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Newsweek story

Discussion in 'Emergency Medicine' started by j-snake, May 10, 2007.

  1. j-snake

    j-snake Member

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    Newsweek is doing a "web exclusive" story on the crisis in Emergency Medicine. They spent some time at Grady Memorial in Atlanta. It's a three part story, and I only have the first two. I'll post the third part when it arrives. The first has to do with cuts to Medicaid. The second article describes a typical Saturday at Grady Memorial and goes in to more issues like overcrowding and lack of funding. My favorite quote from that article is, "Two years ago, Kellerman received a resignation letter from a top-notch doctor. 'I can't take it anymore,” she told him. “I am so afraid of making a mistake that I'm vomiting in my driveway before I go to work.'" They make it look so bleak, and yet I am incredibly excited to get in there next month and start my training. I hope that I am not too much of a naive optimist.


    http://www.msnbc.msn.com/id/18579368/site/newsweek/

    http://www.msnbc.msn.com/id/18598633/site/newsweek/
     
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  3. StudentDoc327

    StudentDoc327 Member

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    Wow, the people of Atlanta would really suffer if Grady was downgraded to a level II, or even worse shut down. I can't believe that option is even on the table but Newsweek is throwing it out there like it is.
     
  4. southerndoc

    southerndoc life is good
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    Grady is the only Level I trauma center in Atlanta. Georgia Baptist, now Atlanta Medical Center, dropped its level I designation in the early 90's. The nearest Level I trauma centers are in Macon (60 miles away), Augusta (70 miles away), or Chattanooga (100 miles away).
     
  5. coldcoldworld

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    I always the thought the only difference between a level 1 and 2 was that level 1 required trauma education and injury prevention programs. As a level 2 they could still provide all of the specialties necessary to handle trauma.
     
  6. DropkickMurphy

    Banned

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    I believe (so I was told) that Level II also does not require in house coverage of all the specialties a Level I does, but can just have them on call. I am not 100% certain of this but this is what I was told by the chief of an ED back home.
     
  7. AmoryBlaine

    AmoryBlaine the last tycoon

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    You might be right but I think Level II implies that not all specialties are neccesarily available. I work at a Level I and I'm pretty sure we don't always have in-house for absolutely everything.
     
  8. southerndoc

    southerndoc life is good
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    That's partially right, but you also have to remember that trauma center designation is primarily a state specific designation.

    Here in Connecticut, Level II's often have in-house general surgeons. In Georgia, that is not the case. Only the Level I's in Georgia have in-house surgeons. Most of the Level II's in Georgia have almost all specialties (neurosurgery, ortho, etc.) available.
     
  9. FISKUS

    FISKUS Gimme a sammich

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    The ACS ( American College of Surgeons) is the gold standard for trauma certification. Many states have their own trauma certification that tend to mirror the ACS but is quite variable from state to state. Some are quite good, up to the standard of the ACS, but other state trauma " Level I" centers are a joke.

    Although there are 6" level I " trauma centers ( state designated) , There is not a single ACS level I trauma center in the state of Illinois
     
  10. southerndoc

    southerndoc life is good
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    I think ACS only verifies level I trauma centers.
     
  11. El Cheba

    El Cheba New Member

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    Grady is not even listed on this? Neither is Vanderbilt?
     
  12. EctopicFetus

    EctopicFetus Keeping it funky enough

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    Im guessing it might be a power play for more money and resources. Its a problem we all face to varying degrees. Emergency services are severely underfunded in the US.
     
  13. FISKUS

    FISKUS Gimme a sammich

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    The ACS has nothing to do with the "verification" of state/ non-ACS trauma centers.

    http://www.facs.org/trauma/verified.html
     
  14. j-snake

    j-snake Member

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    As promised, here is the third Newsweek article in the series:

    http://www.msnbc.msn.com/id/18615533/site/newsweek/

    This one deals with how to fix the problems through better institutional and regional communication and efficiency; and of course funding changes on a national scale. Maybe my experiences are limited, but most of the departments that I have worked in seem to be expanding, adding more fancy equipment, patient rooms, and hiring more board certified EPs. If there is an impending collapse, I don't see it happening for a while--maybe just some of the major urban centers that provide an unsustainable amount of charity care. In any case, I don't think we'll ever get to the point where the system becomes truly bankrupt and we all wake up one morning to find we no longer have a job. I think the country as a whole values the work we do too much to let that happen. Something will be done, it is just a question of when.
     
  15. southerndoc

    southerndoc life is good
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    I stand corrected. I didn't realize ACS verifies level II's. I thought they only verified level I's.

    By the way, I didn't intend for my post to state that ACS verifies state designated trauma centers.
     
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  17. StudentDoc327

    StudentDoc327 Member

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    As an aside, here is a link to a cool website that has the # of trauma admissions, % penetrating/blunt, and # of ED visits per year of academic institutes with trauma and/or critical care fellowships by state.

    http://www.east.org/fellowships/fellowships.asp
     
  18. Blue Frog

    Blue Frog Junior Member

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    Aren't there more than 6 level I trauma centers in Illinois?

    This is what I found on a random google search http://www.ihatoday.org/about/facts/trauma.htm (showing 16)

    I don't understand though why University of Chicago and University of Illinois-Chicago aren't on there
    ...confused
     
  19. Miami_med

    Miami_med Moving Far Away
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    These are only places that have specific trauma/cc surgical fellowships.

    P.S. Good to know that we at Jackson are tied for the highest percentage penetrating trauma in the country. I love Miami ;)
     
  20. StudentDoc327

    StudentDoc327 Member

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    U of Chi is not a level I for adults. They send there residents to Mount Sinai for a month every year which right next to Cook, both of which see more than there fair share of both blunt and penetrating trauma (2000 alerts/yr ~50% penetrating, and 5000/yr ~40% penetrating, respectively -- at least thats what is reported). I didn't interview at UIC but I think there residents split time evenly b/w 3 hospitals, 1 of which is Advocate Illinois Masonic which serves as there level I. I think all the programs in Chi have strong trauma. Christ sees the most level I alerts in the state, NW sends there residents to Cook, and Res sends there residents to both Cook and Sinai.
     
  21. ABBY109

    ABBY109 PGY-28

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    Again - there can be a huge difference between the quality of a "state" level I trauma center and an ACS level I trauma center. I know of a specific example in which a Illinois level I trauma center did not have a neurosurgeon on staff for close to 9 months yet they still held a state level I status. It was a hush hush situation - purely politically motivated. It would have been impossible for this hospital to maintain its ACS level I status - rightfully so.
     
  22. dlung

    dlung Postprelim intern oranges

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    We must work in different areas of the country, because all the EDs I've worked in (with the exception of a couple in po-dunk USA) are over-crowded and not terribly far away from looking like Grady. We just opened a bigger, fancier ED 3 days ago, and it's already over-crowded. One major regional hospital with a trauma center actually is bankrupt and was within a month of closing, until the state stepped in with emergency funding for one more year. Bigger, fancier EDs won't fix the problem either. For example, even though USC/LA County is opening a monsterous new ED soon, the hospital is essentially losing HALF its beds (1000-->600)--you're telling me that those 400 patients won't get backed up into the ED? In any case, if those major urban centers that provide unsustainable amounts of charity care close, that charity care will find its way to other hospitals. Note the local resistance to UCSD's plan to transition its Hillcrest hospital to a stand-alone ED in the next 10 years.

    The problem isn't our job security... it's patient safety...
     

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