Memorial seeks Level One trauma certification

Memorial Hospital aims to achieve Level One status for its emergency room in one to three years.

Memorial Hospital aims to achieve Level One status for its emergency room in one to three years.

Nearly a year after voters approved leasing Memorial Health System to University of Colorado Health, followed by months of new hires and additional equipment, the hospital announced its biggest project yet.

Memorial will seek Level One trauma certification, a designation given only to four hospitals in the state so far, none of them outside Denver. Even Memorial’s esteemed partner, University of Colorado Hospital, doesn’t have the designation.

It will cost millions and take years, experts say. But in the end, if Memorial is successful, it will be worth it.

“This is one of the benefits of this partnership,” Memorial CEO Mike Scialdone said at a news conference announcing the move. “We are able to tap into the experience, and this is just an example of the great support they offer. We’ll be the only hospital outside Denver to have the certification.”

There isn’t much difference between Level One and Level Two certification, experts say, but the differences are what make the change expensive. Both require around-the-clock access to specialty surgeons — neurosurgeons, orthopedic surgeons, cardiothoracic surgeons. The higher certification requires high-tech monitoring and surgical equipment, the ability to perform minimally invasive surgery and to treat the very worst trauma cases at any time, day or night.

There must be enough patients being flown from the region to Denver to make it necessary to obtain the higher certification as well. And there must be a dedicated operating room at the hospital for trauma cases.

“We already deliver very high levels of care,” said Dr. Patrick Faricy, chief medical officer at Memorial. “I have no doubt that this is an important move. We can treat more patients close to home, and it’s just safer to do that.”

Competition’s perspective

The designation would set Memorial apart from its main competitor, Penrose-St. Francis Health Services, but officials at Penrose-St. Francis’ parent company, Centura Health, say they aren’t worried.

“The Centura Health trauma system has improved trauma service capabilities and volume across the state, fulfilling our commitment to the communities we serve,” said Centura spokesman Johnny Rea. “In particular, Penrose-St. Francis has grown trauma volume in Colorado Springs and southern Colorado, while Memorial has seen its trauma volume decline. We absolutely intend to continue increasing our capabilities and maintaining our leadership position as the largest integrated trauma system in the state.”

The guidelines are very specific. And they’re tough. If they succeed, this will be the first Level One hospital in more than 20 years.”

— Randy Kuykendall, Colorado Public Health Dept.

Centura is approaching the competition with UCHealth by extending its reach into the rural areas of the state. It has partnered with eight hospitals on the Western Slope, in eastern Colorado and into Kansas, according to officials.

But Memorial has to meet some specific guidelines before its trauma certification is upgraded.

Colorado follows the rules developed by the American College of Surgeons, said Randy Kuykendall, interim director of health facilities and the EMS division at the Colorado Department of Public Health and Environment.

“The guidelines are very specific,” he said. “And they’re tough.

“If they succeed, this will be the first Level One hospital created in more than 20 years.”

Currently, Swedish Medical Center, Denver Health and St. Anthony’s are Level One centers, as is Children’s Hospital, which has a special pediatric designation and takes only trauma cases that involve children.

“It’s the highest level of care,” Kuykendall said. “It’s going to be expensive to get there.”

But the cost didn’t seem to dampen enthusiasm at Memorial or UCH. Both CEOs are excited about the possibilities.

“There’s a need for this,” said Bruce Schroffel, CEO of UCHealth. “There’s no Level One trauma center in southern Colorado, none in northern New Mexico. This is going to make a difference throughout the entire region.”

And the hospital doesn’t really have that far to go, he said.

“Memorial has some of the Level One capabilities already,” Schroffel said. “It just doesn’t have it all the time.”

Issue with surgeons

That wasn’t always the case. In 2009, the hospital lost its contract with its neurosurgeons, a group of seven doctors in Colorado Springs. Terminating the contract placed Memorial’s Level Two trauma status in jeopardy for about two months. Level Two requires neurosurgeons being available to the hospital 24 hours a day, seven days a week, able to come in on very short notice.

The loss was a blow to Memorial at a time when its future was still up in the air. For about a month, the hospital had to refer all trauma patients to competitor Penrose-St. Francis Health Services for care. But Memorial has recovered with three neurosurgeons on board, and UCH hired two more last year to work at Memorial.

That’s one of the biggest hurdles to jump, said Kuykendall.

“Most hospitals stay at Level Three because of the neurosurgeons,” he said. “There just aren’t that many of them.”

According to recent figures, only about 70 new doctors annually complete the requirements for the specialty in the United States.

Both local hospitals are currently operating Level Two trauma centers, and Kuykendall says he believes there’s enough volume to justify Memorial’s move for Level One services. Currently, the very worst cases are flown to Denver’s trauma centers — a transfer that can take as long as an hour.

“Every second counts, and we think this change will impact care significantly,” said Dr. Rich Zane, chairman of emergency medicine at the University of Colorado School of Medicine. He’ll have a specific, necessary role in the new certification, which requires research, training and scholarship as part of the Level One trauma certification.

“That’s another reason this is a big step,” he said. “It’s a chance to promote science and research. The entire region will benefit from the care, and we stand to gain in terms of the advancement of science as well.”

And Schroffel pointed out, Level One certification was a promise the hospital made when it leased Memorial.

“The voters wanted this,” he said, “and we’re going to do it.”

But it could be 2016 before it happens. Estimates are that the hospital could earn it in as little as a year, but it could also take three years.

“We’re at the very beginning of the assessment now,” Scialdone said. “We have to know where we are and how we’re going to get to where we need to be. This is a huge, profound step forward, however, in terms of quality of care. And it clearly couldn’t happen without this partnership. It’s going to take the expertise of the entire system to get this done.”