Adding Second Trauma Center: Good for Trauma Care?

What happens when a new level II trauma center moves in near an academic level 1 trauma center…and then moves out? Researchers from University of Florida (UF) – Jacksonville and Baylor College of Medicine wanted to find out. Christopher H. Perkins, M.D. is an assistant professor of orthopedic surgery at Baylor College of Medicine. Dr. Perkins told OTW, “Cody Martin, M.D. and I chose to investigate this topic when I was an assistant professor at the University of Florida at Jacksonville. I was one of two orthopedic traumatologists and have since moved to Baylor College of Medicine. In 2012, the state of Florida opened four provisional level II trauma centers, all very close to current academic level I trauma centers. At that time, I was a trauma fellow at the University of Miami where the opening of Kendall Regional Medical Center as a trauma center significantly affected the volume of cases at Jackson Memorial Hospital.”

“UF Jacksonville experienced the same phenomenon with Orange Park Medical Center. We had a unique opportunity in Jacksonville to investigate this effect on a level I trauma center because Orange Park was open for one year and then its trauma status was suspended after verification. This allowed for a period of time before, during, and after closure to investigate the effect on the hospital and on the orthopedic trauma service. Other centers in Florida have remained open which does not allow for investigating the effect after closure.”

“For this work, we used census data including ICD-9 codes of patients seen in the Orange Park Medical Center emergency department (ED) and the related trauma center. We found that ED visits declined when the level 2 trauma centered opened and rebounded after its closure. However, the volume for the orthopedic trauma service did not statistically rebound after the closure of the level 2 trauma center. This suggests that patients with fractures were still being brought by ambulance or walking into the level 2 trauma center despite the change in status.”

“The opening of a non-academic level 2 trauma center close to an academic level I trauma center can have a significant impact on volume and potentially an impact on the quality of patient care. This also has implications on the quality of resident and medical student education and on the financial sustainability of academic level I trauma centers that are responsible for a large burden of indigent care.”

“The results of this study need to be considered when states are planning to designate new trauma centers. Trauma centers need to be strategically placed to maximize patient access to care in a timely fashion and patients who are more severely injured need to be appropriately triaged to a higher level of care to maximize outcomes. To our knowledge, this study is the first to highlight a problem that orthopedic traumatologists practicing at any academic level I trauma center know to be a reality.”

“Trauma surgeons need to be involved in the development of regional and state level trauma networks along with local and state officials to assure that improving patient outcomes remains the most important goal while protecting the viability of academic level I trauma centers to assure the training of future generations of residents and students.”