Level II Trauma Center: From Zero to Designated in Two Years

Fremont, CA

On July 1, 2024, Washington Hospital and Healthcare System in Fremont, California, opened its doors as a provisional Level II trauma center. EMS agencies began bringing injured patients within the first hour of opening, and by the end of the week the trauma program had entered XXX patients into the trauma registry.

Consulting support was integral for building and opening a brand new trauma program in less than 24 months, especially in the early stages before trauma program leadership was in place. The hospital leveraged support from experienced consultants, engaging Bishop+Associates, a trauma consulting firm with 40 years in the field, and subcontracting Sarah Spilman with Diligent Consulting for project management and operational leadership. From the earliest planning stages through opening day, Sarah partnered with hospital leadership, physicians, and staff to build the clinical, operational, and regulatory framework for trauma services. While hospital staff were experienced in treating injured patients, significant coordination was required to elevate all departments to meet 24/7 trauma readiness response expectations

"The consultants were exceptional in helping us develop our Level II Trauma Center. Building a trauma program from scratch is a huge challenge, but their coordinated and hands-on approach helped us systematically plan, develop, educate, and implement trauma care in our hospital. Throughout the project, Sarah served not only as an advisor, but also as an integral part of our team. Any healthcare facility involved in trauma care would benefit from Sarah’s expertise and collaborative spirit."

Terri Hunter
Vice President and Chief Nursing Officer
Washington Hospital

Collaborative, Data-Driven Approach

The consultants were tasked with three key objectives:

Conduct a comprehensive evaluation of all clinical and administrative hospital functions to identify gaps related to Level II trauma center designation.
Coordinate and support hospital staff through all phases of trauma center readiness, including facility and equipment planning, trauma program development, physician coverage, policy creation and implementation, staff training, IT integration, trauma billing, registry development, and performance improvement processes.
Assist the hospital in preparing for obtaining for provisional designation, enabling the trauma center to begin receiving patients.

Key Project Considerations

The Hospital Joined a Mature Trauma System

Washington Hospital is the southern part of Alameda County, a county in the San Francisco Bay Area with 1.68 million residents. The other trauma centers in the region were ACS-verified and had provided optimal care to adults and children in the region for decades. Washington Hospital needed to build a trauma program that could match that quality on Day One so that regional trauma care was enhanced, not diminished.

All Trauma Policies and Processes Need to be Created

Unlike a trauma center that moves to Level II after operating as a lower-level center, Washington Hospital built the program from scratch. All processes of care, guidelines, and department integrations had to be designed and operationalized. All staff needed current trauma education and training. All departments needed to staff and prepare for 24/7 readiness. A brand new trauma registry had to be built. These are significant challenges, even for well-established trauma centers.

Trauma Care Changes Hospital Culture

It is often said that being a trauma center makes a hospital a better hospital. New trauma leadership brought decades of trauma experience from other hospitals and led Washington Hospital physicians and staff into a new era of operation. The
trauma culture of performance improvement, multidisciplinary coordination, and evidence-based practice not only enhance care of the injured patient but also seep into all other departments and service lines.

Impact on the Community

Washington Hospital served 2200+ patients in its first year of operation and was on track to exceed 2xxx patients in its second year. Before Washington Hospital opened its trauma doors, EMS had to travel long distances (in dense traffic) and even transport out-of-county to take patients to the closest trauma center. After Washington became a trauma center, interfacility transfers were reduced by X %. The trauma center contributed to injury prevention and provider education initiatives in the region. The hospital quickly became a trusted part of the already-strong trauma system.

In Fall 2025, Washington Hospital invited the American College of Surgeons (ACS) to the hospital for a consultative visit. They are now preparing for a full Level II verification visit in Winter 2027.

Through strong administrative commitment, motivated staff, and consultant support, Washington Hospital opened its provisional trauma center on schedule, with the systems, staffing, and processes needed to deliver coordinated, timely care. This expanded access to critical services for injured patients in southern Alameda County, fixed a geographic gap in trauma care, responded to population growth and demand in the region, and strengthened the broader trauma system.

"Quote.”

Chet Morrison

Trauma Medical Director

Washington Hospital