To many trauma leaders, the state of Florida illustrates the challenges of building a strong regional trauma system in an environment of competing interests. Yet according to John H. Armstrong, MD, FACS, the Florida experience shows how trauma stakeholders can work together to find balanced solutions to shared challenges.
Dr. Armstrong is the former Florida State Surgeon General and Secretary of Health (2012-16) who successfully navigated significant legal challenges to the state’s trauma system. During a session at the 2016 Annual Conference of the Trauma Center Association of America, he discussed current opportunities for sustaining a trauma system through legislative, regulatory and professional routes.
Trauma center needs assessment
“Over the last few years, the apportionment of trauma centers has emerged as a big challenge in Florida,” Dr. Armstrong said in a separate interview. “There has been significant hospital interest in becoming a trauma center, among both for-profit and non-profit hospitals. At the same time, we have seen a reluctance among existing trauma centers to accommodate these new entrants.”
Dr. Armstrong spoke about the trauma center needs assessment process he led in Florida. “The process can help you put together a coherent framework so that you can apportion trauma centers as rationally as possible,” he said. “It is important to avoid other remedies — such as going through legal routes — that are time-consuming and cost-consuming.”
According to Dr. Armstrong , leaders in other regions can benefit from three key insights. “The first insight is that trauma professionals need to work together to ensure that the system adapts to the needs of the population it serves,” Dr. Armstrong said. “It is really important that you avoid a ‘static’ approach when you think about the need for trauma resources and try to plan your system.” He noted that in Florida the last major legislative and regulatory review of the trauma system took place 25 years ago. “During that same time, our population increased almost 50 percent.”
“Second, there are essential functions in the system that have to be supported, such as teaching and research,” Dr. Armstrong said. “As you increase the number of trauma centers, you need to be wary about what that means for other missions.”
“Third, it is critical that all players work with the state trauma system authority on a regular basis,” he said. “There should not be an adversarial relationship because the trauma system is a public-private partnership that is all about doing right for the injured, inclusive of injured patients, their families, and their communities.”
The key, Dr. Armstrong said, is to think inclusively and proactively. “If you think proactively, you have a very good chance of coming up with an innovative solution.”
Using data to focus thinking
Dr. Armstrong emphasized the importance of statewide data analysis to drive trauma system improvement. A statewide trauma registry that includes all trauma patients should be an essential data source. Florida made substantial improvements in its trauma registry, including participation by trauma centers in the national Trauma Quality Improvement Program (TQIP) and creating a minimum dataset for non-trauma acute care hospitals reporting to the registry.
“When we looked at Florida’s acute care hospital patient statistics trauma data, we realized that just under one-half of our trauma patients in Florida were receiving care in non-trauma acute care facilities,” Dr. Armstrong said. “So there was an opportunity for existing trauma centers concerned about trauma patient volumes to identify these patients and connect them to trauma centers through the system.”
According to Dr. Armstrong, this is an example of what can happen when stakeholders focus on using all the components of a trauma system to achieve better outcomes. “It’s not about taking sides,” he said. “To build a strong trauma system, we need everyone.”