Fragmented Trauma-Response System Prompts Bill to Boost Coordination

Andrew Kitchenman | January 8, 2014 | Health Care
More than five years after critical report, Legislature looks to take action to improve quality and efficiency of high-level emergency services

New Jersey residents are dying unnecessarily due to a fragmented trauma system that fails to provide some patients with the appropriate level of care, according to supporters of a bill that would seek to fix this by establishing a formal state trauma system.

The measure, S-3027/A-4500, would institute a system to increase coordination among hospitals and emergency personnel. It would also create a committee that would recommend additional changes to state health and emergency management officials.

This could head off some problems, such as for-profit ambulance squads taking patients to an inappropriate hospital due to financial incentives, according to a bill sponsor.

The seeds for the legislation were planted in August 2008, when the American College of Surgeons issued a series of criticisms of how the state handles trauma cases in a report that was ordered by the state Department of Health.

The report described the state’s approach to trauma as fragmented, adding: “Many injured patients in New Jersey do not receive the level of care that the system can optimally provide and that the patients and their families deserve. The current response to the injured patient is a function of where they are located in the state at the time of their injury and the ability of the system to respond on that given day to that given location.”

Senate sponsor Sen. Joseph F. Vitale (D-Middlesex) said there is “a significant lack of coordination within the trauma system and among the trauma centers.”

Vitale said he’s concerned that some for-profit ambulance services take patients to hospitals based on financial incentives.

“We have too many admissions of trauma patients at non-trauma facilities,” Vitale said.

While no official statistics are available, Vitale cited estimates gathered from trauma centers that 33 percent of all patients with major trauma injuries are admitted to non-trauma hospitals.

Cooper University Health Care lobbyist Gary Young said the state trauma system advisory committee to be established by the bill could play a crucial role in gathering data, such as creating a registry of all trauma cases. This would allow the state to study ways to improve care. His hospital is one of three “Level I” trauma centers – along with Robert Wood Johnson University Hospital in New Brunswick and University Hospital in Newark — which handle the state’s most serious trauma cases.

“The bottom line is that we’ve got anecdotal data that people are not taken to the right place at the right time, in many cases, trauma-injury patients,” Young said. “What this leads to is people having blunt trauma being inappropriately treated, or (patients) having penetrating trauma bleeding out in places where they shouldn’t have been treated in the first place.”

Young said that one problem with the state’s current approach is that it doesn’t have enforceable regulations that require ambulances to bring patients to trauma centers, only guidelines. This can lead to patients with serious head injuries requiring immediate and specialized trauma care – such as a subdural hematoma — being taken to a hospital without a trauma center, Young said.

Young noted that the new committee is based on a successful model: the state’s cardiovascular health advisory panel, which has helped produce report cards that led to statewide improvements in cardiac surgery.

“We don’t know the degree to which there is a problem because there isn’t a database” of all trauma cases and how they’re handled,” Young said. “The state needs a trauma registry and that will help to hold people accountable for how people have been treating injuries.”

The bill also received the support of the New Jersey Hospital Association. NJHA Senior Vice President Randy Minniear noted the findings of the American College of Surgeons report in detailing why the association backed the measure.

“Increased coordination is a good thing for our trauma system,” he said.

The Senate Health, Human Services and Senior Citizens and Budget and Appropriations committees have supported the bill.

Budget Committee Chairman Sen. Paul A. Sarlo (D-Bergen and Passaic) noted that the bill would create a new position of state trauma medical director. He said the position should be filled by a current state or hospital official, which would alleviate the need for the state to spend money on the position.