2019 / 2020 Best Practice Tariff
Below are the latest NHS Best Practice Tariffs. The Major Trauma Tariff has been updated for 2019 / 2020 and now includes a requirement for a clinical frailty score for MTC patients to achieve the Level 2 tariff (amongst other additions). The relevant section is shown here. The full document is below. The new measures are in red.
12 Major trauma [updated]
Introduced 2012/13
Best practice characteristics changed 2014/15
Two measures removed and one updated from the existing BPT and three new measures added 2019/20
12.1 Purpose
The aim of the BPT for major trauma is to encourage best practice treatment and management of trauma patients within a regional trauma network. The BPT is paid for activity at major trauma centres for the most seriously injured patients.
12.2 Design and criteria
The BPT is made up of two levels of payment, differentiated by the injury severity score (ISS) for the patient and conditional on achieving the criteria set out below. A level 1 BPT is payable for all patients with an ISS of 9 or above, providing that:
If there is any dispute around the timing of referral and arrival at the MTC, this will be subject to local resolution.
A level 2 BPT is payable for all patients with an ISS of 16 or above, providing all level 1 criteria are met and that:
While not currently a condition of level 1 payments, patients with severe injuries being admitted directly to the MTC or transferred as an emergency should be received by a consultant-led trauma team as soon as possible (ideally within 30 minutes).
12.3 Operational
The BPT is not conditional on the patient’s HRG being in the VA chapter (multiple injuries), and applies to both adults and children. Any patients eligible for the major trauma BPT are excluded from the marginal rate emergency rule. A patient cannot attract additional payments for both level 1 and level 2. For example, a patient with an ISS score of 17 would attract a maximum additional payment of the level 2 score, not both level 1 and level 2. The BPT will not be applied through SUS+, and organisations will need to use the TARN database to support manual payment adjustments.
In future iterations of the national tariff we may consider introducing a trauma unit level 1 criterion in the BPT.
12 Major trauma [updated]
Introduced 2012/13
Best practice characteristics changed 2014/15
Two measures removed and one updated from the existing BPT and three new measures added 2019/20
12.1 Purpose
The aim of the BPT for major trauma is to encourage best practice treatment and management of trauma patients within a regional trauma network. The BPT is paid for activity at major trauma centres for the most seriously injured patients.
12.2 Design and criteria
The BPT is made up of two levels of payment, differentiated by the injury severity score (ISS) for the patient and conditional on achieving the criteria set out below. A level 1 BPT is payable for all patients with an ISS of 9 or above, providing that:
- the patient is treated in a major trauma centre
- Trauma Audit and Research Network (TARN) data is completed and submitted within 25 days of discharge
- a rehabilitation prescription is completed for each patient and core components recorded on TARN with documented evidence in patient notes of a copy to the patient, GP and ongoing care provider if applicable
- any coroners’ cases are flagged within TARN as being subject to delay to allow later payment
- if the patient is transferred as a non-emergency they must be admitted to the major trauma centre (MTC) within two calendar days of referral from a trauma unit
- patients with a Glasgow Coma Scale (GCS) score of <9 have documented evidence of intubation being considered within 30 minutes of arrival at the MTC.
If there is any dispute around the timing of referral and arrival at the MTC, this will be subject to local resolution.
A level 2 BPT is payable for all patients with an ISS of 16 or above, providing all level 1 criteria are met and that:
- if the patient is admitted directly to the MTC or transferred as an emergency, they must be received by a trauma team led by a consultant in the MTC; the consultant can be from any specialty, but must be present within five minutes
- patients admitted directly to a MTC with a head injury of abbreviated injury scale (AIS) 1+ and a GCS score of less than 13 (or intubated prehospital), and who do not require emergency surgery or interventional radiology within one hour of admission, receive a head CT scan within 60 minutes of arrival
- tranexamic acid is administered within one hour of arrival at scene (or arrival at the MTC for self-presentations) for patients with at least one injury associated with significant bleeding
- all patients aged 65 years or older have a Clinical Frailty Scale completed within 72 hours of admission by a geriatrician (defined as a consultant, nonconsultant career grade (NCCG) or specialist trainee ST3 or above).
While not currently a condition of level 1 payments, patients with severe injuries being admitted directly to the MTC or transferred as an emergency should be received by a consultant-led trauma team as soon as possible (ideally within 30 minutes).
12.3 Operational
The BPT is not conditional on the patient’s HRG being in the VA chapter (multiple injuries), and applies to both adults and children. Any patients eligible for the major trauma BPT are excluded from the marginal rate emergency rule. A patient cannot attract additional payments for both level 1 and level 2. For example, a patient with an ISS score of 17 would attract a maximum additional payment of the level 2 score, not both level 1 and level 2. The BPT will not be applied through SUS+, and organisations will need to use the TARN database to support manual payment adjustments.
In future iterations of the national tariff we may consider introducing a trauma unit level 1 criterion in the BPT.
| annex_dtd_best_practice_tariffs.pdf |