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Care is same or better

August 10, 2003|by LAURA ERNDE

laurae@herald-mail.com

Surgeons are responding faster to the emergency room since Washington County Hospital reopened its trauma center in October.

The change counters common expectations, given the fact that trauma surgeons are no longer required to stay in the hospital when they're on call.

But trauma center administrators say it's one sign the new trauma program is working well a year after a crisis that culminated in a four-month shutdown of the program.

"The proof is in the pudding. We're meeting people equal or better than before," said Dr. Karl Riggle, administrative director of the trauma center.

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From January through May of 2002, just before the trauma center closed, the average physician response time for trauma cases was 12.2 minutes. During the same period this year, the average response time was 10.6 minutes, said Joan Fortney, manager of trauma and emergency medical service at the hospital.

That's a 13 percent improvement in the amount of time that elapses from when the hospital is notified a trauma patient is on its way until the surgeon arrives in the Emergency Room.

"Most of the time they are here before the patient gets here," said Deborah Addo, the hospital's vice president for patient care.

Emergency service workers are aware of the change and have made an effort to notify the hospital as soon as they know they have a trauma patient so the surgeons have as much lead time as possible, said Alan Matheny, paramedic with the Volunteer Fire Company of Halfway.

Riggle attributed the quicker response time to the fact the trauma surgeons are more conscious about arriving in a timely manner. They didn't feel as pressured for time when they were stationed at the hospital.

Also, morale among the seven trauma surgeons has improved, he said. Although many of them are still tired and overworked between juggling their private practices and covering trauma calls around the clock, it helps that they're not tied down to the hospital during their on-call hours.

"The extra flexibility has made a huge difference," said Riggle, whose beeper went off four times during a 90-minute interview.

In some cases, it's as simple as being able to go to a son's Little League game, sleep in their own bed at night or slip out to their office to get some paperwork done.

Riggle, who lives in Mercersburg, Pa., is one of two trauma surgeons who stays at the hospital when he's on call because it would be too far to travel.

Instituting on-call pay for the trauma surgeons also has improved their attitude about the program, Riggle said.

Trauma center busier


At the same time the response time has improved, the trauma center has gotten busier.

The trauma center saw 307 patients in the first five months of this year, compared to 238 in the same period last year, a 28 percent increase, Fortney said.

It's still a small number when compared to larger trauma centers, but it's an increase Addo said further proves the need for the service.

Riggle said the trauma center has been receiving more patients from Frederick, Md., and Martinsburg, W.Va., than it had before, which could account for the increase in patient load.

There have been some success stories.

Barely a week after the trauma center officially reopened Oct. 2, a West Virginia State Police trooper was shot in the head while responding to a domestic violence call near Hedgesville, W.Va. Robert J. Elswick underwent life-saving surgery at the trauma center, and is now recovering at home after receiving extensive medical treatment.

In June, two patients came into the trauma center with injuries so severe they had a 1-in-5 chance of survival. Both walked out of the hospital, Riggle said.

The Maryland Institute of Emergency Medical Services Systems, which oversees the statewide trauma network, believes the program is working well, said Mary Beachley, director of the office of hospital programs.

Under MIEMSS standards, the program was downgraded from a Level II to a Level III trauma center because of the lack of in-house surgeons.

In all other respects, including the standard of the American College of Surgeons, the hospital meets higher Level II standards, Riggle said.

"We're pleased that they're back operating as a Level III and they're meeting the needs of the community," Beachley said.

MEIMSS recently performed a comprehensive review of the program. Although the results have not yet been published, no problems were found, she said.

Major changes


When he took over as administrative director, Riggle instituted some major changes in the trauma program. One of the most dramatic changes came in the nature of how patients are admitted.

Previously, trauma patients would be admitted under the care of the trauma surgeon who was on call at the time. That doctor would be responsible for follow-up care and billing the patient, Riggle said.

Now, patients are admitted to the trauma program and the surgeons work in collaboration to take care of them. The hospital collects the insurance money.

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