methods: TARN audit data and retrospective notes review of 190 patients > 65 presenting to UHS ED from 1st January 2018 - 31st December 2018 who did not receive a level 1 trauma call on arrival were used to achieve the dataset. Descriptive statistics were combined with multiple logistic regression to look for associations between specific process factors and a missed or delayed diagnosis. Results: The evaluation found that, of the cohort not receiving a level 1 trauma call, 42 (22.1%) patients received a level 2 trauma call; 87 (45.7%) patients were seen initially by a senior clinician, with only 31 (16.3%) patients meeting best practice tariff for consultant within 5 min; 60 (31.5%) patients were seen directly in the resusci-tation room; 48 (25.2%) patients received a trauma CT scan with only 27 (14.2%) meeting BPT for CT head within 1 h; 142 (74.7%) patients were admitted to a trauma specialty after discharge from ED. A total of 76 (40%) patients had a missed diagnosis of major trauma with 80 (42%) having a delayed diagnosis. Logistic regression showed a significant association between being seen in a standard initial assessment area (referred to as pitstop in this article) vs the resuscitation room as a first location (p = 0.007) with a delayed diagnosis; and a significant association between plain film imaging vs CT imaging (p = 0.000) and no trauma call vs trauma call (p = 0.009) with a missed diagnosis of major trauma.Conclusion: The findings of this service evaluation suggest that service improvement initiatives should be aimed at the early stages of the patient journey to improve missed or delayed diagnoses of major trauma in this patient group.

BACKGROUND:Research prioritisation exercises are used to determine which areas of research are important. In major trauma care, nurses and allied health professionals are central to the delivery of evidence-based care but their opinions on research priorities are under-represented in the literature. We aimed to identify the research priorities of major trauma nurses and allied health professionals in the UK.METHODS:A three-round electronic Delphi study was conducted in the UK between November 2019 and May 2021. Round one aimed to generate research questions with rounds two and three questions in order of priority. In stages two and three responses were analysed using descriptive statistics to compute frequencies and proportions for the ranking of each question.RESULTS:Survey rounds were completed by 180, 100 and 91 respondents respectively. The first round generated 285 statements that were condensed into 71 research questions. Analysis of rankings in subsequent rounds prioritised 54 research questions across themes of adult / children's acute care, psychological care and workforce, training and education.DISCUSSION:Nurses and AHPs are well-positioned to determine research priorities in major trauma care. Focusing on these priorities will guide future research and help to build an evidence-base in trauma care.

Objective To systematically review research on acute hospital care for frail or older adults experiencing moderate to major trauma.Setting Electronic databases (Medline, Embase, ASSIA, CINAHL Plus, SCOPUS, PsycINFO, EconLit, The Cochrane Library) were searched using index and key words, and reference lists and related articles hand-searched.Included articles Peer-reviewed articles of any study design, published in English, 1999–2020 inclusive, referring to models of care for frail and/or older people in the acute hospital phase of care following traumatic injury defined as either moderate or major (mean or median Injury Severity Score ≥9). Excluded articles reported no empirical findings, were abstracts or literature reviews, or referred to frailty screening alone.Methods Screening abstracts and full text, and completing data extractions and quality assessments using QualSyst was a blinded parallel process. A narrative synthesis, grouped by intervention type, was undertaken.Outcome measures Any outcomes reported for patients, staff or care system.Results 17 603 references were identified and 518 read in full; 22 were included—frailty and major trauma (n=0), frailty and moderate trauma (n=1), older people and major trauma (n=8), moderate or major trauma (n=7) 0r moderate trauma (n=6) . Studies were observational, heterogeneous in intervention and with variable methodological quality.Specific attention given to the care of older and/or frail people with moderate to major trauma in the North American context resulted in improvements to in-hospital processes and clinical outcomes, but highlights a relative paucity of evidence, particularly in relation to the first 48 hours post-injury.Conclusions This systematic review supports the need for, and further research into an intervention to address the care of frail and/or older patients with major trauma, and for the careful definition of age and frailty in relation to moderate or major trauma.International Prospective Register of Systematic Reviews (PROSPERO) CRD42016032895.

Abstract Introduction Major trauma is a substantial health burden for older patients with a significant proportion having ongoing functional and psychological difficulties long after their injury. Frailty impacts adversely on outcome after trauma but the longer term effects are unknown. This study aimed to determine differences in health related quality of life (HRQoL) and change in dependence for frail and non-frail patients aged 65 or over discharged from Major Trauma Centres (MTCs) following injury. Methods This prospective multi-centre study recruited from five UK MTCs between June 2019 and March 2020. Eligible patients were aged 65 or over requiring ‘trauma team activation’ and admitted to hospital. Follow-up data was collected via questionnaire at two time points: on day of hospital discharge and at 6 months. Primary outcome at follow-up was patient reported health-related quality of life (HRQoL) using the EQ-5D-5L measure. Results Data were analysed from 181 patients. 54 died in the follow-up period and HRQoL data was available for 127 patients. Of these 16% were identified as frail during the trauma hospital admission using the Clinical Frailty Scale. On average, frail patients were older (82 years) compared to non-frail (77 years). HRQoL was rated similarly at discharge in both groups (Non-Frail: 60, Frail: 65, p = 0.137), but at follow-up non-frail patients reported improvement whilst those who were frail had deteriorated from the discharge base-line (Non-Frail: 70, Frail: 50, p = 0.01). At 6 months post injury, half of the frail cohort (49%) were more dependent on care than pre-trauma compared to less than a third of non-frail patients (29%). Conclusion Patients who were frail in-hospital had worse HQRoL than non-frail patients 6 months after discharge from hospital, with increased dependence. Understanding the impact of injury on quality of life is important in planning for, and supporting, the ongoing care of frail older trauma patients.

Abstract Introduction Early assessment of frailty in older major trauma patients is important to providing appropriate care that goes beyond chronological age. Guidance exists that this assessment should be completed as early as possible in the Emergency Department (ED). To increase rates of frailty screening in this group the measurement tool needs to be quick to complete and easy to use. This study aimed to ascertain the preference of nursing staff completing frailty assessment in older major trauma patients in the ED. Method This prospective multi-centre study recruited from five UK MTCs between June 2019 and March 2020. Eligible patients were aged 65 or over requiring ‘trauma team activation’ and admitted to hospital. Patients were assessed for frailty by nurses trained to use three different frailty screening tools—the Clinical Frailty Scale (CFS), the PRISMA-7 tool, and the Trauma Specific Frailty Index (TSFI). Completion rates for each of the tools were calculated and nurses were asked to rate their preference for each of the tools and the reasons for non-completion if relevant. Results Data were analysed from 370 patients. Completion rates for each of the tools varied with highest degree of compliance using the CFS (98.9%). TSFI was least likely to be completed with ‘lack of available information to complete questions’ as the most cited reason. Nurses showed a clear preference for the CFS with 57.3% ranking this as first choice (PRISMA-7 32.16%; TSFI 10.54%). Both PRISMA-7 and CFS were both rated highly as ‘extremely easy to complete’ (PRISMA-7 58.5%, CFS 59.61%). Conclusion User acceptability is an important consideration in the selection of a frailty measurement tool for use in major trauma patients. Our study shows the Clinical Frailty Scale has high rates of completion and acceptability and can be implemented in practice for assessment of frailty in major trauma.

Abstract Introduction Major trauma is a significant health burden for older patients, with worse clinical outcomes when compared to younger people. Various clinical models exist however it is not clear which have most benefit for older patients. This study aimed to map the current provision of clinical pathways and services for older people with major trauma in the United Kingdom (UK). Methods A cross-sectional online survey was undertaken. Case vignettes designed to reflect ‘typical’ older major trauma patients were embedded within the survey. The survey was distributed via trauma network managers and social media, inviting responses from all UK hospitals receiving trauma patients in 2020. Fixed choice questions were analysed with descriptive statistics and free text responses categorised into themes. The survey was not deemed to be research using the UK Health Regulatory Authority tool. Results Responses were received from 20/27 Major Trauma Centres (MTCs), 33 Trauma Units (TUs) and two local emergency hospitals. Older patients were defined by age (range 55 to 82 years) or frailty status. Frailty assessment was routinely performed in more than two-thirds (69.1%) of locations. Availability of trauma-specific guidance for older patients varied, and was greater in TUs than MTCs. Analysis of the vignettes showed wide variability in the admission and subsequent interventions for older major trauma patients across hospitals. Qualitative data showed pre-injury health status, staff availability, and day of the week were factors leading to variation within individual hospitals. Conclusion There is wide variation in the processes of care and pathways for older major trauma patients in the UK. Whilst lack of standardisation may be a result of local service configuration this has the potential to impact negatively on quality of care, multi-disciplinary working and outcomes. Understanding the range of variation in practice provides opportunity to identify good practice and areas for improvement.

OBJECTIVE:Patient and family liaison practitioners are a relatively recent addition to UK helicopter emergency medical services to support patients with their recovery. A service evaluation was completed that mapped the current provision of patient and family liaison practitioner roles in helicopter emergency medical services in the United Kingdom.METHODS:An online survey was distributed to key stakeholders involved with UK helicopter emergency medical service patient and family liaison practitioner roles. Quantitative survey results were described, and open-ended questions were analyzed using content analysis.RESULTS:Twenty UK helicopter emergency medical services responded to the survey. Nine of these services employ patient and family liaison practitioners with 4 additional helicopter emergency medical services planning to initiate the role. There is variation in the employment models used between the services. The patient and family liaison practitioner role provides important benefits to patients and their families, clinicians, and the helicopter emergency medical service.CONCLUSION:Nine UK helicopter emergency medical services employ patient and family liaison practitioners. This role benefits patients, their families, helicopter emergency medical service clinicians, and helicopter emergency medical service charities. Further research is required to understand how the role works in practice and to understand how to maximize the benefits to stakeholders.

Background The introduction of specific pathways of care for older trauma patients has been shown to decrease hospital length of stay and the overall rate of complications. The extent and scope of pathways and services for older major trauma patients in the UK is not currently known. Objective The primary objective of this study was to map the current care pathways and provision of services for older people following major trauma in the UK. Methods A cross-sectional survey of UK hospitals delivering care to major trauma patients (major trauma centres and trauma units). Data were collected on respondent and site characteristics, and local definitions of older trauma patients. To explore pathways for older people with major trauma, four clinical case examples were devised and respondents asked to complete responses that best illustrated the admission pathway for each. Results Responses from 56 hospitals were included in the analysis, including from 25 (84%) of all major trauma centres (MTCs) in the UK. The majority of respondents defined ‘old’ by chronological age, most commonly patients 65 years and over. The specialty team with overall responsibility for the patient in trauma units was most likely to be acute medicine or acute surgery. Patients in MTCs were not always admitted under the care of the major trauma service. Assessment by a geriatrician within 72 hours of admission varied in both major trauma centres and trauma units and was associated with increased age. Conclusions This survey highlights variability in the admitting specialty team and subsequent management of older major trauma patients across hospitals in the UK. Variability appears to be related to patient condition as well as provision of local resources. Whilst lack of standardisation may be a result of local service configuration this has the potential to impact negatively on quality of care, multi-disciplinary working, and outcomes.