Saint Alphonsus’ big Boise hospital loses trauma-center certification. What we know
Saint Alphonsus Regional Medical Center in Boise is no longer certified as a trauma center by its national accrediting organization.
It was not immediately clear Thursday what the practical impact the loss of accreditation, or verification, by the American College of Surgeons might have. The health system said it hasn’t changed anything involving patient care.
1. What are trauma centers?
Trauma centers are specially equipped to handle the most traumatic injuries, such as gunshot wounds or severe vehicle accidents that are life- or limb-threatening. Regular emergency rooms typically treat less-life-threatening injuries like broken bones, burns or lacerations requiring stitches.
Because verified trauma centers are more expensive to maintain, they’re not paid the same as regular emergency-room visits are. Dr. David Pate, former CEO of St. Luke’s Health System, said health insurers are charged extra.
Saint Alphonsus operates a Level 2 trauma center, which it says is the most advanced in Idaho, at its flagship hospital, the Saint Alphonsus Regional Medical Center at 1055 N. Curtis Road.
Five trauma-center levels are recognized by the Idaho Department of Health and Welfare. The higher levels, 1 and 2, treat more-complex patient traumas. The lower the level, the fewer the resources, and the greater the likelihood that some patients may need to be transferred to a higher-level center after receiving initial treatment.
There are no Level 1 trauma centers in Idaho. Those involve a partnership with a medical school.
The nearest American College of Surgeons-verified Level 1 trauma center to Boise, the University of Utah Health Care, is nearly 350 miles away in Salt Lake City. There are two others in and around Salt Lake City, and two pediatric trauma centers in Portland, about 430 miles away.
There are no Level 1 trauma centers verified by the surgeons college in Washington state, though the Washington Department of Health designates one in Seattle: Harborview Medical Center.
2. Why did Saint Alphonsus lose certification?
The surgeons college would not say why it withdrew its stamp of approval. A spokesperson for the college confirmed the hospital’s status Thursday with the Idaho Statesman by email, adding that the college could not comment or provide further details.
For two days, Saint Alphonsus told the Statesman that it was too soon to say.
Letty Ramirez, a spokesperson for the Saint Alphonsus Health System, did not answer the Statesman’s questions about the hospital’s verification status when reached by phone. She told a Statesman reporter Wednesday that the health system had received “some notification” from the surgeons college and would be meeting with the organization this week.
“We are the regional trauma center for the region,” Ramirez said. “Nothing has changed in terms of the quality of patient care or the destination protocols for coming to Saint Alphonsus Regional Medical Center.”
But Thursday night, the health system put out a news release saying that the college’s latest verification review made “four findings that were documentation/administrative in nature.”
3. What were those findings?
In the release, Ramirez wrote, “Immediate actions were implemented to resolve the documentation/administrative findings and a survey for re-verification is in the process of being scheduled for spring of 2024.”
But she did not say what the four findings were.
On Friday, in response to a question about the findings, Ramirez said the statement stands on its own and “we have nothing further to add.”
A spokesperson for Health and Welfare earlier declined to answer questions about the hospital’s verification status and referred inquiries to the health system.
4. Why does certification matter?
The surgeons college, founded in 1913, certifies trauma centers nationwide and is the largest professional association of surgeons in the world. Its verification process is considered the gold standard for assuring top-notch trauma care. The nonprofit organization says on its website that it “has perhaps the highest standards in surgical care in the healthcare industry.”
Dr. Britani Rhea Hill, the president-elect of the Idaho chapter of the surgeons college, told the Statesman by phone that verification is determined by a nationally based verification, review and consultation committee within the trauma program at the surgeons college. Verification reports are not made public, she said.
Pate, the former CEO of St. Luke’s, the largest medical system in the state, said he hoped the news wasn’t true.
“It wouldn’t be good for any of us if they lost that,” Pate told the Statesman by phone. “Having a certified trauma center is really important for the community because, first of all, the data is very clear that if you suffer from trauma, you have better outcomes at a trauma center. That’s why St. Luke’s got certified as a pediatric trauma center.”
Pate recalled an accident in August near Horseshoe Bend, when a school bus full of children returning from a YMCA summer camp rolled over on the Idaho 55 Highway, critically injuring seven passengers and wounding four others. Saint Alphonsus Regional Medical Center in Boise received seven of the underage patients, the Statesman reported.
“Most emergency rooms would not be equipped to deal with that,” Pate said. “There’s all kinds of requirements to be a trauma center, and frankly, those requirements are what make us better prepared for mass-casualty events, which would overwhelm regular ERs, and fewer people would survive.”
He said the criteria include additional staff training, certain nurse-to-patients ratios, and having surgeons of various specialties on call 24-7.
5. Should I still go to Saint Alphonsus for trauma?
Saint Alphonsus said in the release that its clinical services and patient care are not affected, and that its standard of care has not changed.
“Our patients and community can continue to feel confident in having access to the highest quality trauma care available locally,” the release said.
The health system said the hospital retains its verification from the Idaho Time Sensitive Emergency Council, which the Legislature created in 2014 to improve coordination and treatment of care of patients with blunt-trauma injuries, strokes and heart attacks.
The Idaho council conducts its own verification reviews to make sure hospitals are meeting its standards, though state law allows it to skip on-site reviews when a hospital has been verified by a nationally recognized accrediting body like the American College of Surgeons.
“The TSE program creates a seamless transition between each level of care and integrates existing community resources to improve patient outcomes and reduce costs,” Idaho Health and Welfare says on the council’s website.
6. Are ambulances affected?
Ryan Larrondo, a spokesperson for Ada County Paramedics, said the paramedics have standing written orders from the Idaho Time Sensitive Emergency Council that determine where an ambulance takes a patient with trauma.
The orders are outlined in a document on the paramedics’ website, most recently revised on Aug. 14.
Adult trauma patients, classified as age 15 years or older, are by first priority to be taken to Saint Alphonsus Regional Medical Center in Boise. Pediatric trauma patients, age 14 or younger, are to be first transported to St. Luke’s Children’s Hospital in Boise, according to the document’s hospital destination protocol for Ada County.
“Adult and pediatric patients who suffer minor injuries or who do not fall under the trauma priority guidelines do not mandate transfer to a trauma center,” the protocol says. “However, the clinical judgment of the paramedic is essential to ensure proper triage of patients to an appropriate receiving center.”
Another section defines how patients should be prioritized in time-sensitive emergencies, with a detailed list of various injuries and scenarios.
Larrondo said that if an area trauma center were to lose its certification by a national accrediting organization, paramedics would still follow orders outlined by the state council and its medical directors, who could revise the orders if needed.
7. Are any other hospitals certified for trauma care?
A search of verified trauma centers on the surgeons college’s site shows that St. Luke’s Children’s Hospital at 190 E. Bannock St. in Boise is now the only verified trauma center serving southwestern Idaho.
St. Luke’s Health System began the verification process for St. Luke’s Children’s in 2019 but wasn’t able to complete it until June 2022 because of the COVID-19 pandemic, Pate said.
There are now four hospitals in Idaho that are verified as trauma centers by the surgeons college. They are:
St. Luke’s Children’s Hospital in Boise, a Level 2 pediatric trauma center.
Eastern Idaho Regional Medical Center in Idaho Falls, a Level 2 trauma center.
Portneuf Medical Center in Pocatello, a Level 2 trauma center.
Kootenai Health in Coeur d’Alene, a Level 3 trauma center.
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