Opening a New Level II Trauma Center Near an Established Level I Trauma Center: Is This Good for Trauma Care?

Abstract

To describe how the initiation and later removal of a provisional level II trauma center (PL2TC) status at a community hospital affected the volume and severity of injured patients seen at an established academic level 1 trauma center (AL1TC). Census data including counts of injury ICD-9 codes and patients seen in the emergency department (ED) and trauma center at an AL1TC were collected monthly from January 2010 to October 2014. An interrupted time series analysis was used to model the monthly census data with 2 time interruptions to describe the change in patient volume at the interruptions. The interruptions were (1) the initiation of the PL2TC status at a nearby community hospital and (2) the subsequent removal of the PL2TC status. The number of diagnoses, encounters, and patients seen at the AL1TC ED decreased while the PL2TC was operating. After the removal of the PL2TC status, there was a 19.4% increase in the ED patient volume per month at the AL1TC. The number of orthopaedic trauma patients seen through the ED at the AL1TC dropped 11.1% per month when the PL2TC began functioning as a trauma center. However, the volume of orthopaedic patients at the AL1TC did not recuperate after the PL2TC lost level 2 status. A significant decrease in patient volume was seen at the AL1TC with the initiation of the PL2TC in close proximity. Orthopaedic patient volume did not recuperate after the removal of the PL2TC status.