Trauma Center Downgrade

Sometimes hospitals are faced with the decision to downgrade or close the trauma center. This decision has implications for the hospital's finances, community access to trauma care, and staff morale. The decision should not be made lightly.

Diligent Consulting offers consulting services to help hospital leaders decide if they should downgrade the level of (or close) a current trauma center. Most typically, this involves moving from Level II to Level III or giving up trauma center designation.

We understand trauma center operations from the inside. Our team has walked side-by-side with hospital leaders who have had to make this hard decision. We can serve as a strategic advisor as we evaluate the pros and cons, then walk side-by-side as you implement change. We strive to maintain the stability of the trauma system and keeping the community informed of the changes.

What Is Included in Trauma Center Downgrade Consulting Services?

Consulting services for trauma center downgrades cover a broad range of activities aimed at evaluating the current trauma center and determining the best path forward from a financial, strategic, and community perspective. These services typically include:

Market Analysis

If a trauma center is considering a downgrade due to declining trauma volumes, it is important to first understand the market. Using regional trauma and EMS data, consultants will assess the hospital's market share to determine if there is untapped volume in the region (transports in the hospital's service area that are going to other hospitals) or any reversible trends that are impacting trauma volumes.

Reverse Gap Analysis

The consultants will evaluate the American College of Surgeon (ACS) or state standards that would be removed if the hospital downgraded or removed its trauma designation standard. In other words, we will identify the standards that go away, the standards that would remain, and the impact on revenue and staffing. Specifically, we will evaluate if removing the trauma requirement impacts other service lines and estimate the cost savings that would be realized if the hospital no longer had to meet certain requirements. The goal is to ensure full understanding so there are no surprises.

Recommended Timeline and Sequence

Consultants will recommend a plan and schedule for changes in the trauma program to mitigate impact on other departments, staffing, and team morale. Relinquishing a trauma center designation can change the reputation and pride many staff have for the hospital, so the change should not occur suddenly or without warning.

Designation and Verification Support

If the hospital is downgrading levels, there are still standards that must be met. Using the reverse gap analysis results, the consultants will identify the standards that remain with the lower level and help the trauma program prepare for its next verification or designation visit. See more about Trauma Center Verification Support.

What Are Some of the Greatest Challenges in Trauma Program Downgrading?

Some of the most common challenges include:

Resistance to Change

Staff may not be on board with changing the level of trauma care. Some may worry about losing their jobs or not having the resources to care for injured patients. Downgrading the level of the trauma center can change the entire culture of the hospital.

Reputation in Community

Downgrading or closing the trauma program means your hospital will no longer be able to provide the same level of care for injured patients. This will increase transfers, increase transport times, and take patients and their families father from home. This could adversely affect the reputation of your hospital in the community.

Tough Staffing Choices

Presumably, a hospital downgrades a program in response to financial pressures and/or an inability to fully staff the trauma program. When the trauma level is reduced and there are fewer response requirements, some positions will also be eliminated. For example, downgrading from Level II to Level III dramatically reduces the number of medical and surgical specialists required to take call. It also reduces pressures on the OR and other departments. With reduced volumes and lower revenue, hospitals may be forced to make difficult staffing decisions or even eliminate service lines.

Navigating Designation

The process of reducing designation level is not always straightforward. It requires close communication with the local governing body, EMS, referring facilities, and potentially the American College of Surgeons. It is important to be clear in the anticipated clinical capabilities and the timeline for changes.

How Can Diligent Consulting Help?

Downgrading or closing a trauma center requires a careful plan, as well as attention to the cultural and emotional implications of downgrading services. Diligent Consulting can help navigate these difficult changes.