Another Collaborative Trauma Agreement Ends in the U.S.

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Collaborative trauma programs are rare but they can offer several benefits. In a collaborative program, two hospitals work together to function as a single Level I trauma center. Last week, however, a longstanding trauma collaboration between two Illinois hospitals came to an end. A similar agreement in Nebraska broke up last summer. If current trends continue, the “shared” Level I trauma center could soon be extinct.

Supporters of collaborative trauma programs have noted several benefits of these unique agreements. First, collaborative programs let hospitals share the financial burden of trauma care. Partnering hospitals avoid unnecessary duplication of costs and often share services and resources. Collaborative agreements also provide a mechanism for mediating hospital competition. In spite of these advantages, however, population growth and economic changes seem to be working against collaborative trauma programs.

Agreement unravels in Springfield
Since 1999, St. John’s Hospital and Memorial Medical Center, both in Springfield, Ill., have worked together as the Southern Illinois Trauma Center. The hospitals took turns serving as the region’s Level I trauma center on alternating years. Each program was staffed by trauma physicians from the Southern Illinois University (SIU) School of Medicine, who “relocated” annually from one hospital to the other. A 2004 paper in the Journal of Trauma presented the arrangement as a solution for regions where hospital competition creates political barriers to appropriate trauma care.

In August, however, SIU announced its decision to end the two-hospital agreement and base its trauma surgeons permanently at Memorial, according to a State Journal-Register report. Medical school leaders said the annual relocation made it necessary to re-train hospital staff every year. They also stated that centralizing the trauma program in one hospital would support efforts to improve quality, research and education. According to the article, SIU trauma leaders are also interested in seeking trauma center verification from the American College of Surgeons (ACS), which is not open to multi-hospital programs.

The Level I sharing agreement ended officially on January 1, according to a separate State Journal-Register report. St. John’s Hospital hired six trauma surgeons in recent months and has secured state designation as an independent Level I trauma center. The two hospitals are only blocks apart, and the total injury volume for the city is approximately 1,200 trauma patients per year. Local EMS and health system leaders are now working out practical problems in patient triage.

Nebraska split ends 18-year collaboration
A similar collaboration in Omaha, Neb., was dissolved last summer. Since 1994, Nebraska Medical Center (NMC) and Creighton University Medical Center have operated a joint Level I trauma program. NMC received trauma patients on Tuesday, Friday and Sunday, and Creighton received transports on Monday, Wednesday, Thursday and Saturday. The joint program was designated as a Level I trauma center by the state of Nebraska.

As discussed in a 2012 paper in The American Journal of Surgery, the arrangement allowed the two hospitals to share the financial burden of trauma care and the cost of outreach, prevention and education activities. In fact, the program generated revenue for each hospital. Patient outcomes were comparable to national standards. “In 2008, mortality at both hospitals was at about the 50th percentile in comparison with similar-sized level I trauma centers.”

The Omaha trauma collaboration ended on August 1, according to an Omaha World-Herald report. One reason for the breakup: Both hospitals plan to seek Level I verification from the ACS.

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