In response to a report by the state Office of Emergency Medical Services, Duke University Hospital will invest $1.1 million into putting five trauma surgeons on around-the-clock alert in the Trauma Center. Still, despite these changes, the North Carolina EMS Advisory Council recommended last week that Duke's Level 1 trauma center be placed on a nine-month long probation.
The actual decision on the matter will soon be made by the state Office of EMS. "The advisory council is advisory in nature; they take the staff recommendation, review, and make a recommendation back to us," said Drexdal Pratt, chief of the North Carolina OEMS. "The actual decision is taken in the office and will be forthcoming very soon," he added.
The OEMS staff found five deficiencies in their March 14 site review of the Duke Hospital's trauma center. One was reversed after the team learned that an anesthesiologist can be called in by the paging system.
These deficiencies included the following: Neither the attending trauma surgeon nor a post-graduate or senior surgical resident responded within 20 minutes to emergency notification, there was no published backup trauma surgeon schedule and four of the 15 emergency doctors did not have the required 20 hours of continuing medical education.
Prior to 1998, Level 1 status could only be either renewed or revoked. The use of probation reflects a 1998 rule change allowing an intermediate remedy.
"If the deficiencies involve patient care, it's a matter of revocation, but if they are more procedural, revocation is too harsh," said Pratt. "We needed something in between the two."
There are three levels of trauma centers in North Carolina, based partially on the medical specialists available. Level 1 is the highest and is held by five trauma centers in the state. The other four are located in medical centers in Winston-Salem, Charlotte, Chapel Hill and Greenville. The University of North Carolina Hospitals trauma center in Chapel Hill was placed on probation for up to a year following a site visit last December, while the Wake Forest University Baptist Medical Center's trauma center in Winston-Salem was renewed for the maximum period of four years with no cited deficiencies.
The site review team did praise Duke's level of clinical care. "These are procedural issues," said Kevin Sowers, senior associate chief operating officer, adding that Duke is a Level 1 trauma center because of its clinical research and its commitment to and excellence in clinical care.
While Sowers agreed that Duke must maintain its Level 1 status and follow regulations, he also stressed that these procedural issues have no impact on trauma patients.
Although officials expect that the $1.1 million will resolve the cited surgeon deficiency, the investment will add financial strain as current managed care premiums do not cover such costs in trauma centers nationwide, said Sowers.
"Because we are committed to the highest quality comprehensive trauma care... we will commit the necessary funds as we believe that our patients and the communities we serve expect and deserve nothing less," CEO of Duke Hospital Mike Israel wrote in a letter to Pratt on May 8. "However... such investments are becoming increasingly difficult during these times of rapidly diminishing reimbursements."
"We understand [the hospital's] concerns," said Pratt. "The trauma centers are underfunded."
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