“There literally hasn’t been a department in our hospital that hasn’t been improved by becoming the regional trauma center,” says Shawn Miller, Assistant Medical Group Administrator of Kaiser Permanente South Sacramento. He was part of the team at KPSS that originally decided to push for trauma center verification. Besides making sense financially, he and his colleagues were convinced that there would be key “intangible” benefits as well. Now, eight years later, the trauma center designation is creating a “halo effect” in other departments. “Beyond the inherent improvements in the Emergency Room, trauma center designation has improved patient care in other departments that work with the trauma service line such as surgery, laboratory, imaging, or nursing floors.”
One of the departments that Miller oversees at KPSS is the laboratory. “At first, in order to fulfill the requirements set forth by the American College of Surgeons (ACS) for a trauma center, we needed to develop protocols that allowed for rapid turnarounds of key laboratory tests. Once these were in place for trauma, the clinical and administrative staff decided to come together to find ways to use these new processes to decrease the turnaround times for all labs.” This process of adapting fast service for trauma patients to all KPSS patients was repeated in other areas such as radiology and imaging. Competencies learned to care for trauma patients on the inpatient floors filtered to the other nursing units through cross-training. “Even departments that don’t touch trauma patients were improved. The fact that we were now the regional trauma center was a source of pride for employees all throughout the hospital,” says Miller. “We all know that if you are a trauma center, you are the best at what you do. There is a lot of pride associated with that.”
Not an Easy Decision
The decision to become a regional trauma center was not an easy one for Kaiser Permanente South Sacramento to make. Back in 2008, the physicians, administrators, staff, and community members surrounding KPSS spent many hours discussing the merits and risks associated with endeavoring to be Kaiser’s first regional trauma center. While not very onerous in the way of capital requirements, being a regional trauma center meant they would have to fund continuous specialty surgeon and staff coverage as well as engage in several hospital-wide improvement projects. Questions persisted as to the whether the hospital was up to all the changes needed and whether Kaiser corporate would ultimately support the change.
Closed System, Open Emergency Room
Kaiser Permanente is a healthcare system encompassing all three parts of the business of healthcare: hospitals, doctors, and insurance. Being a closed system, only patients that belong to Kaiser’s health plan are allowed to be treated in their hospitals by doctors that work exclusively for the Kaiser network. Some of the Kaiser hospitals have Emergency Rooms, however when non-members are brought in to be treated they are typically stabilized and then sent on to other facilities that accept the patient’s insurance. None of the 40 or so Kaiser acute care hospitals were trauma centers. Kaiser patients needing trauma care would be sent to designated trauma centers and then moved back to a Kaiser facility when able.
Kaiser Permanente South Sacramento is situated on the edge of the Capital city, close to the fastest growing communities in the State and adjacent to the busy Highway 99 corridor. The city had just put out an RFP to be the region’s trauma center. While competing health systems had nearby facilities, administrators at KPSS knew that their hospital was best situated to serve the community’s needs for emergency medicine. They had the location, size, and member base necessary to support a robust trauma program. After extensive analysis, KPSS decided that becoming a verified trauma center would be of significant long term benefit. “It was the right thing to do,” says Miller.
Trauma Center Verification and Contracting Advantages
When Kaiser patients are treated in non-Kaiser hospitals for trauma care, the Kaiser health plan usually has to pay full price to the treating hospital. “There was no incentive for the competing hospitals to contract with us,” says Miller. “We had no leverage with them in regards to reciprocal care.” Opening up a trauma center, however, changed that dynamic. Kaiser patients treated in their own facility allowed KPSS to treat their patients at cost. In addition, Kaiser now had a say in the allocation of trauma resources in the region. “We finally had a seat at the table for regional trauma planning and care. It was a huge benefit to not only our hospital, but to our members as well.”
Other Kaiser Hospitals Considering Trauma Center Verification
Since opening the first trauma center in Sacramento, Kaiser Permanente has made its facility in Vacaville, CA a trauma center and plans on converting other hospitals in the future. “This really has been an all-around success for Kaiser.”