Should ED managers advocate for upgrade?
Should ED managers advocate for upgrade?
In the face of findings at Swedish Medical Center in Denver, that upgrading from a Level II trauma designation to a Level I significantly improves mortality rates, should an ED manager at a Level II facility advocate such an upgrade?
While the answer may seem obvious, it is a bit complicated, says David Bar-Or, MD, FACEP, director of the Trauma Research Department at Swedish and one of the authors of a recent article in Archives of Surgery containing those findings.
"The problem is that the cost is enormous," Bar-Or says. "You need to have a core group of dedicated trauma surgeons in-house 24 hours day. You have to have OR nurses in-house 24 hours a day, and your ICU nurse staff must get additional training." In addition, he notes, the facility is required to be actively involved in clinical and basic science research and to have an affiliation with a teaching or residency program.
Nonetheless, the costs of the upgrade could be justified by additional transfers, Bar-Or says. "It would certainly benefit the ED manager if it was the right location, the right place, and the right time," he says.
Sue Slone, MD, FACS, director of trauma surgery at Swedish and also one of the authors, is an even stronger advocate of such a strategy. "Upgrading would lead to more transfers, as well as to better mortality rates," Sloane asserts.
It also would benefit the ED manager's patients, she says. "In the management of critical care patients, once they are out of the ED, they go to the ICU," she notes. "In facilities like ours, you have a surgeon who stays right with that patient and manages them all throughout the day, so you get a better continuum of care."
In the face of findings at Swedish Medical Center in Denver, that upgrading from a Level II trauma designation to a Level I significantly improves mortality rates, should an ED manager at a Level II facility advocate such an upgrade?Subscribe Now for Access
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