Monday, October 20, 2014

Springs still lacks top-level ER

Posted By on Mon, Oct 20, 2014 at 5:23 PM

click to enlarge Memorial Central: Still no application for top level trauma licensing. - FILE PHOTO
  • File photo
  • Memorial Central: Still no application for top level trauma licensing.
A year after both local hospital systems said they’d seek the highest level of certification for their emergency rooms, neither has submitted an application to state officials.

And there’s no telling when Memorial Hospital or Penrose Hospital will seek the Level 1 trauma designation, although a spokesman for Memorial says the facility is taking steps in “an aggressive fashion” to meet the strict criteria. A Penrose spokesman says the hospital falls short by a third of the number of high-level trauma patients required for the designation, and can’t apply until that number increases.

Meantime, both hospital systems say they provide top-notch care locally.

In August 2013, less than a year after the city leased Memorial to the University of Colorado Health under a 40-year deal in October 2012, Memorial officials told media they would seek a Level 1 designation, the most acute emergency care.

Currently, emergency rooms at Memorial Central and Penrose Hospital have Trauma II designations. Memorial North has no trauma designation, and St. Francis Medical Center, part of the Penrose-St. Francis Health Services system, has a Trauma III label for its ER. Generally speaking, the higher the number, the lower the level of emergency care available.

In September 2013, Penrose said that it, too, would seek the highest designation.

But Mark Salley, spokesman for the Colorado Department of Public Health and Environment, says this via email when asked about the applications:
Both University Memorial and Penrose publicly declared their respective intentions to seek Level I trauma center designation last year. To-date, no applications for designation as a Level I TC have been received by the department. Trauma center designation is a voluntary action by hospitals and they choose the level according to resources, commitment, etc. The department works closely with all of Colorado's 73 designated trauma centers and will look forward to working with the facilities in Colorado Springs in terms of seeking Level I trauma center status.
Penrose-St. Francis Health Services spokesman Chris Valentine says in an e-mail that among the criteria for Trauma 1 is a requirement that an emergency room treat 320 patients a year with high injury severity, based on a complicated scoring system.

“Since Penrose did not yet have enough patients that met the criteria, a complete application could not be submitted for consideration,” Valentine says, noting Penrose fell about 100 patients short in 2013. “Trauma volumes and acuity are increasing at Penrose, and a complete application will be submitted when the required number of patients has been reached.” This year, Penrose’s number is on track to be about the same as 2013, he adds.

University of Colorado Health spokesman Dan Weaver says Memorial is aware of the lengthy process required for Trauma 1 eligibility. Among the complicated requirements are research and resident teaching programs, various specialty physicians on staff and publication of 20 peer-reviewed articles in medical journals within a three-year period.

For example, one requirement calls for an on-call attending trauma surgeon to be in the ER when the patient arrives, and the maximum allowable response time for the surgeon is 15 minutes 80 percent of the time; a postgraduate med student in year four or five of training may begin resuscitation while awaiting the surgeon’s arrival.

“Although we are well on our way to building both an exceptional research program and resident teaching platform,” Weaver says via email, “these programs will not be fully matured instantaneously.”

He notes that Memorial has an orthopedic traumatologist, who specializes in the most complex orthopedic trauma injuries, and the only surgical critical care program and acute care surgery program in Southern Colorado, components of leading-edge trauma programs. The addition of the traumatologist, he adds, means that many patients with severe multiple hip and pelvis fractures who used to be automatically transferred to a Level 1 facility are now treated in Colorado Springs. In addition, Weaver says Memorial’s emergency department is helping push toward that goal through numerous research projects.

“So while we don’t yet have a specific date to apply for level I trauma center certification, our preparation for this is progressing in a meaningful and aggressive fashion,” he says.

Neither Weaver nor Valentine could predict when either hospital system might apply for Level 1 designation. Valentine noted the “silver lining” to Penrose’s inability to reach the number of patients necessary to apply for a Level 1 license means “people in southern Colorado aren’t experiencing these serious injuries.”

There are four Level 1 trauma centers in the state, all in the Denver metropolitan area: Denver Health Medical Center, Denver; St. Anthony Hospital, Lakewood; Swedish Medical Center, Englewood, and Children’s Hospital Colorado (pediatrics), Aurora.

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