Hospital drops top trauma level

Evanston Hospital dropped its designation as a Level I trauma center in June, sending more victims of serious injuries to St. Francis Hospital in south Evanston.

Citing the high costs of staffing a Level I center in relation to the small number of patients seen, Evanston Hospital officials in June elected to be downgraded from a Level I to Level II center under the trauma system administered by the state.

A Level I designation requires that a trauma surgeon be on the premises 24 hours a day, seven days a week. Moreover, specialty surgical services such as neurosurgery, reimplantation and ophthalmologic surgery must be available within 30 minutes from the time the patient is classified.

A Level I trauma center is licensed to handle victims of blunt or penetrating trauma, such as a knife wound, a gunshot wound, a penetrating injury caused by a sharp object and cases suggestive of loss of limb and spinal cord injury.

As a Level II trauma center, Evanston Hospital can continue to provide care to victims of heart attacks, strokes or serious automobile accidents with multiple breaks and fractures, said Joan Trezek, assistant vice president of corporate communications for Evanston Northwestern Healthcare.

The change in designation means that St. Francis Hospital is the only Level I center between Illinois Masonic Hospital on Chicago's North Side and the Wisconsin border.

The nearest Level I center to the west is Lutheran General Hospital in Park Ridge.

Small set of cases

Trezek said the number of Level I cases seen by emergency room doctors at Evanston Hospital has historically been low. In 2002, for example, the number of cases classified as Trauma I dipped from 33 to 30. The hospital logged about 40,000 visits in total to its emergency room the same year.

"The cost of maintaining that level of expertise in-house 24-7 was thought to be no longer prudent or cost-effective," Trezek said.

"In order to keep those skills well honed, you need to see enough (Level I cases) so that when the situations do occur, things come into place. It's 'practice makes perfect,'" she said. "Fortunately for the community, there are a number of other providers."

New rules in place

The change in June came on the eve of new rules cutting back - to 80 - the number of hours that doctors in residency training can spend in the hospital during a week. The limit is based on a four-week average.

The new rules, which also cap the length of a resident's shift at 30 hours, prompted many hospitals to make adjustments, said Sherilyn Hailstone, chief executive officer at St. Francis Hospital.

Hailstone said Monday that experience so far has borne out her early prediction that the hospital would see about 120 more trauma patients a year as a result in the change in designation at Evanston Hospital.

"So far, that is kind of what's been happening," Hailstone said, noting that the hospital has been receiving victims from Glencoe, Northfield, Wilmette and northern Skokie that previously would have gone to Evanston Hospital.

"I think we will see at least 120 additional patients a year. If they get much farther away, then the 15-minute transport time starts to come into play."

Helicopter assist

Trauma procedures specify that if the nearest Trauma I facility is too far away, the patient should be taken to the nearest hospital, stabilized and transported by helicopter to a Trauma I facility.

Under the classification system used at St. Francis, the hospital treated 854 trauma patients during 2002, of which 320 were considered trauma code patients, those with the most serious injuries. The emergency room logs about 34,000 visits per year.

"It takes tremendous resources to hold this designation and it is something we look at all the time," said Christine Rybicki, director of public relations for St. Francis. "Can we continue to provide this valuable community service? Can we, from an economic and financial perspective, afford to do this?"

Hailstone said it is too early to tell whether the added cases will strain St. Francis' resources.

"I think it will depend on how large a volume and how many more uninsured patients, or poorly insured patients there are," she said.

Because the hospital already pays to have trauma surgeons present and neurosurgeons on call, the additional patients, she said, "could help or hurt us."