Trauma Systems & Centres

[caesar ursic]

>  What is interesting, is what the fate of small trauma centers will be.
> If, for a mere reason of low volume, they cannot meet the 'gold standard'
> (assuming that we've adjusted for other confounders) should they be shut
> down or penalized?


*A small trauma center that serves a large geographical area (albeit
probably sparsely populated) will never see enough patients to meet any one
of several proposed benchmarks, given a stable increase in local population
growth.  Shut them down and you are now forcing local EMS agencies to travel
much greater distances to deliver the injured to the 'nearest' trauma
center.  So ask yourself these questions: Can the local infrastructure
support this?  More helicopters, perhaps?  Will eliminating the local Level
II or III facility with 'low' numbers actually improve outcomes in these
patients who are now spending much more time in a pre-hospital setting due
to greater travel times to definitive care?  Will the  'gold standard'
destination trauma center cope well with the sudden increase in the number
of patients arriving at its door?  *


> Or should we bite the bullet, send specialists to these centers and try to
> increase the volume?


*Who is the 'we' of which you speak?  The American College of Surgeons?  The
local/state agencies that regulate trauma centers?  The nearest
University-affiliated teaching hospital?  The military?  And how do you
propose that trauma volume be increased?  How will any given geographic area
increase the incidence / prevalence of serious injury, outside of inciting
riots and dispensing free tequila and Glocks outside bars?*


> Finally, does meeting the 'gold standard' and becoming a center of
> excellence equal improved quality?


*Ahh...well, that depends on whom you read.  Practice does make perfect; the
question is, how much practice? *

>
>  KH
>

*CMU*

-- 
'Twas brillig, and the slithy toves
Did gyre and gimble in the wabe:
All mimsy were the borogoves,
And the mome raths outgrabe.