On-Site, 24/7: Program brings ER trauma surgery under one umbrella

Dr. Kam Outside OREmergency and acute surgical coverage at Munson Medical Center has grown significantly as the hospital fills its role as a regional trauma center. In response, a new general surgery service is taking a unified and streamlined approach to patient care.

Munson Medical Center launched the Trauma and Acute Care Surgery (TACS) program in February 2015. A 22-member team of 12 trauma surgeons and 10 advanced practice professionals (i.e. physician assistants and nurse practitioners) provide on-site 24/7 coverage for emergency and acute surgical issues and injuries.

Prior to TACS, private practice general surgeons were “on-call” for patients coming through the emergency room or needing inpatient consults, but were not always physically in the hospital around the clock. “On-call” requires physicians to be available on-site within 30-minutes for emergencies, and has been common practice among community hospitals and emergency rooms throughout the country.

TACS shifts the model, bringing ER patients and trauma surgery under one umbrella, offering streamlined processes, consistency and access. Most of the trauma surgeons also maintain private practices but the business relationships are separate entities. Physicians serving on one of their 12-hour TACS shifts are on-site at MMC and focused specifically on the acute surgery service.

The approach is being adopted by many medical centers throughout the country and advocated by the American College of Surgeons. Best practices show that protocols and standards for treating trauma and acute surgical needs may be better applied through a single group – such as TACS – than with individual providers rotating and sharing emergency coverage.

“By putting all ER patients and ER trauma under one umbrella, the process is more seamless…we can provide better, more enhanced care for our patients,” said David Kam, MD, FACS. Dr. Kam is the Trauma Medical Director at Munson Medical Center as well as a general surgeon in private practice at Grand Traverse Surgery in Traverse City.

Patients and economics benefit from the streamlined approach. On-site surgeons allow faster access and treatment, while the business end of health care benefits from efficiencies of scale. A significant advantage of a single group approach to trauma and acute surgery is improved ability for data gathering and continuous improvement which, in turn, benefits patient outcomes. Examples include lower infection rates, shorter hospital stays and fewer complications.

According to Dr. Kam, the new approach aligns with quality standards and processes expected at major trauma centers.

“We are the only Level 2 Trauma Center in our (very large) region,” Dr. Kam said, noting the importance to northern Michigan for access to high level care and Level 2 verification. “We need to attain and maintain quality levels expected by the American College of Surgeons.”

“We get there from process and improvements,” he added, noting TACS participates in and follows guidelines set forth by the American College of Surgeons’ Trauma Quality Improvement Program (TQIP), a nationwide effort to elevate the quality of care for trauma patients through data collection, risk-based benchmarking, education, training, networking and information sharing of best practices.”

Munson Medical Center was reverified as a Level 2 Trauma Center by the American College of Surgeons in 2015, a designation first achieved in 2006. It is the only Level 2 center in Northern Lower Michigan and one of only 25 in the state. There are ten Level 1 Trauma Centers located in southern Michigan, primarily affiliated with major teaching hospitals such as the University of Michigan Health System in Ann Arbor, Henry Ford Hospital in Detroit and Spectrum Health in Grand Rapids.

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