With Level IV trauma certification of its Miners Campus, St. Luke’s University Health Network is enhancing the services available in its trauma care network — while speeding patients to advanced care.
Rugged, mountainous country surrounds Coaldale, the township in Schuylkill County where St. Luke’s Miners is located. In fact, the hospital was born of isolation — in the 1910s, local coal miners, weary of the 30-minute train ride for medical care, dedicated one day’s pay a week to building the hospital. Today, 8,000 patients visit the emergency department at St. Luke’s Miners each year, receiving excellent urgent and emergent care 24 hours a day.
Still, many patients require transport to higher-level facilities, which can take 45 minutes by road in good weather. The nearest Level I facility is roughly 30 to 40 miles away. Faced with a severe trauma emergency, paramedics have been challenged with driving patients in Carbon, Schuylkill and lower Luzerne counties long distances to receive immediate treatment delivered with the highest levels of care.
That situation is changing as of Nov. 1. St. Luke’s University Health Network, recognizing the excellent work in emergency care at St. Luke’s Miners, has taken steps to obtain Level IV trauma certification for the facility. This will be the first such certification in Pennsylvania.
“In the fall of 2011, I met with William Hoff, MD, Chief of Trauma and Acute Care Surgery at St. Luke’s Bethlehem, and Gail Wainwright, RN, MSN, Administrator of Trauma Services at St. Luke’s Bethlehem,” says William Moyer, President of St. Luke’s Miners Campus. “We looked at some of the cases we were treating here, and they said, ‘You can qualify as a Level IV trauma center.’ On Nov. 16 of that year, we took the idea to our Board of Trustees, who were in full support of the plan.”
“If you look at the map, there are large areas in Pennsylvania where people cannot get to a trauma center in what most would consider to be a reasonable period of time,” says Dr. Hoff. “These are mostly rural areas. The Level IV standards were developed to provide an elevated level of care and access to patients in these areas.”
“We have a great hospital at St. Luke’s Miners Campus. Level IV trauma certification is another step in our mission to provide a high level of care to our community — and we aren’t finished yet.”
—William Moyer, President, St. Luke’s Miners Campus
What Is Level IV Trauma Certification?
According to the Pennsylvania Trauma Systems Foundation (PTSF), a Level IV trauma center has the ability to “provide initial care and stabilization of traumatic injury while arranging, if necessary, a transfer to a higher level of care.”
Accredited by the PTSF, Level IV programs must meet standards including:
- access to laboratory, radiology and pastoral care services
- continuing education for emergency department nurses
- emergency physician on duty 24 hours a day
- helicopter landing area
- full-time RN coverage of the emergency department
- medical director with Advanced Trauma Life Support (ATLS) certification
- participation in the state Trauma Registry and Performance Improvement and Patient Safety program
- written transfer policy for certain patients
“Pennsylvania basic life support protocols were modified in July to add Level IV certification,” says Melanie Turock, DO, Trauma Program Medical Director at St. Luke’s Miners. “In our case, our emergency department was already giving great trauma care. Our physicians and staff are excellent. It was a rigorous process in terms of the ATLS policies and procedures the state wanted us to implement and follow, which in many cases meant recognizing and documenting what we were already doing. It took us about a year and a half to write all the policies and procedures.”
Security and Speed
While the Level IV certification process largely confirmed the expert care already being provided by St. Luke’s Miners, certification nonetheless heralds a significant benefit for patients. EMS personnel have protocols for routing patients with differing severity of injuries, and a hospital’s trauma designation may make the difference.
Now, instead of directly taking a badly injured patient on the long drive to a Level I or II facility, EMS providers in the Carbon, Schuylkill and lower Luzerne counties area will have the option to transport them to St. Luke’s Miners for stabilization.
“Our emergency volumes grew 3 percent in the past fiscal year,” Moyer says. “We expect more growth as we enhance our capabilities in trauma and emergent care. We’re looking at ways to further raise the bar.”
“Our EMS providers think this certification is great,” Dr. Turock says. “It is a vital benefit if they can bring the patient here to be stabilized before a long journey elsewhere.”
Joni Gestl, EMT-P, Lehighton Ambulance Association Director of Operations, points to the tangible advantages.
“Assessment and necessary lifesaving modalities will be available to our patients sooner,” Gestl says. “As trauma providers, our ultimate goal is the earliest possible initiation of the highest level of treatment available. Trauma centers save lives.”
Typically, says Kristie Leshko, RN, MSN, Trauma Program Coordinator, severely injured patients will stay at St. Luke’s Miners for a minimal time as care is expedited.
“We provide initial care and stabilize injuries,” she says. “We can determine promptly whether a patient needs to be transferred and initiate that process. We generally make a decision within three hours of the time of injury.”
In many cases, however, the hospital’s broad capabilities allow patients who would otherwise have been sent out of the region to remain in the area. For instance, orthopedic surgical care is not a requirement for a Level IV trauma center, but St. Luke’s Miners exceeds the standard. The addition of an orthopedic surgeon, Chandra Reddy, MD, with plans to recruit a second orthopedist, has helped keep many patients at St. Luke’s Miners.
“Our goal is to keep people here in the community rather than send them somewhere else,” Dr. Turock says. “They like to be cared for close to their homes and families.”
“Do not underestimate the power of a Level IV trauma center. Level IV does not imply lesser — it means the facility has achieved the highest certification it can in its location. The importance for the community and for care providers at that facility is enormous. The availability of this certification in Pennsylvania will increase the level of care, expedite care of injured patients and improve medical care for patients throughout the state. The certification process is similar to what we go through at a Level I facility. It is rigorous. The Pennsylvania Trauma Systems Foundation will not be handing these out lightly.”
— Gail Wainwright RN, MSN, Administrator of Trauma Services at St. Luke’s University Hospital–Bethlehem
Partners in Process
In Pennsylvania, St. Luke’s Miners became an essential partner in the development of Level IV trauma protocols. Other hospitals had begun working toward certification earlier, Wainwright says, but St. Luke’s Miners was able to complete the process, estimated to take three years, in less than two.
“When they came for their initial visit, they had some ideas in mind about the program,” Dr. Turock says. “Level IV has not been used frequently here on the East Coast, so we sat down together and planned it out step by step, and then we ran with it.”
“St. Luke’s Miners was instrumental in helping Pennsylvania develop what a Level IV trauma center should look like,” Dr. Hoff says. “In fact, as the process unfolded, Dr. Turock and Leshko became recognized as leaders in Level IV rural trauma care.”
The certification process involved the entire hospital from top to bottom, Dr. Turock says. Administration support, starting with the hospital Board of Trustees and President, made it possible to acquire additional equipment and nurses. Emergency room physicians attended 16 hours of ATLS training in stabilizing and resuscitating patients, while nurses — many of them 30-year veterans of St. Luke’s Miners — took trauma coursework. Emergency department technicians traveled to the Level I Bethlehem facility for additional training.
“This was very much a group effort,” Dr. Turock says. “The whole hospital, from the President to the lab technicians and X-ray clerks, came on board with enormous enthusiasm.”
St. Luke’s hired new professionals to spearhead the process, including Leshko and Dr. Turock. Despite the challenges of taking on new jobs and bringing change to an established department, both dived in eagerly.
“Kristie [Leshko] is a can-do person,” Wainwright says. “When I interviewed her, I told her there would be moments when we could be challenged. She handled every challenge with grace.”
In fact, Leshko immediately endeared herself to her new emergency department staff by working night as well as day shifts so she could get to know every member of her team. Other nurses and physicians showed extraordinary enthusiasm, as well.
“Our Trauma Director, Dr. Turock, volunteered for the position and stepped up for this effort,” Moyer says. “I couldn’t say no to her. Donald Meade, DO, Emergency Department Director, and Lisa Rutter, RN, Nurse Manager, saw this as an opportunity to educate their staffs and improve our levels of care. Our physicians and other employees are devoted to this project, reflecting the dedication and passion we all share at St. Luke’s Miners.”
Help also came from within. St. Luke’s University Health Network provided advice and support to St. Luke’s Miners, including case reviews and care assessments.
“We helped them develop performance improvement projects and clinical management guidelines,” Dr. Hoff says. “It was a neat experience, starting from ground zero and talking through a number of questions: What is the process of care? What resources do they not have that we have here at Bethlehem? How do you provide the same level of process? I anticipate that the processes we put in place will raise the level of all care at St. Luke’s Miners, not just emergency care.”
Ripples of Excellence
Process improvement in trauma care, Wainwright explains, raises the level of care across an entire hospital, and beyond. For one reason, close scrutiny of patient cases factors into Level IV certification, improving care and creating strong ties within provider communities.
“We work with Lehighton Ambulance Association, as well as three to four volunteer companies,” Dr. Turock says. “One paramedic sits on our performance improvement committee, along with surgeons, orthopedic specialists and hospitalists. We discuss trauma cases from the original 911 call to the time of disposition, identifying what we did well and searching for places we can improve.”
“Patients are entered in a registry, and all aspects of their care are reviewed,” Leshko says. “We discuss cases with providers at our monthly meetings. This process makes medicine more cost-effective and prevents unnecessary suffering, relieving the burden of trauma on society.”
Meanwhile, regular surveys will be conducted to maintain certification, involving the hospital in continuous process improvement, Moyer says. Additionally, physicians and nurses will take CME to maintain their trauma readiness levels.
Overall improvement spreading out in ripple effect from the Level IV certification effort is a common theme among those who have taken part in the endeavor. Benchmarks for times to treatment, for example, accelerate care for all patients, not just those who have suffered trauma.
“Everything happens more rapidly for everyone,” Wainwright says. “The culture changes. For example, if CT scans are available more quickly for trauma patients, the changes in process mean everyone gets them faster. Another example is neurological assessments. We order them for trauma patients, but they’re important for stroke patients, too.”
The rigorous standards of a trauma certification imply excellence throughout the center, Wainwright continues, which improves job satisfaction. Physician recruitment and retention also improve.
In the larger picture, Dr. Hoff says, “This is one step in increasing the overall level of care we provide throughout St. Luke’s University Health Network. These patients live in a rural area on the other side of the mountains from our other hospitals. We can’t get a helicopter there all the time. By achieving this certification, we set an example of how we improve care for all our patients throughout the network.”
To learn more, visit sluhn.org or call InfoLink at 1-866-785-8537.