Tufts Medical Center has applied for designation as a trauma center with the American College of Surgeons (ACS). If successful, the center would be able to receive critical-trauma patients who are typically taken to other state-designated trauma centers in Boston.
Certain local trauma centers are objecting to the Tufts-affiliated hospital's attempts, saying that the business Tufts takes away from them could compromise their own wellbeing and ability to maintain high-quality service.
The Medical Center is seeking Level II adult trauma center designation, which will require it to provide care to all trauma patients, no matter the extent of their injuries.
The application process to become a trauma center begins with verification by the ACS. The decision of whether to formally designate the hospital then goes to the state Department of Public Health.
The ACS already visited Tufts Medical Center for a consultation, during which it pinpointed areas that the hospital needed to improve upon before approval, according to Brien Barnewolt, the emergency physician-in-chief at the medical center. The verification visit is scheduled for next month.
The medical center had received trauma patients until federal legislation was passed in 2000 requiring states to develop a trauma system by which hospitals must apply for trauma-center designation, Barnewolt said.
Since Tufts' center already has the appropriate framework, it was only logical to apply to the state, according to Barnewolt. "It wasn't that much of a leap to become a little more organized with a trauma designation," he said. "We debated internally, and ultimately the decision was made to elevate the standard of care for the patients that we have always taken care of."
Four trauma centers are currently located in the Boston area: Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham and Women's Hospital and Massachusetts General Hospital. All four are designated as Level I, which is higher than Level II.
The level of care provided at Level I and II trauma centers is equal, according to Barnewolt. He said that the distinction comes from the volume of patients and research required at a Level I institution.
While Tufts Medical Center does perform research, Barnewolt said, "we didn't feel our volume [of patients] would satisfy a Level I designation."
Tufts' application for the designation has prompted debate among its competitors, who would lose patients if Tufts is successful in its bid.
Michael Rosenblatt, the director of trauma services at the Lahey Clinic in Burlington, Mass. and the chair of the ACS Massachusetts Committee on Trauma, told the Daily that it is conceivable that adding Tufts as a trauma center could significantly impact the patient flow at other sites. This could compromise the ability of hospital staffs to stay well trained.
"The dilution of the overall flow of patients to yet another trauma center may reduce to other hospitals … the volume needed to maintain a high quality of clinical skills," he said.
But Rosenblatt added that the ACS does not consider the number of trauma centers in the area when verifying a hospital's capabilities. This consideration is left up to the state, he said. Rosenblatt has no relation to Michael Rosenblatt, the dean of Tufts' School of Medicine.
The cost of making the transition has also been a point of contention. The Boston Globe published an editorial on Aug. 22 saying that Tufts Medical Center's designation as a trauma center would impose unnecessary costs on its patrons.
But the medical center's executives believe that the hospital already possesses much of the costly infrastructure needed to be a successful trauma center. "There is a misperception that this is a hugely costly venture," Julie Jette, a spokesperson for the hospital, told the Daily. "But Tufts Medical Center already has most of the capabilities in place. We're a very efficient provider in terms of our costs."
The Floating Hospital for Children at Tufts Medical Center became the first Level I pediatric trauma center in the country, Barnewolt said. It still holds this accreditation. The center now requires the Floating Hospital to be outfitted with sophisticated technology and medical capabilities.
But Rosenblatt minimized the advantage of the pediatric trauma center. While technology can be used for both pediatric and adult care, the adult designation is a completely different process, he said.
Barnewolt said he has seen several instances in which patients have been turned away due to Tufts' limited trauma status. "Children have been transported here because of the pediatric designation, but you can't transport [an injured] parent," he said.
University administrators both on Tufts' Medford/Somerville campus and at the School of Medicine in Boston see the trauma-center designation as a way of enhancing the education of medical students.
"Tufts' medical school has historically educated a major portion of the primary care and family medicine physicians in the state," President Lawrence Bacow said in e-mail sent by a spokesperson. "Further strengthening their education is unambiguously a public good."
Giovanni Russonello contributed reporting to this article.
