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MTCs and TUs in England should undergo regular peer reviews within the National Peer Review Programme with their performance judged according to national major trauma measures.⁹⁸

All new spinal cord injury patients should be referred through the NHS Spinal Cord Injury Service (NSCIS) and registered on the National Spinal Cord Injury Database (NSCID).^29,99 The incidence of complications should be recorded.

There should be clear processes and policies for reporting and learning from near misses and critical incidents. National patient safety alerts should be communicated and actions agreed locally to reduce the risk of harm.

Nationally agreed key performance indicators should be used to monitor the performance of the pathways for hip fractures and major trauma and reviewed by a multidisciplinary committee including a Trauma Lead anaesthetist. In addition, local quality indicators should be developed proactively, to support continuing improvement of these services within organisations.

Policies and equipment must be in place to protect patients and staff from cross infection, including the safe disposal of sharps¹⁹ and healthcare waste.²⁰

Impact of enhanced recovery pathways for elective surgery should be audited to focus beyond the length of stay to improve patient outcome and satisfaction.⁹⁹

Evaluation of patient centred outcomes on pain management and quality of recovery in hospital and after discharge using a validated questionnaire can be a useful tool to guide quality improvement in care pathways.¹⁰¹

Patient information leaflets on hip fractures should be available for patients, relatives and carers.⁵¹

For patients with complex trauma, including spinal cord injuries and traumatic brain injury, there should be rapid access to key professionals and regional specialists.³⁹ Patients, relatives and carers should be directed to appropriate support groups where relevant e.g. the Spinal Injuries Association.¹⁰²

Enhanced Recovery Programmes for patients undergoing primary arthroplasty surgery should provide comprehensive details of the patient journey including MDT led hip and knee school and expectations in terms of early mobilisation postoperative physiotherapy. Information provided should be comprehensive and include details of regional anaesthesia.