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Harbor-UCLA's good medicine

Trauma care at the hospital has improved since King/Drew's unit closed. Observers say big caseload may help.

October 23, 2008|Rong-Gong Lin II | Lin is a Times staff writer.

Since county officials shuttered Martin Luther King Jr./Drew Medical Center's trauma unit three years ago, rising numbers of severely injured patients have been transported to Harbor-UCLA Medical Center, a 10-mile drive away.

The closure of the busy trauma center in Willowbrook, just south of Watts, raised concern that it would take longer to move patients and put them at greater risk of death.

Instead, at least at Harbor-UCLA, one of three hospitals to take in trauma patients that would have been sent to King/Drew, the influx of more trauma victims actually led to better outcomes, according to a study published this month in the journal American Surgeon.

Researchers at the Los Angeles Biomedical Research Institute at Harbor-UCLA compared outcomes of trauma patients at Harbor-UCLA between Jan. 1, 1997, and Feb. 28, 2005, when King/Drew's trauma unit closed, to patient outcomes between March 1, 2005, and March 1, 2006.

They found that Harbor-UCLA saw a 55% increase in trauma patients during that year. Of admitted trauma patients, the percentage that had potentially life-threatening injuries went up from 17% to 24%, with a similar rise in those with gunshot, stabbing or other penetrating wounds.

At the same time, in somewhat of a surprise, the median paramedic transport times increased by only a minute, from 12 minutes to 13.

Additionally, researchers found that the probability of death of Harbor-UCLA trauma patients decreased by 31% after King/Drew's trauma center closed, once researchers adjusted for the increase in severely injured trauma patients. The study's authors hypothesized that Harbor-UCLA has benefited from a busier trauma caseload.

"Increased complexity and volume gives you more experience," said Dr. Christian de Virgilio, a coauthor of the study and UCLA surgery professor who works twice a month at Harbor-UCLA's trauma unit.

Numerous studies have backed up that hypothesis, said Carol Meyer, interim chief network officer for the Los Angeles County Department of Health Services, which runs Harbor-UCLA.

"You don't want a trauma center at every corner. If you do that, then the surgeons in the trauma centers all get a few patients and no one becomes an expert," she said.

De Virgilio noted that further study is needed to determine how patients overall in the South Los Angeles area are faring after the closure of King/Drew.

"The ideal situation would be to look at all the hospitals, all the trauma centers that were impacted by the closure," De Virgilio said. "We're giving you the picture of our own institution."

Meyer said the county continues to support the reopening of a hospital and emergency room at the site of King/Drew, now known as Martin Luther King Jr. Multi-Service Ambulatory Care Center. The facility offers an urgent care center, treating non-life-threatening illnesses like fevers and colds, and has about 70 outpatient clinics in specialties that include general medicine, cardiology, dermatology, dentistry and geriatrics.

Meyer declined to say whether the county should reopen a trauma unit, saying that question should wait until the hospital is reopened.

Although Harbor-UCLA appears to have benefited from increased trauma cases, the hospital was cited by government officials earlier this year for overcrowding in its emergency room, which they contended had placed patients in immediate jeopardy. The citation came after an emergency room patient left the hospital before treatment was finished and was found dead in a parking lot across the street last Dec. 22.

Meyer said that since then, the hospital has reduced overcrowding by having doctors evaluate patients as soon as they enter the emergency room, allowing for quick discharge of patients with minor injuries, and by expanding the hospital's urgent care clinic to run 24 hours a day, seven days a week to treat patients with minor illnesses.

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ron.lin@latimes.com

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