The Impact of Including Level III Trauma Centers in Pennsylvania

16th Annual PTSF/PaCOT Conference

October 25, 2012

Juliet Geiger RN, MSN –Executive Director, PTSFDavid Scaff, DO – Trauma Program Medical Director,

Pocono Medical Center

Historical Background

• 1985 – Standards of Accreditation for Adult L1/2 and Pediatric L1 trauma centers developed

• 1992 – L2 Pediatric Standards developed• 2004 – Act 15 0f 2004 signed mandating

L3 standards be developed• 2010 – L4 standards approved by PTSF

Board• 2012 – Five hospitals pursue L4

accreditation

Level III Accreditation History

• 2007 – First L3 accredited• 2008 – Two L3 centers in system• 2009 – Four L3 centers in system• 2010 – Two L3 center is system – 2

withdraw citing financial difficulties• 2011 – Two L3 in system. Pursuit funding

restored.• 2012 – One L3 in system. One withdraws.

Two hospitals pursuing L3 accreditation.

Level III Accreditation History

2007 2008 2009 2010 2011 20120

1

2

3

4

One withdrawsOne remainsTwo hospitals pursuing

2 withdraw citing financialdifficulties – state funding delayed Pursuit funding

restored

Questionnaire

• Questionnaire sent to eligible hospitals that received pursuit funding and those eligible hospitals that elected not to pursue accreditation in order to describe:– Reasons for pursuing or not pursuing Level III

accreditation– Barriers preventing a hospital from pursuing

accreditation– Barriers to becoming accredited for those that received

funding– Resources that would have helped with pursuit– Factors that would be necessary before pursuing

accreditation in the future.– Outcomes as a result of pursuit effort

Results:Reasons for Pursuing Accreditation

• Enhanced quality of care • Increased marketing of hospitals to

generate higher volumes of patients

• Receipt of grant funding

Results: Positive Outcomes

• Enhanced level of care of injured patients

• Improved care of all patients within hospital

• Implementing standardized protocols and policies for care of injured patients

• Energized nursing and physician staff in the care of injured patients

• Improved Performance Improvement efforts

County A Injury Mortality Rates

2007 2008 2009 2010 2011

4.8

2 2.41.8 1.3

6.5

5.24.3 4.7

PTOS Mortality Rate DOH Mortality Rate

L3 Accreditation 11/1/09

County B Injury Mortality Rates

2007 2008 2009 2010 2011

65

3 2.63.3

77

6 6

PTOS Mortality DOH Mortality

L3 Accreditation11-1-08

Barriers to Pursuing Accreditation: Surgeon Support

Feared increased patient volumes and injury severity

2 yr

s Pr

e-Acc

red

1 yr

Pre

-Acc

red

1st y

ear a

s TC

2nd

year

as T

C

0

40

80

120

160

AdmissionsTransfers outOrtho consultsAdmit to orthoAvg ISSGS admits

1 yr Pre-Accred

1st year as TC

2nd year as TC

3rd year as TC

050

100150200250300350400450500

AdmissionsTransfers OutOrtho consultsAdmit to OrthoAvg ISSGS Admits

County A (accredited 2009) County B (Accredited 2008)

Barriers to Pursuing Accreditation: Physician Leadership

• Trauma Medical Director must be a surgeon

• Rural areas predominately have private practice physician groups

• Peer Review process challenging

Barriers to Pursuing Accreditation: Funding

• Administration feared insufficient funding and disappearance of funding.

• In 2010 a two year delay did occur due to the West Virginia lawsuit that delayed trauma funding to all trauma centers and those pursuing accreditation.

Barriers to Pursing Accreditation:Education

• From PTSF– Education limited to state wide in-

person forums with limited 1:1 visits– L3 inclusion started almost 20 years

after L1/2 trauma centers developed

• From Trauma Centers – Unclear of role and how to support L3

development– Not fully supportive of L3 inclusion in

PA.

PTSF Next Steps… • Foster relationship building between

higher level trauma centers and their rural colleagues

• Enhance PTSF’s educational approach • Continue Level IV trauma center

development• Perform trauma system research geared

toward measuring the trauma center/system value.

• Continue to advocate for state and federal funding of trauma centers

• Embark on a public education campaign