Trauma centers prep for rankings

Northern Colorado’s trauma centers and emergency-room personnel are working hard to qualify for new state certification that will standardize procedures and create guidelines for trauma centers.

Colorado is developing guidelines and a certification program to rank trauma, according to the capabilities of each center around the state.

Soon, each hospital will have a ranking that will tell people what level of care the hospital is qualified to give, and the certification will standardize the level of care for patients entering each trauma center.

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“The goal is to develop a statewide system so people get to the right place at the right time,´ said Lori McDonald, trauma coordinator at Poudre Valley Hospital in Fort Collins.

McDonald said people in rural areas were not always getting the same level of care as people located near large metropolitan hospitals.

“So now if a patient needs a certain level of care in one area, transfer mechanisms are in place,” she said.

Patients may be transferred to hospitals outside their area if they need a level of care not available to them where they live.

The state began looking for ways to standardize care for trauma patients several years ago, when Amy Jackson, a high-school student from Alamosa, was injured in a car accident and taken to a hospital in Denver that was not equipped to handle trauma patients.

Jackson’s death brought trauma-patient care to the attention of state officials, who began looking for ways to get critically injured patients to facilities that were prepared to handle trauma emergencies, to standardize the level of care for all patients in trauma units and develop a classification system and a transport system so hospitals could know which trauma centers were equipped to handle each level of injury or emergency.

McDonald said the state passed legislation in June 1995 on trauma care and began a selection process at that time for a group of people who eventually formed the Colorado Trauma Advisory Council.

McDonald is a member of that council with 10 other people, including five physicians, two administrators, three ex-officio members, one member of the community at large, one county government official and one other nurse besides McDonald. The community-at-large member is Amy Jackson’s father.

The council is establishing a rating system for trauma centers at hospitals, standards that the trauma centers must meet and a tracking system whereby all trauma patients are monitored from the time they enter a center to the time they return to the community.

“There are five levels of trauma care, starting with level 1, which is the most comprehensive care, to level 5, which is a hospital not designated as a trauma center,” McDonald said. “These may be large hospitals but choose not to have trauma centers.”

These hospitals would stabilize an emergency patient and then send the patient to an appropriate trauma center.

Level 1 trauma centers must have a full-time trauma team in place around the clock with a neurosurgeon, cardio-thorasic surgeon, plastic surgeon and burn care, and must demonstrate commitments to public education and outreach programs. Level 1 centers also must do research.

McDonald said there are usually very few level 1 trauma centers in a state, and only a few centers are needed with that level of certification. In Colorado, St. Anthony’s Central and Denver Health and Medical Center are the only level 1 trauma centers.

A level 2 center is very similar to a level 1, except for the research element. Poudre Valley Hospital is working on a level 2 certification.

“We are going through the verification process in February, and we will know in six to eight weeks after that if we have received our level 2 certification,” McDonald said.

Level 3 centers have fewer surgical specialists on staff, and level 4 certification is a possible classification for some rural areas that may have physicians but not surgeons on staff. Level 5 is for hospitals nondesignated as a trauma center.

Some hospitals choose not to be designated as a trauma center because they do not have the staff to support a center or because they feel the level of commitment and money are too great an investment.

“We started our trauma service here in 1993,” McDonald said. “We have an excellent facility here with state-of-the-art equipment. So we are working on our system, and we increased the staff on our trauma team. One of our goals is to take care of our own people in our own community. We want to keep our care here.”

McKee Medical Center in Loveland is waiting to hear if it has received level 3 certification.

“We had our survey by the American College of Surgeons on Nov. 18th,´ said Roshelle Geroche, trauma nurse coordinator at McKee. “So we are just waiting for our official certification. We can’t call ourselves a trauma center until we pass the certification, but we are functioning as a trauma center. I think we will know in a couple of weeks.”

Geroche said that McKee started two years ago to meet the requirements for certification.

“To be a trauma center, it is a requirement to have a trauma coordinator,´ said Geroche, who joined the staff two years ago to coordinate the trauma teem.

Requirements for certification are currently defined by the American College of Surgeons, which sends a team of specialists from Chicago to evaluate trauma centers around the country when the centers request certification.

The Colorado Trauma Institute, a voluntary group of hospitals around the state, currently can certify trauma centers in the state, using the American College of Surgeons recommendations. However, after July 1997, the state will take over the certification process based on the certification procedures that the Colorado Trauma Advisory Council decides to adhere to.

McDonald said that procedures will be very similar to those used by the American Council of Surgeons. Trauma centers, she said, must get recertification every three years.

Certification at McKee, Geroche said, was a process of looking at the system and defining the trauma team.

“The process of being a trauma center is to identify where the specialty centers are, such as burn centers for some patients, and to send the patients there,” she said. “Where to send a patient depends on the criticality of the patient, weather conditions and many other factors.”

McKee, Geroche said, has been moving in this direction for a long time.

“We have not been scurrying, but we want to be proactive,” she said. “We stood back to look at what is happening. We wanted to do this for the people in the community.”

At North Colorado Medical Center in Greeley, trauma coordinator Chris Hoffman said NCMC is seeking a level 2 certification.

“We started three years ago taking a look at things and actively pursuing a level 2 trauma center,” Hoffman said. “The qualifications are so strict, that it raises the level of care for the whole hospital.”

The Greeley hospital is able to apply for a level 2 certification because three new surgeons recently moved to town, and they all came from level 1 trauma centers.

“We are establishing guidelines for our trauma center,” Hoffman said. “We have our trauma unit in place, and we are taking a look at the whole process.”

Hoffman said that late next summer or early in the fall, they hope to have a consultation visit from either the American College of Surgeons or from the Colorado certification team if it is in place at that time.

Hoffman said she expects that it will be some time in 1998 before NCMC receives its official certification for a level 2 trauma center.

“It is a very intense process,” she said. “It takes a lot of commitment and a lot of money. We are equipped to do open-heart surgery, but we don’t do research. We won’t go for a level 1 trauma center. Our volume is not that high to require level 1.”

The state will eventually be divided into regions, which will be created for the management of trauma patients. McDonald said these regions will be self-governing, and they will each write a plan for trauma care in their region.

A group of hospitals in Northern Colorado has already formed the Northeast Colorado Trauma Consortium, which covers Yuma, Larimer, Weld, Sedgwick, Phillips, Logan, Morgan, parts of Jackson and Washington counties.

“We were one of the first groups to organize, because we wanted to get up to speed and to be kept informed,” she said. “The plan is to better serve the rural areas. We worked up a needs and assessment document, and the state has adopted ours as a model and sent it out to other groups in the state.”