St. Francis applies for Level III trauma designation

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G.E. Johnson recently completed work on the St. Anthony Medical Center in Summit County.

G.E. Johnson recently completed work on the St. Anthony Medical Center in Summit County.

Hospitals in El Paso County are asking for heightened designation for their emergency trauma departments.

Penrose-St. Francis Health Services has asked the Colorado Department of Health to designate the St. Francis Medical Center at Woodmen Road and Powers Boulevard as a Level III trauma center.

Now at Level II designation, both Penrose and Memorial hospitals in the downtown area requested Level I designation late last year from the Colorado Department of Public Health and Environment, which assigns the designations.

St. Francis Hospital opened in 2008 at a Level IV.

“One of the benefits of being affiliated with the University of Colorado System is working toward a surgical residency program.”

– Dr. Andrew Berson

[/pullquote]The state takes surveys on a regular basis, “and we got outstanding reviews,” Penrose-St. Francis spokesman Chris Valentine said.

“It’s not a big jump from Level IV enhanced to Level III,” he added. But moving Penrose from Level II to Level I is more intense.

“It’s a long process,” Valentine said. “It’s not as easy.”

The hospital is now in the process of putting all the procedures in line.

“We can take care of 99.5 percent of the patients at Penrose or Memorial,” Valentine said. “Just a few would have to go to Denver. Very few.”

“We have to see a certain number of patients with traumatic injuries within a certain time period. It’s not something we have control over but it’s a requirement to be a Level I trauma center,” Valentine said.

Added requirements of Level I

Most — 90 percent — of medical procedures that can be done as a Level II hospital can be done at a Level I hospital, said Dr. Andrew Berson, medical director of the trauma program at Memorial Hospital.

There is an increased need for microvascular surgery, or surgery to repair, for example, a severed limb at the vascular level. “Aside from that, it’s more of a volume issue,” Berson said.

To attain Level I status, trauma centers must take care of 320 patients annually who have an injury severity score (ISS) of greater than 15, a severely injured patient, Berson said.

Memorial currently sees an average of 200 patients a year with an ISS of 16 or greater, he said. “It’s not that we’re not capable,” but the hospital doesn’t have the numbers yet, Berson said. “Some Denver area trauma centers are struggling with that as well.”

In addition, the hospital must have an active residency program with a surgery and trauma component, and there are research and education requirements, with physicians publishing a certain volume of professional articles.

Memorial, managed by University of Colorado Health, does not currently have a residency program.

“One of the benefits of being affiliated with the University of Colorado system is working toward a surgical residency program,” Berson said, adding that the goal is to have it up and running in July 2015.

Different requirements

Colorado has five levels of trauma care. In a Level I hospital, emergency physicians, nurses and surgeons are available 24 hours a day.

Level II is less intensive, providing “definitive care for complex and severe trauma patients,” according to the state CDPHE website. “Emergency physicians and nurses are in-house and immediately available … to direct patient care and initiate resuscitation and stabilization. A surgeon is available upon patient arrival in the Emergency Department. A broad range of specialists, comprehensive diagnostic capabilities and support equipment are available.”

In Level III, patients are evaluated and stabilized, surgically if needed. Surgeons would be available within 20 minutes.

Level IV hospitals stabilize patients and transfer them to a hospital with a higher level of care. In these hospitals, a trauma-trained nurse must be available immediately, and physicians are available.

At Level V trauma centers, which are not required to be open 24 hours a day, the staff evaluates and stabilizes the patients before transferring them. Hospitals that do not have a designation, like Memorial Hospital North, must transfer most patients to an appropriate trauma center.