Ballad Health announces initiative to create regional, comprehensive trauma system, other systemic improvements

Highlights: Regional trauma and emergency system to better meet region’s needs; new pediatric trauma service; new pediatric ERs in Kingsport and Bristol; stronger high-acuity care in Kingsport

Ballad Health leaders today announced plans for systemwide improvements in care, including the creation of a comprehensive regional trauma and emergency care system including pediatric trauma, the addition of Niswonger Children’s Hospital pediatric emergency rooms in Kingsport and Bristol, and the strengthening of high-acuity care in Kingsport.

“These improvements are significant advances in care for our region,” said Alan Levine, executive chairman and CEO of Ballad Health. “They are important next steps in realizing the vision behind Ballad Health – to create a strong, single system that brings excellent care to the people of our region and that makes best use of our resources and the skills of our outstanding team of physicians and employees.”

These improvements, which will be implemented over the next 10 months, will expand access to new and existing services and increase the effectiveness of care through specialization and better coordination.

Comprehensive Regional Trauma and Emergency System

Ballad Health is creating a fully-integrated and highly-coordinated comprehensive regional trauma and emergency system to better meet the needs of Northeast Tennessee and Southwest Virginia.

The first of its kind in Tennessee and one of only a few in the nation, the system will better integrate emergency and trauma services and emergency medical services (EMS) agencies across Ballad Health’s diverse geography to ensure that patients get the right care in the right place as quickly as possible. The system will align with evidence-based best practices, which indicate that the highest-acuity services are best provided in a higher-volume setting where staff and physician coverage is consistent, and quality is improved.

“Our goal is to save lives and improve quality of life,” said Dr. Jerry Blackwell, executive vice president and chief clinical officer for Ballad Health. “The regional trauma and emergency system will better integrate our highly-skilled trauma experts in Kingsport, Bristol and Johnson City with EMS, helicopter transport and our other emergency departments across the region to ensure assessment and rapid transport of patients to the center most appropriate for the patient’s needs.”

The system will launch in mid-2019. Major elements include:

• Ballad Health’s three existing trauma centers in Kingsport, Bristol and Johnson City will be closely connected to all of the emergency rooms at Ballad Health acute-care hospitals. Supporting that system will be a new medical call center for system-wide coordination in real time, with seamless and timely transport.
• The most serious 10% of trauma cases will be treated at Johnson City Medical Center, where 60% of trauma cases and a majority of high-severity cases in the region currently take place.
• Bristol Regional Medical Center and Holston Valley Medical Center will continue to be trauma centers. While “major” trauma cases – representing approximately 10% of all trauma – will be transported to Johnson City Medical Center, the majority of the cases will continue to be served in the trauma center closest to the patient. The overwhelming majority of specialty consults for trauma are for orthopedics, neurosurgery and general surgery. Those specialties will remain available for trauma coverage at all three trauma centers.
• Ballad Health will also pursue verification for its level I trauma program by the American College of Surgeons within three years. Currently neither of its level I centers have this verification.
• Niswonger Children’s Hospital, in partnership with Johnson City Medical Center, will offer new pediatric trauma services, which will improve outcomes for children with injuries.
• The Tri-Cities will continue to benefit from Johnson City Medical Center serving as an essential access safety net institution and from the system’s existing regional designated and certified comprehensive stroke program.
• Ballad Health will anchor this new regional system with research and outreach to prevent trauma. The region has a higher-than-average incidence of geriatric falls – half of Ballad Health’s total trauma cases are for people over age 64, and 85 percent of those (more than 2,070 cases) are due to falls. The first research and outreach project of the new regional trauma system will be a geriatric falls initiative to identify the causes and begin taking steps to reduce the incidence of such injuries.

Long-time trauma leader at Holston Valley, Dr. George Testerman will serve as the new vice president of trauma and emergency services for Ballad Health. Dr. Testerman will oversee the development of the trauma system and the deployment of emergency services throughout the system. Dr. Bracken Burns will serve as assistant vice president of trauma services and will continue as medical director of the level I trauma center at JCMC.

“This innovative approach to trauma and emergency services will elevate the level of care we are able to provide to our entire region,” said Dr. Testerman. “This would absolutely not be possible without the strong clinical foundation developed here over the last 30 years.”

New Pediatric Services

Niswonger Children’s Hospital is one of only five state-designated perinatal centers in Tennessee. In addition to investing in the region’s first pediatric trauma service at Niswonger, Ballad Health will also establish new Niswonger Children’s Hospital pediatric emergency rooms in Kingsport and Bristol, making pediatric emergency practitioners available in child-friendly settings for the more than 20,000 annual pediatric ER visits in those two communities.

Additional pediatric enhancements for the region include:

• Investing in new pediatric subspecialties to serve the region, including: pediatric surgery, pediatric gastroenterology, pediatric pulmonology, pediatric neurology, pediatric ENT, pediatric urology, pediatric critical care, pediatric neurosurgery, pediatric ophthalmology and child abuse.
• Realignment of level III neonatal intensive care (NICU) services at Niswonger, where high-risk newborns can benefit from the expertise provided at the region’s state-designated perinatal center.
• Connecting all of Ballad Health’s hospitals to Niswonger through telemedicine, allowing access to pediatric sub-specialists at rural hospitals, by mid-2019.

Realignment of High-Acuity Services in Kingsport

“Much like Johnson City, Kingsport has two hospitals only a few miles apart,” said Eric Deaton, senior vice president of market operations for Ballad Health. “Our Kingsport hospitals now have the opportunity to work in collaboration with each other to customize services to best fit the needs of area residents.”

Studies have shown that focusing higher-acuity services in one location – allowing doctors and nurses to perform more of the same procedures – improves outcomes and reduces costs.

With that in mind, all Kingsport-based interventional cardiology, orthopedic surgery and neurosurgery in Kingsport will take place at Holston Valley Medical Center. Medical cardiology services will remain at Indian Path Community Hospital. There will be no workforce reduction as a result of these changes.

“This move will strengthen the team by uniting all Ballad Health’s Kingsport market physicians, nurses and techs who are specialized in orthopedic surgery, neurosurgery and interventional cardiology,” said Deaton. “It will improve our ability to recruit, retain and train top doctors.”

“We are grateful to our local leadership, our physicians and other experts who worked collaboratively for months to plan all of these evidence-based improvements,” Levine said. “We thank them for their insight, experience and forward thinking.”

Read more about the trauma center initiative, including frequently asked questions.