HomeMy WebLinkAboutMINUTES - 12091986 - T.1 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
DATE: December 9 , 1986 MATTER OF RECORD
SUBJECT; Trauma Center
Janiece Nolan, Senior Vice President, John Muir
Hospital, appeared and presented the attached status report on the
Trauma Center following its first 16 weeks of operation.
THIS IS A MATTER FOR RECORD PURPOSES ONLY
NO BOARD ACTION TAKEN
ren er
TRAUMA CENTER FIRST REPORT
INTRODUCTION
John Muir Memorial Hospital became the single Trauma Center for Contra
Costa County on June 30, 1986. Since then (June 30 to November 1), 334
trauma patients were brought to the Trauma Center, or an average of 2.7
patients per day. The number of trauma cases has ranged from zero to
5 per day. Patients meeting certain criteria at the scenes of accidents
are brought directly to the Trauma Center, instead of to other hospitals
which may be closer. The Trauma Center provides immediately:
• A Board Certified Trauma Surgeon (in-house 24 hours a day)
• A Board Certified Neurosurgeon (dedicated to the Trauma Center 24
hours a day)
• Trauma Resuscitation Room
• Multi-disciplinary trauma team of 11 specially qualified personnel waiting
for the trauma victim
• Designated operating room at all times (with a team of nurses, techni-
cians and Board Certified Anesthesiologist)
• Intensive Care Unit and Qualified trauma trained nurses
Howard Taekman, M.D. is the Trauma Chief, leading a team of 9 Board
Certified Trauma Surgeons. Vivian Brailoff, R.N.,M.S., is the Trauma Nurse
Coordinator.
In addition to the Trauma Surgeons, Trauma Team, and Emergency Depart-
ment physicians, the majority of cases have been treated by specialists in
orthopedics, anesthesiology, neurosurgery, plastic surgery, internal medicine,
radiology, and pediatrics. Other medical and surgical specialties are utilized
on a case by case basis and are essential to Trauma Center capability.
Commitment and teamwork among the medical staff, nursing, operating
room, Emergency Department and ancillary staff is vital to the success
of the Trauma Center.
A SERVICE OF JOHN MUIR MEMORIAL HOSPITAL
1601 Ygnacio Valley Road Walnut Creek, California 94598 • (415) 939-3000
SYSTEMS APPROACH
Although John Muir is the county's Trauma Center, it is only one part of
the trauma network involving many participants, delivering life-saving care,
such as:
• "First-in responders" - the Fire Department
• Pre-hospital care staff of paramedics, EMT's (and ambulance agencies)
• Other Paramedic Base Stations, including Mt. Diablo and Los Medanos
Hospitals
• Other hospitals who can consult with the trauma surgeon on duty regard-
ing specific cases
• EMS office/County
° Law enforcement
TRANSPORT TO THE TRAUMA CENTER
The majority of the patients originate in Central County. Transportation
from the East and West Counties, on an average, takes less than 30 minutes
by ground ambulance, and medical helicopters are utilized when appropriate.
Since July, the Trauma Center has been receiving on an average of 3 heli-
copter patients per week. Flight time from any part of the County is less
than 15 minutes.
Other hospitals have transferred only 3 patients to the Trauma Center during
the first 4 months; all other trauma patients have come directly from the
field.
DATA
The geographic origin of patients, sex/age, time of arrival (day and time
of day), and mechanism of injury are illustrated in the attachments. About
26% of the trauma patients have surgery during the first 24 hours, with
an additional 11% having subsequent surgeries during their inpatient stay.
The Trauma Center expects to receive about 700 patients the first year
(or 2 per day). At least 500 patients per year are essential for proficiency
in clinical skills and financial viability (due to high fixed costs). One Trauma
Center continues to be the appropriate number for this county.
QUALITY ASSURANCE
In accordance with standard monitoring criteria developed by the county
and the John Muir Hospital Trauma Service, the care rendered to each trauma
-2-
patient is routinely examined by experts, including non-Trauma Center physi-
cians. The results of these evaluations, as well as specific patient case
reviews, are presented and discussed at the monthly bi-county Trauma Audit
Committee. Patient care is examined with attention to all phases of interven-
tion: Pre-hospital care, resuscitation treatment, and inpatient, medical,
nursing, and ancillary services. The County audits the hospital periodically.
The audits have been complimentary to the Trauma Center and no major
problems were found.
IMPACT ON HOSPITAL
Being a Trauma Center requires the hospital to provide a patient the
exact same level of care at midnight and on the weekends as one would
receive during the morning of a usual weekday. Gearing up for this
constant readiness has been a challenge and not without strain on the
nurses, ancillary staff and physicians.
Upon Trauma Center designation, the hospital staffed the nursing units
and ancillary services, expecting a rate of about 500 patients per year.
We experienced immediately a rate of approximately 700 patients per
year and had to quickly increase staff in order to provide optimal care
to these critical patients. Recruiting is taking time and in the interim,
the existing staff has put in much overtime to allow John Muir to func-
tion effectively as the Trauma Center. This commitment continues
as we recruit and train staff.
During the period of Trauma Center implementation, John Muir also
started an Open Heart Surgery Program and experienced a higher census
than usual for summertime. A major building program has begun and
will be completed in two years.
Despite these stresses, the hospital personnel and medical staff have
done an excellent job in implementing the Trauma Center.
FINANCE
Financial Projections
It is too early to make a determination about the financial viability
of a Trauma Center. We are collecting approximately 70% of billed
charges, as anticipated. John Muir's start-up operating expenses in
1986 were over $700,000 before new revenues were realized. We origi-
nally geared up for 500 patients per year, but are seeing a much higher
number, thus increasing our expenses, especially those for additional
training and orientation of new staff.
-3-
Capital Costs .
The major- cost of the Center is in personnel; however, we have had
capital expense in the range of $75,000.
Transfers to the Trauma Center
An initial concern was with possible inappropriate transfer of patients
from other hospital emergency departments to the Trauma Center for
other than medical reasons. It is a credit to the system and to the
other receiving hospitals that this concern has not materialized, and
the Trauma Center has been utilized appropriately.
PUBLIC EDUCATION
Our Trauma Chief and other staff are making presentations on the Trauma
System to other hospitals and community groups. Newspaper ads, informa-
tional articles, and brochures are being utilized to promote trauma awareness.
Special programs in trauma prevention, such as dealing with alcohol and
substance abuse, as well as water safety, are being designed in cooperation
with the appropriate local agencies.
FUTURE
Continued cooperation from law enforcement, fire and other community
agencies is vital. Less urgent non-trauma cases continue to be handled well
in the John Muir Emergency Department because of increased staffing.
The Trauma Center has stressed the staff, but they have risen to the chal-
lenge. All the skills and resources required for trauma readiness spill over
into our readiness as a major medical referral center.
Janie a S. Nolan, Ph.D.
Senior Vice President
John Muir Memorial Hospital
-4-
0
0
tA,
N
d
o�04N
d" vop v
ow
v�
O of
0 o 0 a. .
o
00
?' 7 N,
' c ,
co r
t,.
o A
d
Z r
o c
co o
CO r v
W c r
oa
r� uo
o
O � o
1''
p o j N
c .�
r,
CO
� D
d ✓ too
N �
%
0
� O
Z �
to
v
O
LLr.+
O a
N
T
cr
U) w
m
Za o
U $ a) 0
LU
W �,
Z
a
W n
U O O co
a °
cc
cq
r
J
Of �
O O O O O O O O O O
+Ln
O Of CD P t0 47 Of N
uj S1N311bd 30 838wnN
W
N Q
T
Z ccuj
O :� Lc? LL
WW `\
O
a U \
O
LU
�\toa
N
aAva\ CM m ate:S: \ \ C7
a m 7\\\7,,\
h
COD � SOD tO � (� N O 'VIII • I'
S1N31IVd ziO u3ewnN