Trauma is a key hospital service line. Richard Buchler, FACHE, managing director and principle of Trauma Ready, describes six important steps to build a functional and profitable hospital trauma program.
1. Know the requirements. The American College of Surgeons defines trauma center requirements and audits trauma programs every three years to ensure those requirements are met. At the most basic level, these requirements define a hospital as a Level I, II or III trauma center. Learning all of the requirements and successfully implementing the resources to serve as a successful trauma center is a detailed process. "Like any service line it can be done quickly, but to set up a trauma program to give excellent care and a strong financial contribution, plan on one to two years at least," says Mr. Buchler.
2. Understand the financial aspects. Many hospitals have the attitude that trauma "just isn't a money maker," but this not necessarily true. "Get to know your payer mix and build ease of coding into your system so you get reimbursed for the work you do," says Mr. Buchler. "Well-run trauma centers do contribute to the bottom line both directly and in terms of downstream revenue."
Key areas to focus on include:
• Physician documentation. It takes time to work with surgeons to elicit proper and adequate documentation, which is needed for appropriate reimbursement.
• Coding. Correct coding is needed to receive proper reimbursement. For each minute a trauma surgeon spends with a patient after stabilization, the center receives extra reimbursement. But, many centers fail to use that code and do not receive that reimbursement.
3. Build a system. It requires detailed knowledge of complex trauma issues to develop and run an effective trauma program. "Design your trauma system to have quality and regulatory compliance built in from the beginning," says Mr. Buchler. "It takes an entire hospital ecosystem to do trauma and to do it well." The system needs to be built and understood by everyone involved in the:
• Pre-hospital phase of care
• Emergency department phase of care
• Operating room procedures
• Subspecialist involvement
• Follow-up
4. Learn about capacity issues. Trauma patient volumes are difficult to predict and require careful planning to adequately handle capacity. "Trauma requires preparedness at all hours and under all conditions. It is filled with fluid uncertain situations and critically ill patients," says Mr. Buchler. "As a result, surges in patient volume that frequently occur require a unique staffing model that can flex up."
ED staff and ICU staff can both be trained for the trauma center team. "Remember, trauma is a disease of nights and weekends. Is your staffing system trauma ready?" Staff members can volunteer to be on the trauma team or bonus incentives can be offered to ensure a hospital always has the staff ready for a worst case scenario trauma situation.
5. Look beyond the trauma bay. "Hiring trauma doctors and outfitting a trauma bay do not a trauma system make," says Mr. Buchler. Throughout the process of creating a functioning, productive trauma program, it becomes evident that the system is not insular; the whole hospital is affected. Prepare other service lines for possible impact. Orthopedics, neurology, radiology and imaging will all be affected by a busy trauma program.
6. Reach out to the community. A trauma center, like all other hospital service lines, is designed to service the surrounding community. A part of a functional trauma program is providing education to prevent trauma. "The community benefits to a great degree from a functional trauma center," says Mr. Buchler. "Take a moment to highlight how having a local hospital at the ready for some of the sickest patients impacts the community in a positive way."
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