New designation to enhance Rice's treatment of trauma

WILLMAR -- When someone arrives in Rice Memorial Hospital's emergency room with injuries from a highway crash, the whole staff is ready to act swiftly to evaluate, treat and stabilize the patient.

The hospital's recent designation as a Level 3 trauma center takes this process up another notch by joining a new statewide trauma system that brings more cohesion to how injured patients are cared for.

"It ensures that patients get prompt evaluation and transfer if necessary," said Dr. Scott Abrams, an emergency room physician. "Absolutely it's a good thing to be part of."

The Minnesota Legislature passed a law in 2005 that creates a comprehensive statewide trauma system.

One of the goals: to spur better outcomes across the state for traumatically injured patients and to ensure all of them have prompt access to the highest level of appropriate care.

Often this means treatment at a local hospital. If someone is severely injured, however, and in need of definitive care at a larger hospital, the statewide trauma system creates a pathway for getting the patient stabilized and transferred rapidly.

Officials at Rice hope that by being part of a coordinated trauma system, they can continue to hone their skills and increase the multidisciplinary teamwork that's needed for treating injured patients.

"We already have a tremendous base of emergency medical professionals. They are so well-trained," said Dr. Steven Kidd, a general surgeon at Affiliated Community Medical Centers and the newly designated trauma director at Rice.

But there's now greater opportunity for education and sharing best practices in emergency rooms across the state, he said. "Each case will be so unique and different but you certainly have to apply some base principles. You do 'ABC' at every level and that keeps things consistent."

"We already do a good job at this," said June Boie, clinical lead for acute care services. "I do think the coordination will be an improvement."

Most Minnesota hospitals are expected to voluntarily join the trauma system, which requires them to be formally designated as a level 1, 2, 3 or 4 trauma center.

Level 1 hospitals are tertiary care facilities with highly specialized services, such as Hennepin County Medical Center. Level 4 contains Minnesota's smallest rural hospitals.

At level 3, hospitals must have a general surgeon rapidly available. They're also required to have an emergency room that's staffed around the clock and the support of radiology and laboratory services.

All these resources were already in place, Kidd said. "I don't think we saw much change there."

Nevertheless, it was still "a lengthy process" to become designated, Boie said. "We had to implement a couple of new policies and procedures and tweak some of the ones we already had."

Rice also had to revise the organizational structure of its emergency room.

"Now it's a free-standing entity within the department. It has its own director and its own coordinator," Kidd said.

Last year, Rice's emergency room had 112 cases entered into the state trauma registry. They included head injuries, broken bones, lacerations and burns that were severe enough to require hospitalization.

Trauma-related injuries can be among the most challenging to deal with. They encompass everything from burns and crush injuries to gunshot and stab wounds. The most common, and often the most complicated, however, are motor vehicle crash injuries.

These frequently involve multiple patients with multiple injuries, Abrams said.

"Those patients most often are the ones that require rapid evaluation and transport. It gets very complex to stay on top of. You call in extra people," he said. "Time is of the essence. You have to put in chest tubes. You have to intubate. You have to stop bleeding."

Some critically injured patients have severe head injuries that require advanced care, but are losing so much blood from internal injuries that they might not survive the trip to a larger hospital.

"That's one of the most complicated patients -- the one you can't get out of here because they're not stable," Abrams said.

It makes teamwork vitally important, said Kidd.

One of the benefits of joining the statewide trauma system is the boost it will give emergency medical teams to function more smoothly across disciplines, he said. "That's a form of ongoing training. It's training as a team."

The development of a statewide trauma registry also will give hospitals a better ability to collect data, benchmark their performance and learn about the best and latest ways to effectively treat traumatic injuries.

There's something to be learned from each case, Boie said. "If something didn't go quite the way we wanted it, how could we do it better?"

As a result of Rice's participation in the trauma system, injured patients taken to Rice ultimately will have better survival rates and overall outcomes, Kidd said.

"We want to learn. We want to know how things are done elsewhere," he said. "We all have a common goal: care of the injured patient."