National Study: Ballad Health, ETSU Trauma Consolidation Saves Hundreds of Lives

Study shows “significantly decreased” death rates and decreased transfers to other facilities from the most serious traumatic injuries since consolidation of Level 1 trauma centers in the Appalachian Highlands

A peer-reviewed study released on Friday, March 29, by the national publication The American Surgeon reported that after consolidation of two Level 1 trauma centers in the Appalachian Highlands, the rate of deaths among patients who were the highest level of trauma activation (requiring surgery in the first 24 hours and admission to the surgical intensive care unit) decreased by almost 24%.

The study concluded the decrease in the rate of deaths was “significant,” and it also concluded that, irrespective of the level of injury, “patients in the post consolidation group, regardless of level of trauma activation, required decreased incidence of discharge to other care facilities,” such as rehabilitation or skilled nursing. For the highest acuity patients, or those requiring an ICU admission and surgical intervention, the percentage of patients requiring discharge to a post-acute care facility declined from 47% to 36%, a total decrease of 23.4%. The study found the decrease in patients requiring discharge to post-acute facilities was statistically significant.

In terms of lives, the reduction in the rate of deaths equates to hundreds of lives saved due to the successful consolidation of the region’s two Level 1 trauma centers.

The peer-reviewed study reviewed the care provided to nearly 6,700 patients at the Level 1 Trauma Center at Johnson City Medical Center from January 2017 (pre-consolidation) through Jan. 31, 2022 (post-consolidation), reviewing outcomes by level and severity of trauma. It found the patients with the highest likelihood of death due to severity had significantly improved survival rates post-consolidation.

The authors of the study stated that, “to our knowledge, a study assessing the impact of trauma center consolidation on adult trauma patients had yet to be performed.” Referring to previous studies that state higher-volume trauma centers are likely to lead to better outcomes, the most recent results appear to validate that, for higher-acuity patients most at-risk for death or complications, higher-volume facilities with depth in specialty coverage and experience have a better likelihood of survival and a positive outcome.

In 2018, Ballad Health, in partnership with the ETSU Quillen College of Medicine, assembled an advisory group of physicians and community leaders to review the trauma system and make recommendations on how to improve care for the residents of the Appalachian Highlands. Assisted by national experts, the advisory group recommended consolidation of the region’s two Level 1 trauma centers into one at Johnson City Medical Center, while maintaining Level 3 trauma services at Holston Valley Medical Center and Bristol Regional Medical Center. Additionally, the advisory group recommended the creation of a regional system of trauma care, girded by a regional communications system that would coordinate the placement of patients to the appropriate level of trauma care based on the assessed injury of the patient.

Ballad Health and ETSU Quillen College of Medicine accepted the recommendation of the advisory group and partnered to implement the recommendation, which was initiated in October 2019. Led by ETSU Quillen College of Medicine professor and practicing surgeon Dr. Bracken Burns, who serves as the director of the trauma program, the physicians, clinical staff and leadership teams of Ballad Health and East Tennessee State University collaborated to create the regional trauma system in October 2019.

After conducting an in-depth review of the Level 1 Trauma Center at Johnson City Medical Center in July 2021, the State of Tennessee concluded that, “Johnson City Medical Center has demonstrated an outstanding commitment to care for the injured patient. The hospital administration has shown significant support of this endeavor and the institution and trauma program have made investments and changes resulting in significant growth.”

In the state report, experts cited Ballad Health’s:

• Response times to trauma activations, noted in the study as “excellent”
• 24/7 coverage of required surgical specialties
• Appropriate nurse ratios in the Intensive Care Unit (ICU) with immediate access to support services
• Consolidation of air-medical transport services and centralization of trauma traffic
• Significant growth in community outreach and injury prevention
• Significant increase in research publications

Following the state report, national organizations began recognizing the improved trauma care, with Johnson City Medical Center being named by Quantros, Inc. as the No. 1 hospital in the state for patient safety in trauma care in its 2024 CareChex® awards.

“The release of this peer-reviewed study lends additional credibility to the previous surveys by the state and national organizations, which have concluded that more lives are being saved in our region due to the hard work of our clinical teams throughout Ballad Health and ETSU’s Quillen College of Medicine,” said Kenny Shafer, CEO of Johnson City Medical Center.

“Excellent trauma care is a team effort from every corner of our region,” said Ballad Health Chairman and CEO Alan Levine. “From the exceptional work of emergency medical services in our 29 counties to the air-transport teams, to the high-volume teams at our Level 3 trauma centers – and to the clinical team at Johnson City Medical Center – the Ballad Health Trauma Network is a national example for how a trauma system should operate. It is no surprise to us that we have seen such a significant improvement in the survival rate of patients suffering from traumatic injuries in our region. This was the basis of the decision we made to consolidate trauma services in 2019, and it was the right decision.”

Dr. Bill Block, Dean of the ETSU Quillen College of Medicine, added, “I am immensely proud of the work of the ETSU Health trauma team and thankful for Ballad Health’s support. These results would not have happened without all of us working together.”

“The only thing surprising about the results of the study is the significance of the improvement in survival rates for the patients most likely to die from their injuries,” said Dr. Burns. “We expected improvement in mortality rates, and we expected to see fewer patients transferred out. But the significance of the improvement is stunning and is a result I think experts will point to as support for the regionalization of trauma care.”

Dr. Burns added, “I am very proud of our team, all of whom care deeply about the survival of our patients. The bottom line is that consolidation of trauma services into a single Level 1 Trauma Center in a rural health system led to higher trauma volume and higher acuity of patients, but most importantly, it led to decreased mortality for the most severely injured trauma patients. This is something our region should be proud of; we certainly are.”

Dr. Clay Runnels, a practicing emergency room physician and chief physician executive at Ballad Health, said, “The partnership between Ballad Health and ETSU is so important to our region. The opportunities to deliver high-quality healthcare while learning and sharing with our academic and professional colleagues is special. The beneficiaries of this are the patients I see in our emergency department, and I’m proud of our entire team and our partnership.”

President of ETSU and Lead Independent Director of the Board of Ballad Health, Dr. Brian Noland, echoed the opinions of the importance of research and outcomes produced by the partnership between Ballad Health and ETSU.

“Our mutual goals are to improve the lives of the people throughout the Appalachian Highlands. We are committed to making these important decisions based on evidence and what will lead to positive outcomes for our region,” Noland said. “As this study decisively demonstrates, our communities are benefitting from the regionalization of trauma care and more people are alive today because of it.”

The statistically significant reduction in the necessity for patients requiring the utilization of post-acute care facilities has saved taxpayers, employers and insurers, millions of dollars thus reducing the cost of healthcare while leading to better outcomes in the Appalachian Highlands.