Grady Trauma Program Re-designated as a Level I Trauma Center

March 2013

Metro Atlanta citizens and Georgians within a 100-mile radius of downtown are so accustomed to the Level I designation attached to the trauma program at Grady Memorial Hospital, they might be startled to learn that the most advanced trauma center in the state had to re-earn that ranking in 2013—trauma centers in Georgia must renew their designation every three years. Unsurprisingly, the Grady Health System retained its Level I Trauma Center designation following a successful site visit conducted by J. Patrick O'Neal, MD, Director of Health Protection for the Georgia Department of Public Health (DPH), and Renee Morgan, State Trauma System Manager of the DPH, on February 27, 2013.

In the official notice of re-designation addressed to Dr. Jeffrey Nicholas, Chief of Trauma and Director of the Marcus Trauma Center at Grady, Dr. O'Neal wrote, "We commend Grady on the formation of an impressive process improvement program. We also would like to acknowledge the fine leadership of you as Chief of Trauma and the obvious commitment of the entire trauma team. We would be terribly remiss if we did not also commend the extraordinary administrative support of Mr. John Haupert." Mr. Haupert is President and CEO of Grady Health System.

To achieve Level I designation, a trauma center must have a full-range of specialists and equipment available 24/7/365, admit a minimum required volume of 1,200 severely injured patients (Grady admits approximately 3500 annually), have a research program, be a leader in trauma education and injury prevention, a referral source for communities in neighboring regions, and be committed to continued improvement through a Performance Improvement and Patient Safety (PIPS) Program. 

"The re-designation comes after significantly rebuilding the infrastructure and organizing the performance improvement plan over the last six months, a process more than ably managed by Dr. Nicholas," says Dr. Sheryl Gabram, Emory’s Surgeon-in-Chief of Grady Memorial Hospital. "The Grady Trauma Program, supported by Grady administrative leadership, also sponsored an on-site Trauma Outcomes and Performance Improvement Course (TOPIC) in November 2012 for all Grady trauma healthcare providers. This nationally recognized course, taught by Jorie Klein, RN, from the Society of Trauma Nurses, and Glen Tinkoff, MD, representing the American College of Surgeons, consisted of detailed training for structuring a PI program from the ground up. Many of the initiatives suggested during the course were implemented for Grady's re-designation visit."

Other upgrades included the renovation of the resuscitation bay into the high tech and larger capacity Marcus Trauma Center; the development of assessment tools for tracking the continuum of trauma care and monitoring patient outcomes; and the addition of new staff in positions that were originally unsupported at the time of the prior site visit. These include Injury Prevention Coordinator Emma Frank, Outreach and Education Coordinator Felicia Mobley, Research Coordinator Julie Mayo, Performance Improvement Coordinator Tony Volrath, and five paramedic dispatch coordinators that have streamlined communication with pre-hospital personnel and improved documentation and activation of the trauma team.

The growth in research involving the center has also been significant. New grants include Dr. Christopher Dente's Department of Defense-funded pilot study of wound closure, his National Cancer Institute-backed evaluation of the detection and management of non-compressible hemorrhage by vena cava ultrasonography, and Dr. Ravi Rajani's participation in the multi-center TRANSFIX study of a special endovascular graft for treating blunt thoracic aortic injury.

"I am fortunate to have taken over the trauma program at a time of tremendous administrative support from Grady, and our progress demonstrates that," says Dr. Nicholas. "Trauma care is a team effort, and I am blessed with a great supporting cast of players. Fran Lewis, the Trauma Program Director, has been outstanding in leading the changes we have made. Our clinical care has always been top notch, but we are finally capable of seeing and using our data and leveraging it to take the program to new heights. It is a great time for Grady and the city of Atlanta, and I am extremely proud of our entire team and our momentum." 

Dr. Nicholas views the re-designation as a major step towards the Trauma Program's goal of hosting an American College of Surgeons (ACS) consultative visit and ultimately striving to become an ACS-verified Level I Trauma Center. There is currently no trauma center in the state with this distinction. "The ACS endorsement is the gold standard of recognition for a trauma center," he says. "It signifies that a trauma center has demonstrated true commitment from pre-hospital care through discharge and rehabilitation, and that it has a robust PIPS Program aimed at providing the highest quality trauma care for all injured patients."

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