As part of cutbacks at University of Maryland Medical System, the vaunted Maryland Shock Trauma Center is closing one 20-bed unit.
John W. Ashworth III, director of the Shock Trauma Center, said the closing was a response to empty beds, as patients are discharged more quickly. The closing will mean a staff reduction in Shock Trauma of 66. Of those, half are nurses, aides and technicians, a reduction of 10 percent in direct patient care staff. The other half are in administration and support such as billing and information systems, a cut of 18.5 percent.
While Shock Trauma had 94 patients on a typical day as recently as three years ago, it now averages 75, a drop of 25 percent, according to Joel G. Lee, vice president for market development and communications of the medical system.
Quicker discharges, Ashworth said, result in part from insurance pressure to keep costs down, but also are made possible by technological changes and by development of "alternate sites where the patients can be cared for in other ways, such as rehabilitation facilities and home health services."
Just 10 years ago, he added, the average patient stayed in Shock Trauma 17 days. Now that's down to five days, although a Shock Trauma stay might be followed by care in another facility.
The Shock Trauma cuts are designed to save $3.5 million a year, part of $17 million in system-wide savings from a total budget of half a billion dollars, Lee said.
In addition to the Shock Trauma unit, the hospital closed a 16-bed surgical-oncology unit, merging it with other units, and is consolidating its cancer intensive care unit with its bone marrow transplant unit. Overall, the system is eliminating 255 jobs.
Although it is increasingly profitable -- from $3.9 million five years ago (1.3 percent of revenue) to $17.5 million in fiscal 1996 (4.1 percent of revenue) -- the system needs surpluses to meet capital requirements for construction, renovation and new technology, according to Robert A. Chrencik, senior vice president for finance.
Dick Johnson, president of The Golden Hour Coalition, a group ** concerned about Shock Trauma issues, said he believes care in the famed center has declined over the years, although he said he was unsure what impact the closing of the unit would have.
Ashworth said the closing, and the shorter hospital stays that led it, have "absolutely" not hurt patient care. "Our mortality rates are superb, and remain that way," he said. "Our patient satisfaction numbers are as good as they have been or better. The quality indicators are there."
Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems, a state agency that sets standards for trauma centers, also said a study by his staff also showed no changes in quality measures as length of stay in trauma centers has dropped.
Both Bass and Ashworth also said there was no indication the closing, at the end of last month, had limited access to Shock Trauma. Ashworth said there was one "fly-by" so far this month, in which a patient was taken by helicopter to another hospital because Shock Trauma was full. By comparison, he said, there was one in October, none in September and three in August.
Trauma centers have felt compelled to shorten stays, Bass said, because "third-party payers can drive prices down by not allowing more days of care." Afraid that insurers might move patients to lower-cost facilities after initial trauma care, he said, trauma centers "want to be efficient to the point that insurers don't feel compelled to transfer those patients out."
Shorter stays -- increasingly, with some care provided at other sites or at home -- is a trend seen at places other than Shock Trauma. Overall in Maryland, the average stay at a hospital dropped from 5.2 days for the year ending June 10, 1995, to 4.9 days a year later, according to the Maryland Hospital Association.
In response, hospitals have developed outpatient and primary care centers. The University of Maryland Medical System has branched out from University Hospital. Just this year, it opened the 128-bed William Donald Schaefer Rehabilitation Center at Kernan Hospital and bought the 370-bed Deaton Specialty Hospital and Home, a long-term care facility.
With those facilities available -- and less expensive -- Ashworth said Shock Trauma felt it could close a 20-bed "step-down" unit, which was providing care at a lower level than intensive-care beds in Shock Trauma. The unit cared both for patients who were stabilized enough to move out of intensive care and those who were sent to Shock Trauma but turned out not to be injured as seriously as first feared.
Shock Trauma retains 82 spots, including 24 beds equivalent to those closed, Ashworth said. Lee said all patient care staff, and some of the others, would be offered other posts in the system.
Pub Date: 11/21/96