Cheryl Martin (Host): This is One-On-One with Regional One Health; your inside look at how we're building healthier tomorrows for our patients and our community. Stay tuned as we get to know some of the individuals who help provide life saving, life-changing care for our community. I'm Cheryl Martin. Today, Dr. Andy Kerwin and Josh Dugal from Regional One Health's Elvis Presley Trauma Center join us to talk about the Trauma center's recent verification by the American College of Surgeons. This is one of the highest honors a trauma center can receive. Dr. Kerwin serves as the Chief of Trauma and Trauma Medical Director. Josh Dugal is the Vice President of Trauma and Burn Services.

Thank you both for coming on.

Andrew Kerwin, MD: Thank you, Cheryl, for having us. We're excited to be here and, and talk about the Elvis Presley Trauma Center.

Host: Thank you. So Dr. Kerwin, first bring us up to date on all things Elvis Presley Trauma Center. What does it mean to be your region's level one trauma center? And how does your team go about caring for those critically injured patients?

Andrew Kerwin, MD: Sure. So first start with up to date, what's happening in the Elvis Presley Trauma Center. The key thing has been the verification by the American College of Surgeons is that a level one trauma center, which has been an important step for us in our 40 plus year history of taking care of trauma patients. We had previously been designated by three states, Tennessee, Mississippi, and Arkansas.

And that's related to our unique geography. And, that kept us really busy because every three years those states would revisit us, and redo our designation. And now by achieving the American College of Surgeons verification, we can do one site visit and all three states have agreed to accept that as part of their designation process.

And so every three years we'll participate in an American College of Surgeons verification visit. Which is then accepted by the three states that we cover. And so what does it mean to us to be the level one trauma center for the region? It's really a very important role that we play in the region.

We cover about 150 square mile radius from Memphis, which is nearly 4.7 million patients that we could provide trauma care for, on a moment's notice. And I think that's the key thing about a level one trauma center that separates us from your community hospital that is not a trauma center.

We have a group of physicians, nurses, therapists, Chaplains, anesthesiologists, orthopedic surgeons, neurosurgeons, emergency medicine physicians that are all dedicated to providing trauma care on a moment's notice, 24 hours a day, seven days a week. And, we really make that part of our practice and we're committed to that and dedicated to doing that and doing it better each time.

We're there no matter what time of day it is. And no matter what happens to you. We're there ready and waiting to take care of a patient that's critically injured and get them better. And I, think it starts right in the beginning of how we get patients better and then how we, get them through their hospital stay, get them through rehab and get them back to their families so that they can be back in the community, back working, and, living with their families again.

Host: That's great, Dr. Kerwin. Josh, let me ask you, why did you decide to pursue the American College of Surgeons verification, and what does that process involve?

Josh Dugal: Yeah. Thank you, Cheryl, for that great question about why we decided to go down the route of becoming an American College of Surgeons Verified Trauma Center. And I'll also give you a little bit insight of the process and timeline in order to get us there. So, as Dr. Kerwin mentioned, we've been a state designated trauma center for many years, over 40 years in the state of Tennessee. And while it's fantastic to be state designated, it's not the gold standard. The gold standard is truly being an American College of Surgeons or otherwise we know it as the ACS. You may hear us talk about it in that way. That's seen as the gold standard measuring stick of all trauma centers across the United States because it's a universal standard.

So you know that if you are an ACS verified level one center and, another center in a major city is at that same level, you can rest assure that both of those centers can provide the exact same level of care and readiness to their community. And that means a lot to us in the business of being a trauma center. Whenever I think about the timeline, in order to become verified, and this is not something that you decide to do and six months later you are done. We've been doing trauma care here for over four decades, and honestly, it takes a good amount of time of doing the clinical side of the business as well as starting really into the process improvement side of trauma care in order to be ready to even consider going down the route of becoming verified.

I would say Regional One has been really invested since at least 2022. Whenever we brought in an outside team to do what we call a consultative visit, looking at all of our processes, looking to see how we would measure up if we decided to be, visited that day and attempt to become verified.

We took a look at that and made an action plan, and it took the better part of two and a half years in order to knock out every one of those action point issues so that we could be ready to be verified. What it takes then is submitting an application about a year and a half before you would ever have that site visit, where people are going to come on site to take a look at your processes and your clinical care.

With that, we submitted over a thousand documents to the ACS verification committee as well as, around 65 patient charts where they could really dive into seeing whether or not our clinical care was as good as every other verified center in the country. Once that team takes a look at those things, they'll actually come on site.

Ours was actually a virtual site visit, but it encompassed all the things they would be if they were here physically. They're going to review all of those documents. They're going to meet with all of the key players within the trauma program, all the way from our executive administration to all the different liaisons from the different programs, as well as the bedside staff, who cares for our patients, whether that be nursing, radiology, laboratory, any of those support services.

And they measure us against a book of standards, which is the optimal standards for trauma care. And we were able to be successful with zero deficiencies during this review, which is pretty much unheard of to go through your very first review process and come out of it with zero deficiencies. We do have a couple of opportunities that I think we'll talk about in the future later on in this podcast, but those are normal and expected and we actually look forward to having those opportunities.

But it's a very prolonged process, one that takes a lot of attention to detail, and we're very proud to have completed that this August.

Host: I can understand why. Just a rigorous and intensive program as you explained it. So, Dr. Kerwin, you touched on this a little bit, but why is the ACS verification so important to the trauma center, and what does it say to the patients and families you care for?

Andrew Kerwin, MD: I think when we ask why the ACS verification is so important and what it means to the patients and families in our community, I think a couple things come to mind. It shows that we've put forth the effort to meet the rigorous criteria that the American College of Surgeons has set forth for many, many years, and these criteria are presented in what's called the optimal resources document that's available online.

It's 170 pages or so that list every thing that you need to have to be a verified level one trauma center. It starts with the administration support of the program all the way down to all the equipment that's necessary and the physicians and nursing that's part of that.

And so, that's important to, I think the community because it shows the hospital's commitment to the program and that they're willing to put forward the necessary resources, in terms of personnel. It shows that they're going to commit to quality. And I, think that's really an important piece for the patients and families and the community to remember. The quality of the American College of Surgeons expects for the program is really high, and they really stress our performance improvement program and they really look at how we examine all of our cases, so that if we get an outcome we don't like, that's not what we expected; what did we do to make sure that the next time we saw a similar situation, we didn't have that same outcome?

And so I think people in our community can really rest assured that Regional One Health and the Trauma Program are fully committed to quality care and trying to achieve the highest quality that we can for our patients. So we can get them through their hospitalization and get them back to their families and back to work.

I think that's one of the biggest things that I feel patients and families in the community should know, is that we've made a strong commitment to quality and we're going to keep going forward with that. And we're going to keep working on that every day so we get better and better every day.

Josh Dugal: And I'd like to add just a little bit more to that, thinking about what does this mean to the community? Knowing that you have an ACS verified level one trauma center in your community is huge. Because whenever you think about healthcare, this is the one time where you don't get to do research and pick a provider or pick a practice that you go to.

You don't get to talk to a friend and talk about which physician would be great for you to get your healthcare from. You're forced into using the trauma resources that are there and knowing that your trauma center has spent the time and effort to become verified at the highest level, knowing that there's no better care that you're going to find for trauma care in the country, and knowing that that's available to you; I think is huge, not only to our patients, but I think local businesses, the community at large. It's just a fantastic thing to have in your area.

Andrew Kerwin, MD: Nobody gets up in the morning and says they're going to fall off the ladder while they're cleaning their gutters or hanging their holiday lights, right? But it happens. Nobody expects to get in a car crash or fall slip and fall on ice or whatever that may happen.

But, if they do, they want to know that the resources to take care of them and get them back to their family are present in our community. I liken it to the fire department. Nobody thinks about the fire department, and where the fire stations are, but they want to know that if their house catches fire, they're coming.

And so I think we're like the fire department in that regards. You don't have to think about us. But if you do get hurt, you can know that you're coming to the best place around to get care and get back to your family.

Host: Great point. Josh, so what are your key takeaways from the verification process in terms of continuing to provide excellent critical care and even improve upon what you already do?

Josh Dugal: So thinking back about the verification and you know, my takeaways from the process and all of the documentation that came from the visit is that Regional One Health's Elvis Presley Trauma Center, over 40 years ago, was set up for success physically. So we have a dedicated trauma emergency room.

We have four trauma operating rooms that are staffed 24-7. We have a trauma ICU that's right next door to those things. And one of the key things that we heard from our reviewers who were other long-term trauma surgeons in the United States but had never been here, was that we had such a fantastic physical layout. It was just too small. Whenever this place was designed in the 1980s, it was set up to take care of around 400 patients a month, and now we see regularly a thousand to 1200 patients a month that come through. So they applauded us on the design. They also just commented that we were way too small for what we were working with, but also what they found is that while we're in an aging physical plant, the quality of our clinical care was exceptional. And really they found no issues in the clinical care that we provide here, which I think is something that we can all rest assured. I know, not only as a leader of the trauma program, but a citizen that goes to sleep every night here, I can rest assured that that's there.

And I know Dr. Kerwin as the Trauma Medical Director was quite proud that the clinical patient care side of our verification was exceptional. Some of the takeaways that we brought from this is, as we mentioned earlier, Dr. Kerwin talked a little bit about performance improvement and how we look at every patient that comes through to make sure that we provide an exceptional trauma care to them, and if we found anything that deviated from that, we had an action plan in order to make that better.

One of the key things that we came is that we need to speed up that process a little bit more. That, time is memory. And so our team is working diligently to make sure that they're having our patient reviews done as quickly as possible so that we can involve not only our trauma surgeons, but all the different specialty services, such as neurosurgery, orthopedics, radiology, vascular services, any of those teams to make sure that they're able to provide great insight and how we can provide better care. But one of the biggest things is knowing that we went through our survey and had no critical deficiencies, but we did have a couple of opportunities that we're going to work on over the next three years so that whenever we are visited again, in 2028, we have all of those taken care of and we've shown that we've improved our trauma program even more than what we thought was possible in August of this year.

Host: So let's take a minute to celebrate this big achievement. Dr. Kerwin, who are some of the key players in achieving verification, and what does it say about Regional One Health as a whole as it moves into the future?

Andrew Kerwin, MD: Thanks, Cheryl. I, think you hit it, right on the head when you talk about celebrating, because we want to talk about who we're going to celebrate. It's not just Josh and I. There are so many people involved from the beginning. As I said, first off, you have to have a commitment from the hospital. And so that starts with Dr. Cooper, as the CEO. He has to commit to the process. And then it involves Dr. Linda Hewlett, our CNO, Dr. Martin Cro, the CMO, Manoucheka Thermitus, our COO. So they have to give us the resources. Josh and I can go and say, we need to do this. And they have to commit to those resources.

So I think we have to start with them. And, that's why that's the first chapter in the optimal resources document is commitment from the hospital administration. So we had that. So we have to celebrate that as part of this process. And then you really look the trauma center is not just a building. It's the building, yes. But it's everything that's inside of that. And so it starts with trauma surgeons like myself, orthopedic surgeons, neurosurgeons, ENT surgeons, oral surgeons, radiologists, anesthesiologists, emergency medicine physicians, our pathologists that run our blood bank, our nurses, our nurses aides, the respiratory therapists, physical therapists, occupational therapists, I could go on. It's our transportation teams, our EVS staff that cleans our rooms and gets them ready for the next patient. All of that goes into becoming a verified level one trauma center and all those people need to be celebrated as part of this process. Again, it's not just Josh and I. A lot of the work, in terms of submitting the application and all the documents; I'd be remiss if I didn't mention Erica Nicer, who's our trauma program manager. Erica, stepped into this role as the trauma program manager a couple years ago. And really did an outstanding job with helping to prepare all the documents and the policies and procedures for there. And so I definitely have to mention Erica as part of this process.

And what does this mean as we move forward and, as Regional One? I think it's a stepping stone into, how we're going to build the new hospital. Again, it's that focus on quality. I think it allows people to take pride in their work. And so as we move forward and are building our new academic medical center, we carry this forward as again, a quality initiative.

We carry it forward in terms of performance improvements. Commitments from the hospital, commitment from all of the providers, the nurses, therapists, all of those team members that help make this building a trauma center. So that's really important as, we go forward over the next five years of building the new academic medical center.

Host: You have so much to be proud of. Dr. Andy Kerwin and Josh Dugal thanks for speaking to the exceptional clinical care available at the trauma center and it receiving the high honor of verification, the gold standard from the American College of Surgeons. Thank you so much. Congratulations.

Andrew Kerwin, MD: Thanks Cheryl. It's a great honor and I'm proud to be a leader here, so thank you.

Josh Dugal: I'll say the same thing, Cheryl. It's been fantastic to talk with you today and look back at where we've come from to become a verified trauma center here at Regional One and also towards the future of trauma care in the region.

Host: Well, you can learn more about the Elvis Presley Trauma center@regionalonehealth.org/eptc. If you found this podcast helpful, please share it on your social channels and explore the full podcast library for other topics of interest to you. Thanks for making One-On-One with Regional One Health part of your journey to better health. Join us next time as we introduce you to another member of the Regional One Health Family.