About a year after University Hospitals opened the region's second Level 1 adult trauma center, the initial effects on both UH and MetroHealth — previously the only such trauma location — have been greater than expected.
UH was surprised by how many patients it saw, while MetroHealth took a greater hit to its finances than expected.
The true test of the success of having two Level 1 centers will be measuring outcomes. Data for that won't be available until early next year.
"My concern — and this needs to be seen — is what is the trauma mortality rate?" MetroHealth president and CEO Dr. Akram Boutros said. "What's happened to it in our region. Did it get better? That's what the promise was."
For a Level 1 designation, UH's trauma center needs to see a minimum of 1,200 patients, which the system was confident it could reach, said Dr. Michael R. Anderson, UH chief medical officer. But he said they were pleasantly surprised that the center, which opened Dec. 1, 2015, will far surpass that, having admitted nearly 1,500 patients through October.
MetroHealth saw a 27% drop in trauma activations, which Boutros said translated to a $35 million loss in revenue, much higher than the $20 million it predicted. But he is quick to note that the system has grown in other ways so the loss won't hurt the organization. Though it's not without its issues, the system can handle the loss, he said.
"We as a hospital can deal with the dollars — clearly we can," Boutros said, referencing MetroHealth's recently announced plan to replace its aging patient towers with a new hospital and move forward with its campus transformation on its own credit.
The trauma numbers have reached a plateau and have been stable for the past six months, Boutros said.
In January through October of this year, MetroHealth had 4,188 trauma activations — meaning people it saw and discharged from the emergency department, or admitted — compared to 5,737 for the same time span in 2015.
Also within those months, UH admitted 1,450 patients with a trauma diagnosis and treated and discharged or transferred 604 patients with a trauma diagnosis.
The American College of Surgeons will visit UH in February to review its first year and determine whether the center will become a fully designated Level 1 adult trauma center. This would be an addition to its Level 1 Pediatric Trauma Center, which admitted 669 patients from January through October this year.
Though the designation is an important milestone for UH and would shift the adult trauma center from provisional to full status, it doesn't change capability or operations, Anderson said.
UH's announcement in May 2015 that it planned to open its own Level 1 trauma center stirred community-wide debate. The plan was embraced by public officials, particularly those on the East Side who felt there had been a void in the area for such care since the Cleveland Clinic shuttered Huron Hospital in East Cleveland. Opponents, including MetroHealth and the Northern Ohio Trauma System, argued that the move was financially driven and that a competing center could negatively affect care.
The Northern Ohio Trauma System, or NOTS, is a regional trauma network that brings together various entities involved in trauma work — be it at Level 1, 2 or 3 centers — to share data and protocols and review outcomes and processes.
As of now, UH is not a member, which Anderson said was a sore spot for many.
There have been some meetings to outline a new regional trauma organization, Anderson said. He declined to provide detail other than to say, “I think as 2017 begins we're going to have some pretty good news.”
Edward Eckart, assistant director of public safety for the city of Cleveland and member of the NOTS Advisory board, would like to see UH at the NOTS table, which he said is a necessity in order for the group to reach its full potential. For EMS work, the addition of a second Level 1 center has meant revamping protocols to accommodate the decision-making process that now takes place on a scene to choose the appropriate hospital, said Eckart, who oversees EMS and fire for the city.
They've also had to make some operational adjustments, he said. Previously, when an ambulance was transporting a patient to MetroHealth from the East Side, it would be out of service and another would have to cover the area where it had been stationed.
When UH came online, it lessened the out-of-service times for EMS. There wasn't much of an effect on response time, Eckart said, because trauma accounts for only a couple thousand of the roughly 75,000 people transported in a year.
If UH were to become a member of NOTS, he said the shared data would help give a full picture of what the East Side Level 1 trauma center has meant.
“It's a big piece of the pie that's missing from the overall picture of trauma within Northeast Ohio,” Eckart said. “It would be nice to see this loop finally closed so that we're all functioning under the same guidelines, same protocols.”
Eckart commends the hospitals for their collaboration in the past several years in overall health care delivery in the community. The most recent visible effort being coordinating preparation for the Republican National Convention over the summer.
Anderson said the ultimate measure of the success of two Level 1 trauma centers will be improved outcomes.
“That same collaborative spirit that we felt preparing for and then being a part of the RNC, how do we continue to move that forward?” said Anderson, who is leaving UH at the end of the year to become president of the University of California San Francisco Benioff Children's Hospital. “How do people get rapid access to trauma care? How does that trauma care continue to decrease mortality? Quite frankly, how do we continue to improve trauma prevention?”
If trauma outcomes are positive, then great, Boutros said. But if not, “We've gotta fix it, because that's lives.”
"University Hospitals, MetroHealth feel effects of trauma center" originally appeared in Crain's Cleveland Business.