Yampa Valley Medical Center has informed the Colorado Department of Public Health it will give up its status as a "Level 3" trauma center and step down to the Level 4 designation. However, hospital CEO Karl Gills offered assurances this week the change in the status of the emergency department will not have a negative impact on patient care.
The hospital moved up to the Level 3 designation in July 1998 with the help of a waiver from the state on requirements related to physician response time. Now, Gills said, the state is withdrawing the waiver and after a careful study, hospital administration has decided to accept the change in status.
"Our level of service and care will remain significantly higher than the minimum required for a Level 4 designation," Gills said. "The board and medical staff leadership feel that the level of care provided by our physicians and hospital will not change. YVMC will continue to meet the requirements for Level 3 in most areas of the emergency department, as well as the overall medical center."
Economic considerations were a part of the decision, he said.
State government assigns hospital emergency departments one of six level designations to standardize capabilities and readiness. When YVMC first attained the Level 3 designation in 1998, Gills said, it was granted a waiver to requirements that an emergency room physician be present 24 hours a day and that a general surgeon be able to respond to the emergency room within 20 minutes of a patient's arrival. The waiver was an acknowledgment of YVMC's location in a rural area and the cyclical nature of its business because of its location in a resort town.
When YVMC officials were informed of the state's plan to remove the waiver, Gills said hospital staff undertook a thorough review of emergency room cases to find out how patient care would benefit from stepping up to the higher standards.
"The requirement of 'in-house' physician coverage does not make sense for YVMC at all times of the year," said Dr. Larry Bookman, head of emergency services at YVMC. "We have not determined any case where patient care was compromised based on our current system."
"We went through and looked at a two-year period for surgeries that required a short (response) time period," Gills said. "We found no patient care issues" that would have resulted from the 45-minute response time allowed Level 4 trauma centers.
The higher state standards would have resulted in two sets of economic impacts, Gills said.
Emergency room physicians are self-employed. The requirement that they cover shifts around the clock would have meant physicians would collectively be on duty at the hospital without an increase in business.
Emergency room physicians already are on site or on call to give 24-hour coverage at YVMC, he added, and are not compensated for being on call. When on call, they begin their trip to the hospital as soon as ambulances are paged out on a run.
The second set of economic impacts on the horizon would have resulted from the requirement that general surgeons be at the hospital within 20 minutes of a trauma patient's arrival. YVMC was on the verge of needing to pay surgeons for being on call, Gills said.
Under Level 4 requirements, response time is determined by the individual hospital based on its needs.
The shift to Level 4 at YVMC doesn't necessarily mean general surgeons won't meet the Level 3 requirement and be on hand within 20 minutes or be waiting when patients arrive, Gills said.
"We have great confidence in our emergency room physicians' ability to resuscitate and stabilize trauma patients," Gills said. They are in touch with EMTs in the field and can call in surgeons before the patient reaches the hospital when the situation warrants.
Hospitals in Colorado with the highest Level 1 designation include Denver Health Medical Center and Saint Anthony Central Hospital-Centura Health in Denver. Poudre Valley Hospital in Fort Collins and Saint Mary's Hospital in Grand Junction are at Level 2.
As of April, Valley View Hospital in Glenwood Springs, Vail Valley Medical Center and Aspen Valley Hospital had Level 3 trauma centers. Level 4 centers included those in Breckenridge, Frisco, Leadville, Granby and The Memorial Hospital in Craig.
Gills said it would be misleading to make direct comparisons between Steamboat's capabilities and those of other hospitals based on their designation alone.
YVMC ramped up its capabilities when it originally achieved Level 3, he said, and those capabilities, including a 24-hour laboratory and 24-hour in-house radiology department, will still be available.
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