Side Effects: 8 Wide-Reaching Benefits of Becoming a Trauma Center

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Achieving trauma center designation or recertification is a complicated process that can seem overwhelming to many hospital administrators. However, completing the process is well worth the effort. There are both operational and financial benefits outside the trauma department that act as "ripple effect" improvements that stem directly from trauma service implementation.

Trauma surgery is a natural and important offshoot of the broader realm of acute-care surgery (sometimes referred to as emergency surgery). While acute-care surgery is a less-recognizable term to those outside of the healthcare industry, trauma designations have become a widely-known, quantifiable benchmark that hospitals nation-wide use to demonstrate quality of care. As CEO of EmCare Acute Care Surgery, my primary goal is taking hospitals through trauma designation and recertification, and we have a 100 percent success rate. And, despite the fact that we work with many different hospitals of various ages, sizes and situations, we have constantly seen certain positive results stem from the designation.

1. There are meaningful financial advantages.
Medicare offers disproportionate funding to hospitals with trauma centers. Additionally, the Patient Protection and Affordable Care Act reinstitute the trauma stabilization act, which will unlock some government funding for the development of trauma programs. On top of that, as a designated trauma center, hospitals can actually bill and collect for certain activation fees that are paid by both Medicare and private insurance companies. Those fees can be very meaningful, sometimes more than funding the trauma program itself.

2. There is a "halo effect."
"The halo effect" is a term that's used to describe the increase of throughput in the emergency department after a trauma program is developed at a hospital. What we've found, and it's been pretty well documented in the medical literature, is that when a hospital becomes a designated trauma facility, it receives increased traffic from the emergency medical services agencies that already come there. Additionally, the facility also starts receiving traffic from EMS agencies that traditionally went to other facilities. Once emergency medical technicians and paramedics get comfortable with a certain emergency department, they start going there more and more frequently. The EMS no longer comes to the trauma-designated hospital just for trauma, they start bringing chest pain patients, stroke patients and patients with a wide array of conditions to that trauma-designated hospital as well. Trauma-designated hospitals simply have busier EDs.

The "halo effect" also impacts the remainder of the hospital simply because the ED gets busier — the inpatient beds are filled more quickly and regularly, there are significantly more higher-acuity patients so there are more X-rays needed, more laboratory tests ordered and more patients who need the rehab facilities. The general surgery referrals get busier, the orthopedic referrals grow. The volume in the operating rooms tends to grow as well.

3. It acts as a process improvement program.
Another key reason for wanting to become trauma-designated is that the trauma program itself can serve as a process improvement program. Trauma designation has been shown to raise the bar throughout a hospital. On the back end of the trauma verification process, I have had many hospital administrators tell me that their hospital just performs better than it used to after receiving trauma designation.

4. It can increase surgeon satisfaction.
Designated acute-care surgery programs usually require a surgeon to be on call for trauma. So that surgeon can also be on call for the emergency general surgery that's coming in through that location. In many cases, this allows practicing general surgeons to take call only if they want to, which makes that hospital the desired location in the community for surgeons to bring their patients. Sometimes surgeons view call as a burden. So if a hospital can take call service off the table for the other practicing surgeons, many times that hospital becomes the preferred location for their practice. Not being on call can allow surgeons to run a much more efficient elective general surgery practice. These surgeons also tend to appreciate knowing that the trauma-designated hospital will have a surgeon dedicated to seeing those trauma patients in a timely fashion and taking good care of them in the hospital.

A trauma surgeon taking the general surgery call can also see patients sooner in the emergency department, get them out of the emergency department and on the OR schedule at a time when there's a gap in the schedule that already exists. So it decreases the after-hours burden of cases and improves the efficiency of utilization of the personnel that hospitals are already paying for during the day.

These benefits for general surgeons and sub-specialists also tend to be duplicated with primary care physicians; when PCPs are aware of the trauma designation and the enhanced surgical coverage and resultant process improvement that comes from trauma designation, they increase their referrals to that location.

5. It can help with surgeon recruiting.
Allowing general surgeons to avoid being on call can also be a great recruiting advantage. Hospitals often struggle to recruit surgical sub-specialists because being on the medical staff usually means spending time on call. If they know that all the general surgery calls are already taken, or they don't have to participate, it allows the hospital to better recruit subspecialty surgeons.

6. Trauma designation brings clout.
Trauma is the first Center of Excellence Designation. It's verified by the American College of Surgeons and can go a long way towards elevating the reputation of a hospital. Each level of trauma designation comes with an implied level of capability. The most prestigious trauma centers in the country are American College of Surgeon verified Level 1 trauma centers. Typically Level 1 trauma centers are major teaching institutions, facilities affiliated with large universities and medical schools. So the idea of taking a community hospital and making it a Level 1 trauma center just conveys that same level of stature to them within the community and within the trauma region. It can also serve as a beneficial marketing tool.

7. Trauma designation can be outsourced.
Many of the hospital administrators I meet with say the reason they have not attempted to become designated as trauma centers is because they have no "buy-in" from their medical staff. Outsourcing trauma designation development gives hospitals a credible, trusted, experienced partner for the hospital that may have reticent personnel.

8. It can improve overall service.
Perhaps the most important reason for a hospital to become trauma-designated is it allows that hospital to better serve its community. The mission of every hospital is to provide comprehensive care to the people in its community. Offering trauma care is an added service for the area the hospital serves.

Patients who arrive at a hospital in need of trauma surgery get to be treated by a surgeon who is on-site and dedicated to that hospital. That surgeon can help speed the patient through their course of care so that the patient gets seen sooner, evaluated sooner and operated on sooner, if surgery is needed. And that means that they're going to recover sooner. Patient satisfaction scores tend to go up when patients are treated quickly.

Results
As I've discussed, trauma designation can provide a variety of benefits to hospitals. Several hospitals that were struggling prior to trauma designation — they were newer facilities in a saturated area, they were older places unsuccessfully competing with shiny new high-tech sites — went on to become the most robust, well-regarded facilities in their communities. Trauma designation has allowed these challenged hospitals to build on strong, positive reputations of quality and have tremendous success at recapturing a lot of patients. Becoming a trauma facility truly can help breathe new life into a hospital.

John Josephs, MD, is the founder of Acute Surgical Care Specialists, which became EmCare Acute Care Surgery in 2012. He graduated from the University of Texas Southwestern Medical School in Dallas. His surgical residency training was completed at the University of Texas Southwestern Medical Center and affiliated hospitals in Dallas where he also completed a fellowship in Trauma & Surgical Critical Care. Dr. Josephs' extensive clinical appointments include chief of trauma surgery at Presbyterian Hospital of Plano, and he has also served as the chairman of surgical services at Texas Health Presbyterian Hospital of Plano, vice chairman of the department of surgery at Trinity Medical Center in Carrollton, Texas, and chief of trauma at the Wilford Hall Medical Center on Lackland Air Force Base, the United States Air Force’s flagship hospital which serves as a Level I trauma center in Texas.


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