A web of shadow trauma centers covers Chicago

Community hospitals throughout Cook County are acting as de facto trauma centers for gunshot victims who show up in their emergency rooms, despite not having specialized teams to treat them.

Holy Cross Hospital in Marquette Park on the Southwest Side, surrounded by neighborhoods with some of the highest rates of gun violence in Chicago, treated the most of any of the community hospitals, with 338 gunshot victims from 2009 through 2013.

That's more than some of the Level 1 trauma centers in the Chicago area designated by the state to take on the most severe trauma cases.

Rounding out the top three: Advocate Trinity Hospital on Chicago's South Side, in the Calumet Heights neighborhood, with 224 patients, and West Suburban Medical Center in Oak Park, with 218 cases.

The research, published today in JAMA Surgery, aims to underscore how community hospitals without trauma centers play a vital role in providing such care and should be a bigger part of shaping policy and medical training for the specialized treatment.

You can read the study at the bottom of this story.

More coverage:

• The fight for a University of Chicago adult trauma center

• Emergency room waiting game

• Hospitals have a new partner in coping with gun violence

• A most violent month and the toll on Chicago's children

“We've highlighted Cook County because it has a narrative that is representative of what is happening all over the country,” said Lee Friedman, a public health expert at the University of Illinois at Chicago and one of three authors on the study. “You have an unequal distribution of resources.”

Gunshot victims on the West and South sides, particularly in southern Cook County, aren't near trauma centers and were the most likely to be treated at hospitals without the specialized units.

The study comes at a critical time for Chicago, which has made headlines around the world for its gun violence. The battle for more trauma care, especially on Chicago's South Side, has been brewing among activists for years. They targeted University of Chicago Medicine, an academic medical center in Hyde Park surrounded by impoverished, violent neighborhoods. That health system heeded their call and plans to debut a new adult trauma center in the spring of 2018.

The journal study analyzed inpatient and outpatient data from 2009 through 2013 for gunshot victims who live in Cook County and were treated at hospitals without trauma centers. Gunshot wounds are just one type of trauma, which also includes car crashes and falls.

Among the findings:

• Despite 19 trauma centers in Cook County with teams of specialists who can treat the gravest injuries, roughly three out of 10 gunshot victims were treated at hospitals without trauma units;

• Only 10 percent of patients who were initially treated at a non-trauma center, but needed a higher level of care, were transferred to a center. Some doctors told the researchers they felt their transfer requests to centers were blocked;

• Gunshot victims who just showed up at community hospitals' emergency rooms, and long transport times for emergency medical providers who opted for closer facilities rather than risk longer commutes to trauma centers, contributed to non-trauma centers taking on cases;

• Gunshot victims who were treated at community hospitals were less likely to die than patients at trauma centers. Friedman attributes this to trauma center patients likely being more severely injured.

Friedman said the number of gunshot cases shouldered by community hospitals highlights a need for better regional coordination between hospitals with and without trauma centers, particularly when patients are transferred to a center.

“There's a lot more room for (patients) to fall through the cracks,” Friedman said.

How community hospitals perform with trauma cases remains unclear. Unlike trauma centers, they aren't required to keep track of patients and report if they lived or died.

That's where Dr. Kip Adrian, who heads the emergency medicine department at West Suburban Medical Center, sees a need for improvement. His hospital sits just across the street from Austin, a West Side neighborhood that sees a lot of gun violence, so his team of up to 25 physicians routinely trains to treat trauma patients. They typically transfer about 25 percent of patients a year to trauma centers.

“I think that's probably largely driven independently by hospital interest and just hospital experience,” Adrian said of community hospitals taking on trauma cases.

Despite his team's expertise, Adrian said he doesn't have the financial resources to apply to state regulators to become a trauma center. Launching and running a trauma center can cost at least $30 million a year, and it's typically a money-loser for hospitals. Many patients are poor or uninsured.

Jose Sanchez, CEO of Norwegian American Hospital in the Humboldt Part neighborhood on the West Side, said his doctors and patients alike could benefit from having more trauma training that could come from a broader relationship with trauma centers. His hospital treated 151 gunshot victims from 2009-2013, the seventh-highest amount among area facilities without trauma units.

“Community hospitals should be part of the conversation,” he said.

Dr. Bernie Heilicser, medical director for the South Cook County EMS System and an emergency room physician at Ingalls Health System in south suburban Harvey, said leaders in his trauma region meet at least once a quarter to discuss what is and isn't working. Still, he adds, “there's always room for improvement.”

"A web of shadow trauma centers covers Chicago" originally appeared in Crain's Chicago Business.