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St. Al's seeks re-verification for trauma services

Saint Alphonsus Regional Medical Center is pursuing American College of Surgeons' re-verification for its trauma center after losing it four years ago, according to Dr. Frederick Foss, trauma medical director at the hospital.

"It is one way of acknowledging the commitment to trauma that a center has," he said. "It's a stamp of approval. It's a good housekeeping seal."

But according to some experts and a study from the hospital's own emergency room, ACS's seal of approval is more than good housekeeping. It's a reflection on the quality of care.

"They had a bunch of deficiencies," said Dr. Robert Coscia, St. Al's previous trauma medical director.

St. Al's Marketing Manager Sarah Berg said the hospital lost its verification because of some issues with its physician contracts—discrepancies between what services the physicians wanted to provide and what services the ACS requires verified hospitals to provide. She said the issue has been resolved and nothing about the quality of care ever changed.

But Coscia, who was the trauma director at the time that the hospital lost its verification, said quality did slip, and that St. Al's failed ACS's quality inspection in five or six categories. These weren't simple contracting issues, either, he said.

"They were some major things that they [the hospital administration] would not correct. You can thank Ms. Bruce for that," he said, referring to hospital CEO Sandra Bruce, who will resign Oct. 17 to become CEO of Resurrection Health Care.

St. Alphonsus refused to provide the American College of Surgeons' findings.

ACS verification tends to improve quality of care at trauma centers, according to Coscia. Coscia co-authored a study in the Journal of Trauma that found that after a nonprofit community hospital's trauma center attains Level Two ACS verification, mortality rates decline and patients spend less time in the hospital. The study was published in 2003, a year before St. Al's lost its Level Two verification.

Idaho has a lousy record of emergency care and currently has only one ACS-verified trauma center, at Eastern Idaho Regional Medical Center in Idaho Falls. The American College of Emergency Physicians gave Idaho a "D" for emergency medical care in 2006 and ranked it 50 among all the states and Washington, D.C.—just above Arkansas—in large part due to Idaho's lack of trauma centers. So re-verification of one of the state's biggest trauma centers could be important for emergency care in Idaho.

"Verification shows a trauma center's dedication to providing the best care possible to injured patients," said Cory Petty, senior public information assistant for the American College of Surgeons. "It's really an ideal for providing optimal care."

In the verification process, ACS inspects trauma centers' quality-control measures, organization and verifies whether hospitals follow its standards for optimal trauma care. Petty stressed that it's a voluntary program and that many trauma centers around the nation are not verified but still provide exemplary trauma care.

In 2006 St. Al's claimed to have put any plans to pursue verification on hold to see if the state of Idaho would create its own trauma center verification program, something the state hasn't done.

Coscia, meanwhile, left St. Al's in September 2005. The hospital asked him to stay on for two years, he said, but he refused because "they wouldn't do what needed to be done."

But St. Al's said it has made great strides since 2006 to improve quality in the trauma center and pursue verification, starting with hiring Foss in July 2006.

Foss earned his trauma fellowship at Shock Trauma in Baltimore, Md., one of the premiere trauma facilities in the United States, according to Berg. Foss also served as the trauma medical director at Mayo Health System in Minnesota.

Instead of jumping straight into the re-verification process, Foss began a major overhaul of the trauma department.

Prior to his arrival, the trauma center was staffed with general surgeons. It was brutal for them, Foss said. They had to take time out from their general surgery practices to work with trauma patients, disrupting their practices, he said.

Foss told the administration of St. Al's that he wanted his own surgeons dedicated specifically to the trauma department—"surgeons who live, breathe and eat trauma," he said. The hospital set about hiring four trauma surgeons: Dr. Bill Morgan, who received his trauma fellowship at the University of California-San Francisco in Fresno; Dr. Nicholas Gyles, who earned his trauma fellowship at St. Louis University; Dr. Steven Casos, who went to the University of Kentucky, Louisville for his trauma fellowship; and Dr. A. George Munayirji, who had worked in the trauma center at St. Al's previously, but had advanced training in cardiothoracic surgery from Oregon Health Sciences University.

It took time to build a new trauma team.

"Trauma surgeons are as rare as hen's teeth," Foss said, citing the odd hours they often work. "I was up till 3 this morning taking care of patients. It's disruptive to your circadian rhythms."

But now St. Al's always has a trauma surgeon and a backup surgeon on call.

Foss and the other trauma surgeons keep a critical eye on patient care and tweak their quality control systems to improve care. "We get in a room and we're very candid about things," he said.

As a result of the new trauma surgeons and the changes they suggested, the mortality rate at St. Al's has gone down and is now below the national average, Foss said. This, despite the fact that the hospital is seeing more severely injured patients than it was just a few years ago. Foss said he thinks the increase in severe injuries may be due to more congested traffic and higher numbers of traffic accidents.

With the trauma center in a better position, St. Al's is about to start the application process to re-verify its trauma center, Foss said. Once the application is complete, the American College of Surgeons would send a team of two physicians and a trauma program manager to the hospital for a 48-hour review. The entire process can take six to nine months, Berg said.

A re-verified trauma center at St. Al's would be the second piece of welcome news for emergency medicine in Idaho. Eastern Idaho Regional Medical Center, which was ranked as a Level Three trauma center two years ago, has moved up in the ranks to a Level Two trauma center.

But Coscia was skeptical about news that St. Al's will pursue verification again.

"I've got some oceanfront property in Idaho, too," he said.

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