Page 5 - Winter 2020 Castle MD

Level III Trauma: Enhanced Care for our Windward Community
By Rachel Dick
Director of Quality Resources
Adventist Health Castle is on its way to becoming a level III trauma facility. Having a trauma facility on the Windward side allows a trauma victim access to acute care quickly. For trauma, like stroke and acute heart attack, early access to care and intervention are vital for optimal outcomes. Additional benefits to our community
Volume Analysis
Review
In Third Quarter 2019 a volume analysis was completed by medical service type, region and zip code for YTD June 2018 vs YTD June 2019 to try to understand the decrease in volume seen earlier in the year. Known challenges that impacted Adventist Health Castle’s inpatient volume included the Pali tunnel closure in February 2019, lack of specialty coverage – specifically cardiology, urology and nephrology coverage – the transfer process into AHCS was challenging for other O‘ahu hospitals, Castle Health Group’s (CHG) work to decrease inpatient admissions for the
include allowing patients to be treated close to home and family and enhancing our partnerships and resources available to other Windward health care facilities.
Trauma codes are defined by how the injury occurred. For example, a pedestrian being hit by a car going five miles an hour may
be identified as a modified trauma whereas a pedestrian hit by a car going 50 miles
an hour is a full trauma. A full code trauma activates the whole team, including the trauma surgeon, due to the anticipated severity of the injuries.
Over the next year we will be tracking data on patients who present to our facility
and qualify for a trauma designation. We will also be evaluating and fine tuning our processes and procedures. EMS will not
population it serves and the state change that all O‘ahu hospitals are required to take behavioral health patients. Previously, A hospital in town and AHCS were the primary locations.
The analysis concluded that the lack of specialty coverage, along with the work that CHG is doing to reduce inpatient admissions and changes in BHS referral patterns, accounts for 89% of the year over year variance from 2018. The Pali closure, estimated based only on Honolulu discharges, has impacted AHCS by 48 discharges YTD (Note that this is likely understated as other cities outside of Honolulu are also impacted by the Pali). The decline in AHCS’s PSA is likely due to the lack of specialty coverage and the loss
be bringing in trauma patients that aren’t already being transporting to us until after we are certified as a trauma facility. Providing community education on injury prevention topics such as water safety, keiki car seat/booster seat installation and pedestrian safety are also an important part of being a designated trauma facility. These opportunities will be ramping up soon.
We are very excited about becoming the first facility in Adventist Health to become a level III trauma facility. In addition to having associates at Adventist Health Castle enhance their skills, it will also allow us to take better care of our community.
of referrals due to this lack of coverage. Lost physician’s and reduced workloads for physician’s also impacted the inpatient surgery volume.
Since completing the analysis, the Pali reopened, AHCS streamlined its transfer process and accepts all transfers from O‘ahu hospitals, an interventional cardiologist has come on board and a urologist is being actively recruited. At
the time of this printing volume slightly improved. The hospital is looking at new marketing campaigns and outpatient service lines to address the decrease in volume as well. More exciting news coming soon!
Admissions
408
% Impacted
Years over Year IP Volume Decline
Lack of Specialty Coverage
177
43%
BHS Substance Abuse Referral Pattern
106
26%
CHG Admission Reduction
72
18%
Pali Closure (Honolulu Only Impact)
48
12%
Total Admission Explanation
403
% Explained
99%
WINTER ‘20 · 5