Emory

[SK14CAT]

Hey guys,

Just wanted to get some opinions on what they have heard about the Emory situation. Just heard some new stuff about JAHCCO violations and the possibility of Grady losing its Level 1 status. Any thoughts/opinions?

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[iridesingltrack]

Hey SK14CAT,

I am relatively new to the forum and am about to give up my anonymity on my 5th post...bummer, it was fun while it lasted.

When it comes to Grady it seems the rumors fly this year...I am an Emory M4 and have been at Emory/Grady in one form or another since 1999 after moving from So Cal after college. I say this only to point out that I've been watching this situation brew for a long time.

To directly address your questions I have to say that in all honesty I don't think anyone knows about the JHACO report as it hasn't been released yet. I've not heard any credible rumors about it either. However, I am sure that Grady is deficient in some areas but, I would be surprised (read: "shocked") if JHACO did more than slap Grady on the wrist, especially given the radical changes they are making in their governance. Also, the State is not going to strip Grady of its "level I" status, this rumor is patently false. In fact Gov. Purdue has recently called for the creation of a statewide trauma network, which includes $53 million to Grady to get the program started.

You didn't mention this but I've also heard many compare Grady's current situation to MLK in LA and I honestly fail to see the similarity. In my opinion Grady is in a different position because:

1. It is the only level I trauma center AND burn center for ALL of metro Atlanta (that is roughly 5 million people), the 9th largest metro area in the US per Wikipedia. Imagine for one second what closure of Grady would really look like.
2. The next nearest level I trauma center is Medical College of GA (MCG) in Augusta, more than 3 hours away (if the ambulance drives on one of those rare days when traffic is light, say 3am Sunday. Traffic. Now that is great reason to lower Emory on your ROL). In the likely event that MCG can't take the patient(s), Atlanta could ship their major trauma to UAB 4 hours to the west, or Savannah 5 hours to the east…multicasualty events would be an unmitigated disaster.
3. It is home to the only poison center in the entire state of GA, add to that the poison center is indeed one of the busiest call centers in the country, receiving 117,000 calls per year according to their website.
4. Grady provides the largest, most active and highly trained EMS in the region. The EMS system is already quite fragile in Atlanta; a loss in this arena would be quite dramatic and would be felt by people in the entire region insured or otherwise. In all seriousness, I am not sure who would/could transport Atlanta patients to area hospitals let alone to other level I trauma centers in or around the state. Unlike other regions local fire departments are not big players in EMS here.

I guess to conclude my war & peace length post I will say that I plan to rank Emory highly because of the faculty, residents and the patient population. I know the Emory EM faculty well and I would gladly trust them with my residency training.

 

[southerndoc]

EMS is a moot point as to why Grady can't close. Trust me, there are plenty of services willing to scoop up the Atlanta city limit zone. Rural/Metro, AMR, MetroAtlanta, or any other private service could provide transport with the city/county providing contract funding (like it does with Grady).

The other reasons that Grady can't close are right on. I don't see Grady closing anytime soon.

 

[iridesingltrack]

Point well taken. I do imagine, however, that there would be a fairly significant lag time to bring other EMS operations up to speed.

 

[Hercules]

Hey SK14CAT,

Atlanta could ship their major trauma to UAB 4 hours to the west

Just as a side note... we are plenty busy in Birmingham with all of Alabama's trauma without absorbing Atlanta's as well, so you guys are welcome to keep it in state. Seriously though, I agree that the closing of Grady would have major repercussions for Atlanta, Georgia, and the surrounding region.

 

[SK14CAT]

Thanks guys for all your opinions. I truly like the Emory program but have recently heard all these rumors and don't want another MLK situation at hand. So thank you for all your info. A question to the Emory M4, do you feel that there is still a lot of scut (wheeling patients, ivs etc) that need to be done at grady? I have found mixed views on this as well.

 

[iridesingltrack]

SK14CAT,

A significant problem at Grady is throughput. Reasons for this are broad: overwhelmed/understaffed ancillary services is among them. Therefore, residents, and even attendings, will on occasion push patients to Radiology, or rarely start an IV just to keep things moving. Like all EDs the goal is to take care of the patient and given the relatively limited ancillary support, that sometimes mean doing a little scut. Hope that helps.

 

[met19]

Thanks guys for all your opinions. I truly like the Emory program but have recently heard all these rumors and don't want another MLK situation at hand. So thank you for all your info. A question to the Emory M4, do you feel that there is still a lot of scut (wheeling patients, ivs etc) that need to be done at grady? I have found mixed views on this as well.

if you are expecting to go to a busy urban level 1 trauma center in an underserved area and not occaionsionally push a pt to rads, start an IV you might want to reconsider those places. I am at a similar institution, and I often will start lines to expitite pt care (e.g. nurse go gets the meds while I place the line....). On the other hand you want to be able to tell your ancillary support, this, this and this needs to be done, but an ED is all about team players.....

 

[SK14CAT]

if you are expecting to go to a busy urban level 1 trauma center in an underserved area and not occaionsionally push a pt to rads, start an IV you might want to reconsider those places. I am at a similar institution, and I often will start lines to expitite pt care (e.g. nurse go gets the meds while I place the line....). On the other hand you want to be able to tell your ancillary support, this, this and this needs to be done, but an ED is all about team players.....

No I definitely am not opposed to doing my own IVs or helping out when needed but I rotated at a county program where the nurses were unionized and took "nap breaks" and looked at you really funny when u asked for a hand. Just wanted to see where on the spectrum grady was at.
Thanks for the help!

 

[iliacus]

it' seems like a stretch to compare it to MLK.

 

[surgical06]

some of these rumors are just rediculous, most major urban trauma centers historically have to go through these periods of "will it close" , mainly because the trauma they see is an extensive financial burden to the hospital, and most patients have no insurance. cook county in chicago, detroit general all had similar problems. mlk closed because there is a competitor w/in one mile who wanted to absorb that patient population.

anyone who is interested in a program that sees the breadth that grady does, i would strongly encourage you to go. it may not be pretty, but the knowledge you come away with is awsome.

BOTTOM LINE: grady will not close, and to suggest major trauma goes to alabama.... i'm not sure what gunshot wound to the box is going to make it that long...

 

[wook]

2The next nearest level I trauma center is Medical College of GA (MCG) in Augusta, more than 3 hours away (if the ambulance drives on one of those rare days when traffic is light, say 3am Sunday. Traffic. Now that is great reason to lower Emory on your ROL). In the likely event that MCG can't take the patient(s), Atlanta could ship their major trauma to UAB 4 hours to the west, or Savannah 5 hours to the east…multicasualty events would be an unmitigated disaster.

Funny thing is, there have been people (both trauma and PICU) patients shipped from Atlanta to MCG and vice versa (although by bird not by ground). It's a small world.



Wook