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Trauma Care
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Trauma centers
aren’t necessarily profitable, but they save lives, enhancing the
quality of life for the region.
By Kevin Kipp
It gets expensive to keep a half-dozen physicians on standby: $4.3
million a year.
That’s the Missouri Department of Health estimate of what a level
I trauma center costs...”just to have the doors open,” says Dr.
James Crane, associate vice chancellor for clinical affairs at the
Washington University School of Medicine.
Of course, if somebody comes in, the cost goes up.
In laymen’s terms, trauma centers are the emergency rooms that handle
the really really bad accidents. Or gunshot wounds.
But if every hospital has an E.R., only those that have met certain
standards—and overcome a variety of other obstacles—are designated
“trauma centers.”
The Missouri Department of Health assigns level I, II or III to
reflect—among other criteria—the availability of “trauma subspecialists”:
trauma surgeons, neurosurgeons, anesthesiologists, intensive care
docs and emergency medicine docs.
Surgeons, like good-hitting shortstops, are generally hard to come
by, and therein lies the scrub.
St. John’s Mercy has a level I trauma center. Mike Morgan, president
and CEO, says, “Scheduling is a challenge...finding highly qualified
orthopedic surgeons and neurosurgeons is especially difficult for
level I trauma centers because of the volume.”
It’s not just the wee hours. “The middle of the day can be a challenge,
too,” he says, “because that’s when they’re busy with their own
scheduled patients.”
But if you want to be a level I trauma center, you need them on-site
around the clock...“24 by 7,” Crane calls it. At a level II facility,
the talent needs to be able to get into the operating room within
20 minutes.
Washington University physicians staff St. Louis Children’s and
Barnes-Jewish Hospitals’ level I trauma centers.
St. Louis’ other level I trauma centers are located at Saint Louis
University Hospital and SSM Cardinal Glennon Children’s Hospital.
Cardinal Glennon’s, like Children’s, is a pediatric level I trauma
center, Crane says. “We’re blessed to have two in St. Louis.”
Kevin Kast, president/CEO/market executive of SSM St. Joseph Health
Center and SSM St. Joseph Hospital West in St. Charles County, oversees
operations that include a level II and a level III trauma center.
“Every accredited hospital has physicians in the E.R. to stabilize
patients,” Kast explains. “The question for trauma centers is whether
they can take a patient to the operating room within minutes...365
days-a-year, 24 hours-a-day. We’re organized so that we’ll have
surgeons and their ancillary team in the O.R. within 20 minutes.
Coincidentally, that’s about how long it takes to get the patient
from an accident on the highway into the O.R. But the team will
be there.”
Kast says that teams at a level III trauma center might not immediately
include a neurosurgeon. Moreover, surgeons have 30 minutes to get
on site, and the state doesn’t limit the number of level III sites,
like it does levels I and II. Economics does.
Missouri has 34 trauma centers, says Crane, designated level I or
II or III. “In aggregate on a cost basis, they have about $32 million
a year in facility-based losses, and an additional $14 million in
physician-operating losses.”
That may help explain why Christian Northeast closed its level II
trauma center last year, Crane agrees, adding that a level III trauma
center in Branson is closing “because they just can’t bear the financial
burden of providing this care.”
More could follow.
Morgan says, “The greatest challenges to trauma centers are reimbursement
issues from both the federal and state level.
“But,” Morgan says, speaking for his trauma center team, “this is
what we trained for, this is what we do, this is what it takes to
be a level I trauma center...to provide the care our community needs.”
Kast asks rhetorically, “Why organize this way if it’s not an income
generator?”
Then he answered, “Trauma centers save lives, and it enhances the
quality of life for our communities. If we can do that, we should.
You don’t make all your decisions based on profit and loss. You
consider what are the community’s needs, and you do everything you
can to accommodate those needs.”
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Last
month, the Charles F. Knight Emergency and Trauma Center—a
52,000-square-foot, 61-bed facility —replaced three separate
emergency care areas. The new Emergency and Trauma Center
at Barnes-Jewish Hospital offers the latest in technological
advances.
Barnes-Jewish Hospital’s trauma program has earned the distinction
of Level I verification from the American College of Surgeons,
the highest national recognition possible. Barnes-Jewish Hospital
is the only hospital in the St. Louis area to earn this prestigious
honor.
The Emergency and Trauma Center is named for Charles F. Knight,
chairman of Emerson and former chairman of the BJC Board of
Directors, in recognition of his vision and contributions
during planning of the Medical Center’s campus integration
project.
The trauma/critical care area includes two full-body CT scanners
and six trauma/critical care rooms that are separated from
the emergency care area, providing privacy and high-tech care.
The heliport on the roof offers private elevator access so
air transfers are more convenient and less disruptive. |
According to data Crane provided, those needs amount to handling
about 370,000 cases annually in Missouri’s 10 level I and 12 level
II trauma centers. At SSM St. Joseph West in Lake St. Louis, where
one of Missouri’s 12 level III trauma centers operates, the emergency
department saw 28,098 patients in 2001.
Statewide, about 3,500 people die each year from trauma, Crane says.
“For people under 45, it is the leading cause of death. On top of
that, roughly three times the number of people who die will suffer
a permanent debilitating injury from trauma. That’s 10,000 Missourians
last year.”
As a response, Crane says, trauma centers across the state have
joined forces with the Missouri Hospital Association, the Missouri
State Medical Association and the Missouri Association of Osteopathic
Physicians & Surgeons to “work on this in the Missouri Legislature.”
The joint effort is called the Missouri Trauma Care Initiative.
Part of what it’s after includes “increased state reimbursement
to ease burden on trauma centers.”
Crane says the package they back also seeks “funding an added focus
on reducing the death rate through prevention and education programs
and increased support for the State’s Trauma Registry.
By tracking meaningful data, he says, the registry can contribute
“to effective interventions to reduce the prevalence of trauma.”
First-class could be more economical than standby.
Kevin Kipp runs Bubble Communications, a creative services and
community relations firm in St. Charles.
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