Hospitals statewide are sending more patients to Shock Trauma for its concentration of resources and expertise.
The sixth floor of the Shock Trauma Center will be transformed into a critical care and intermediate care unit, where Angela Weir, RN, BA, and other staff will provide a more intense level of nursing.
The R Adams Cowley Shock Trauma Center does whatever it takes to save the lives of Maryland's most severely injured patients. For the next several years, that will include expanding its facilities to accommodate a growing number of patients each year.
The Medical Center is beginning an $83 million initiative to increase Shock Trauma's bed capacity; improve the electrical, heating, ventilation and air conditioning systems; and upgrade clinical technologies. The expansion and improvements are necessary to address an increased need throughout the region for the highest level of trauma care for the most severely injured patients.
"We already exceed our occupancy on a daily basis," says John Spearman, who is the Medical Center's vice president for Shock Trauma. "We will receive 8,800 patients a year by 2011. That's what's driving these renovations."
The projected growth in patients indicates Shock Trauma would need to grow from its current 94 beds, which include the TRU, to a total of 141. However, some of those acute-care beds can be accommodated within other units of the Medical Center adjacent to Shock Trauma, while Shock Trauma converts existing beds and adds 12 more beds for critical care on the third floor. The current Shock Trauma facilities were built in 1989 to handle about 3,500 patients each year. Today, the annual admissions exceed 7,000 patients.
There are days when Shock Trauma already operates at up to 112 percent capacity. Shock Trauma is able to do that because the trauma resuscitation unit (TRU) bays are all designed to accommodate two beds, when necessary. This design was originally adopted in the 1980s to be able to rapidly and routinely shift to mass-casualty capability, but it has also allowed the hospital to keep up with admissions for now.
"After the TRU and, often, surgery, our patients nearly always need to go to a critical care unit, and this is where we most immediately need to expand the number of beds," says Thomas M. Scalea, MD, physician-in-chief of the Shock Trauma Center.
For this reason, the sixth floor of the Trauma Center is being transformed from an acute care unit, to more intensively staffed critical care and intermediate care beds.
"The sixth floor conversion includes promoting the knowledge and skills of the current staff of the acute care unit nurses in preparation for critical care," says Theresa DiNardo, RN, MSN, CCRN, patient care services manager for the sixth floor. "We're providing education, helping nurses enhance their certification and pairing them with mentor nurses who already work in critical care."
"The patients the other hospitals are transferring here are going to be primarily critical care cases," says Spearman. "We need more critical care bed capacity right away."
As those patients improve, they need acute care beds, so part of the expansion will include more acute care beds as well.
"Once we increase our capacity, we will be at about 87 percent occupancy, which is optimal," Spearman says.
Funding and Construction
The plan is to fund this expansion through a combination of University of Maryland Medical Center funds as well as a multi-year committment from the state of Maryland. Additional funds from federal sources are also expected.
Construction is set to begin this year with the relocation and expansion of the trauma ambulatory clinic, from the first floor of the Shock Trauma Center to a larger space on the ground floor formerly occupied by several groups including Clinical Engineering, Maryland ExpressCare and Respiratory Care Services.
This expansion will have a positive domino effect. Expanding the capacity for follow-up care after discharge will allow more beds in the hospital to be available for new, severely injured patients. No units will be shut down during the work, Spearman says, with as few rooms as possible out of use at a time.
The increase in critical-care patients is expected to include people who are transferred from other medical centers that don't have the level of ondemand resources found at Shock Trauma. Other hospitals have, in the past, had to send patients to Shock Trauma because they did not have enough surgeons - in particular, orthopedic surgeons, neurosurgeons and oral-maxillofacial surgeons - available on a 24-hour basis.
The Trauma Resuscitation Unit TRU) of Shock Trauma was recently renovated and expanded with three more bays.
Several hospitals have felt compelled to consider whether and how to keep their trauma centers open over the past four years. When Washington County Hospital's trauma center actually did close for four months in the summer of 2002, Shock Trauma received 250 more patients than usual during that period, Spearman says.
With a concentration of highly trained and experienced clinical staff, Shock Trauma has always been the core of trauma care in the state - and even more so now. "This is very much linked to a state-wide trauma system we have built in Maryland, and Shock Trauma's role [as both the core and the safety net] in that system," Spearman says.
Already, one expansion has taken place partly to address the need for more space, but also to accommodate the latest technology, the Statscan machine, a low-dose X-ray scanner that, in 13 seconds, produces a full-body image. For patients with multiple injuries, the scan allows quick detection of any broken bones and potentially fatal softtissue injuries.
Between 2003 and 2006, the new Mirmiran Diagnostic Imaging Suite was added, and the TRU was expanded from 10 bays to 13 bays. One of those 13 bays is dedicated to the Statscan machine, so that patients don't have to be moved out of the TRU for imaging, saving precious minutes.
For decades, Shock Trauma has served as the core institution for the statewide emergency medical system, and was given that formal designation in 1993 by the Maryland General Assembly in House Bill 1222. The National Highway Traffic Safety Administration (NHSTA) did a review of the Maryland system to determine how it could serve as a model for other states.
"The key thing is the Maryland system is changing in response to challenges in health care. The Shock Trauma Center has to change as well," Spearman says. "This plan is going to give us the ability to continue to meet those challenges."