The argument for improving trauma care in Georgia hospitals boils down to one point: More critically injured people will survive.
The medical treatment patients receive for blunt force or penetration injuries most often seen in car crashes and falls got renewed attention when the state legislature last year passed a “Superspeeder” bill.
The new law tacks on extra fines for certain speeding violations and should raise about $23 million annually to help fund Georgia’s 16 designated trauma centers. Officials say that still isn’t nearly enough money to cover the extra costs those hospitals incur by meeting a long checklist of state-monitored requirements. And there still aren’t enough hospitals designated as trauma centers.
The Georgia Trauma Care Network Commission says the state needs about 10 more designated trauma centers in order to provide uniform standards of trauma care for every injured person within a 50-mile radius. Such a network should improve Georgia’s trauma death rate, which is 63 per 100,000 compared to 56 per 100,000 nationally. The commission says bringing Georgia up to the national average would save 700 lives a year.
In virtually the whole of Northeast Georgia, from Hall County and up, there are no designated trauma centers. The closest trauma center in the region is Gwinnett Medical Center in Lawrenceville.
Northeast Georgia Medical Center, which serves a 13-county region, has become a de facto trauma center for many critically injured patients, though it does not have the official state-certified designation and likely won’t seek it any time soon.
The hospital’s board of directors late last year appointed a study group to look at trauma care. Earlier this year the group recommended against seeking trauma center designation. The hospital instead will undertake efforts to improve how it coordinates trauma care and shares information with other hospitals.
“There is not (a designated trauma center) in Northeast Georgia, and at this point, we felt that is OK,” said Dr. Mohak Dave, Northeast Georgia Medical Center’s vice chief of the department of emergency medicine and emergency medical services medical director for Georgia’s Region 2.
Dave said the hospital already provides trauma care for 700 patients a year, ranking it seventh in the state. It has many of the resources, including the necessary surgeons, intensive care specialists and emergency department infrastructure, required of trauma centers.
“We have the responsibility to the community to treat trauma patients, which we have a high volume of already, so we are looking at what we need to do to improve the care of those patients who suffer from major trauma,” Dave said.
That will include designating a surgeon to serve as surgical director for the hospital’s trauma program, hiring a nurse to coordinate trauma care and joining a statewide registry that serves as a clearinghouse for trauma case information.
Some steps toward improved trauma care have already been taken.
Working with the Hall County 911 Center’s emergency medical dispatch program and area emergency medical technicians who respond to traumas, the hospital has created an alert system that identifies patients with critical injuries prior to arrival and puts staff on notice.
The hospital also provides trauma prevention education with initiatives like Safe Kids.
“The study group recognized the various assets our system has, and our focus now is coordinating that care at its optimum,” said Tracy Vardeman, Northeast Georgia Medical Center’s vice president for strategic planning.
The biggest sticking point in seeking official trauma center designation is money.
“When people think of a designated trauma center, they think of one hospital in the state of Georgia, and that’s Grady (Memorial Hospital),” Dave said. “And when you talk about a bankrupt hospital in Georgia, one hospital comes to mind as well, and that’s Grady.”
Grady Memorial Hospital, which has struggled in recent years to manage a budget saddled with more than $300 million annually in uncompensated care, is one of only four Level I trauma centers in the state. Level I trauma centers meet strict state requirements that include residency programs and research components.
Northeast Georgia Medical Center officials say if the hospital sought trauma center designation in the future, it would not be at Level I. There are four levels of trauma center designation.
Dr. Dennis Ashley, a Macon trauma surgeon and chairman of the Georgia Trauma Care Network Commission, said the funding of designated trauma centers “really gets to the heart of the problem as we try to recruit hospitals.”
“Having all the infrastructure in place and staff and service lines is expensive,” Ashley said. “And when you’re designated by the state, they check all of that. It’s not like you can say, ‘I will sort of half-do it.’ If you’re going to be designated as a trauma center, you’ve got to have checks in the boxes, and that takes commitment. That’s why we’ve been fighting for permanent, sustainable trauma funding.”
Ashley said hospitals should become trauma centers to have independent verification that they are doing a good job treating trauma patients.
“Designation allows the state to review your system and see that you have all the parts to make it efficient,” Ashley said. “By saying your hospital is a trauma center, you’ve shown you can do all these things, and that you will continue to monitor and evaluate them.”
Northeast Georgia Medical Center officials say they plan to monitor their trauma system’s effectiveness as they go forward. Joining the statewide trauma registry will be a big first step toward that goal, said Dane Henry, the hospital’s vice president of support services.
“It’s important in coming up with an organized approach as to how we care for trauma patients and how we compare and contrast and contribute at the state level,” Henry said.
“What gets measured gets improved,” Vardeman said.
Northeast Georgia Medical Center officials aren’t ruling out seeking trauma center designation in the future.
Ashley, the trauma commission chairman, hopes they will, but understands in the current economic climate that designation is a hard sell.
“This is the worst time to try to build a trauma system, obviously,” Ashley said.
Vardeman said improving trauma care will be a priority for the hospital, regardless.
“We think our biggest opportunity is to focus on how we improve the care and processes for the patients who are coming through our doors today, and then perhaps build upon that at some future date,” she said.