Cleveland hospitals solidify Northern Ohio Trauma System with University Hospitals deal

Major hospital systems in the greater Cleveland Area have joined together to form a new regional trauma network to provide coordinated care to patients in Cuyahoga County and the seven-county Northeast Ohio region.

Dubbed the Northern Ohio Trauma System, it includes MetroHealth, the Cleveland Clinic, University Hospitals and Southwest General. NOTS was originally formed in 2010, but at the time did not include University Hospitals. Having officially made the announcement that they will join the network earlier this week, NOTS has formed a new charter and agreement for the expanded organization. The original agreement allowed for the addition of new members.

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NOTS members will coordinate with public safety personnel and network hospitals so that patients are taken to the appropriate level of care within the network. The NOTS network has expanded to include three regional Level I Adult Trauma Centers: Cleveland Clinic Akron General Hospital, MetroHealth main campus emergency department and University Hospitals Cleveland Medical Center. The most severe patients will be treated at these locations and at UH Rainbow Babies & Children's Hospital Pediatric Level I Trauma Center, NOTS said in a statement. Less severe trauma patients will be taken to one of Northeast Ohio's Level II Adult Trauma Centers.

University Hospitals' entrance into NOTS comes a little more than a year after they opened a new level one trauma center on the East Side of Cleveland in December 2015. Bernard Boulanger, MetroHealth System executive vice president and chief clinical officer, said once they came to the table, it took a year of meeting with University Hospitals, looking at the existing agreement and developing a new one, as well as adjusting the composition of NOTS boards and committees.

"We needed to build up trust amongst the three systems as we entered into this new agreement in which we are collaborators," Boulanger said. "The three organizations were competitors in many ways, so there is always issues with the fact that we are competitors. But also UH had resisted entering into NOTS … it took some time to work through the details of the new agreement. I can tell you the process was very collaborative and the end result is excellent," Boulanger said.

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"Doctors all said that they have been meeting for the past year to discuss launching a new NOTS network that would include UH," University Hospitals said in a statement. "So this has been an ongoing discussion in monthly meetings by the hospitals' chief medical officers and their teams, which resulted in this new agreement."

After University Hospitals opened their level-one trauma center, MetroHealth's trauma patient volume dropped 25 to 30 percent, according to Boulanger.

"There were financial impacts. When you have a rapid reduction in volume it does have a financial impact. We have adjusted extremely well and have grown in other ways," he said.

He said the expansion of their ambulatory clinic network allowed them to make up for the drop in volume in trauma cases. The system integrated four clinics that were former Healthspan facilities, and added more than 70 providers. They are now caring for thousands more patients as a result of that integration, which occurred over the last year. The facilities are now branded as MetroHealth.

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Boulanger pointed out that regional trauma organizations are known nationwide to improve outcomes. NOTS will do that through collaboration between systems and development of policies and protocols that are shared and improve coordination of trauma. More specifically, EMS providers on the scene looking after patient need guidance as to what to do and where to take the patient for care; a lot of factors play into that including weather, location and severity of injuries. NOTS can provide that education so that the care of the patient is well-coordinated, he said.

"It's about getting the patient to the right location at right time, which is normally as quick as possible."

NOTS is governed by an advisory board which will appoint a medical director and a pediatric medical director to serve two-year terms.

Twitter: @BethJSanborn