Long Island Community Hospital: Trauma and Vascular Programs Support Advanced Emergency Care

By Jennifer Webster
Tuesday, February 26, 2019

Since being verified in 2018 by the American College of Surgeons (ACS) as a Level III trauma center, Long Island Community Hospital has been able to offer expanded lifesaving emergency care. The new trauma designation, combined with the addition of an on-site vascular medicine program, means more emergency patients than ever will be able to receive their care entirely at Long Island Community Hospital.

Brian Lee, MD, Chair of the Department of Emergency Medicine at Long Island Community Hospital, is quick to credit collaboration among disciplines and institutions when he tells the story of this burgeoning success. For years, the Trauma Center’s partnership with Stony Brook Medicine has led to enhanced support, including most recently bringing a vascular medicine program to Long Island Community Hospital.

“Assisted by Stony Brook, the hospital has taken another step forward as a premier provider of trauma care,” Dr. Lee says. “Our relationship with Stony Brook’s trauma team has expanded to include other service lines.”

Brian Lee, MD, Chair of the Department of Emergency Medicine, leads a team of 26 emergency physicians.

In particular, the presence of vascular surgeons on-site at critical moments allows patients with severe injuries to be treated at Long Island Community Hospital, sparing many transfers to another hospital.

“The formal relationship with Stony Brook’s vascular program has really provided beneficial care to patients who arrive with trauma-related issues,” Dr. Lee says. “In many cases, we are able to treat patients close to home.”

Level III Trauma Center Recognition

James Vosswinkel, MD, Chief of Trauma Surgery at Long Island Community Hospital, who also holds multiple positions at Stony Brook Medicine, has been part of the liaison between Stony Brook and Long Island Community Hospital for several years. He has focused a great deal of energy on helping the hospital achieve New York state designation as a Level III trauma center as verified by the American College of Surgeons. This recognition underscores both the hospital’s growth and the strength of the partnerships it has forged.

Pamela S. Kim, MD, vascular specialist, and Apostolos K. Tassiopoulos, MD, Chief of the Division of Vascular Surgery for Stony Brook Medicine, consult on a vascular study.

“There are only about 30 New York state-designated trauma centers,” Dr. Vosswinkel says. “The presence of a hospital that is recognized as one of these few resources is a tremendous benefit to the local community. It’s an achievement that verifiably defines us; it’s proof that we can provide a complete line of services to patients who are acutely injured, from the time they enter the Emergency Department (ED) through treatment by other service lines to stabilization and successful discharge.”

The wide range of cases that can be treated at a Level III trauma center include serious pelvic fractures with vascular injuries, limb amputations, crush injuries and compartment syndromes. In the event the most serious cases cannot be treated at Long Island Community Hospital, patients still can be stabilized there before being transferred to another facility. Level III recognition, additionally, means the hospital expands its community presence by such activities as participation in regional disaster management strategies and exercises. Its new status indicates that the hospital offers both a refuge for the seriously injured and a resource for prevention of, and response to, disasters of all kinds — widespread as well as individual.

The journey to achieve this recognition is long and arduous, a process that Dr. Vosswinkel described on a local media channel as “the gold standard process among all trauma centers in this country.”

A cadre of specialized personnel, resources and equipment — all of excellent quality — must be assembled and backed by evidence-based protocols to ensure patients receive maximum treatment from the time an injury or illness is radioed in to the patient’s discharge, rehabilitation and full recovery. Advanced treatments and procedures must be performed expeditiously on-site, at any hour, day or night. Maintaining the manpower and equipment to perform these procedures, along with the policies to ensure a routinely high, consistent standard of implementation, takes enormous effort and remains evidence of deep institutional commitment to the hospital’s mission in the community.

A Magnet for Trauma Care in Suffolk County

In 2018, Long Island Community Hospital was verified as a Level III trauma center by the American College of Surgeons. The process to become recognized is a strict one. On-site visits and rigorous scrutiny of the hospital’s practices and capabilities determined that Long Island Community Hospital was well able to meet the needs of trauma patients “from pre-hospitalization through rehabilitation,” in other words — through the full cycle of their care.

Among the facets covered by the designation, Long Island Community Hospital demonstrated:

  • 24-hour coverage by emergency physicians
  • A full quality assessment program
  • Community prevention and outreach initiatives
  • Continuing medical education for physicians, nurses and ancillary staff
  • Established transfer agreements to a Level I center
  • Rapid access to anesthesiologists and general surgeons

For patients living nearby, this designation makes a big difference in how soon they can receive emergency care in the event of a major illness or accident. Long Island Community Hospital is now the only New York state-designated trauma center in the south central part of Suffolk County. Emergency medical services bring even the most critical patients to Long Island Community Hospital, knowing they will receive high-quality care.

An Enhanced Emergency Experience

One key component to the excellent emergency medicine available at Long Island Community Hospital is a staff of residency-trained and board-certified emergency physicians. The hospital launched an affiliation with Progressive Emergency Physicians in July, a relationship that has enhanced the quality and experience of emergency care at Long Island Community Hospital.

“Progressive Emergency Physicians is an ED physician practice that provides emergency specialists and also offers deep insight into metric-driven operational improvement,” Dr. Lee explains. “Working with them has really enhanced our ED.”

For example, a new pilot express care program is transforming the patient experience and workflow in the ED. Once through the triage process, individuals who have been identified as patients who can be treated and released without a hospital stay are placed in a specific area of the ED. The goal for those designated patients is to conclude their visit within 90 minutes of their arrival. In the three months since the program started, Dr. Lee says, patients are expressing high levels of satisfaction with the new process and the levels of service offered.

“The other day a patient arrived with kidney stones,” he says. “In the past, this patient would have been mixed in with trauma and stroke patients — a very chaotic situation. Instead, the patient went to a private room. The patient received a CT scan and a diagnosis. Pain medication was administered, and the patient left within 90 minutes. That’s very different from what was previously experienced at the hospital.”

“At Long Island Community Hospital, one of our paramount goals is the overall patient experience. Everything we do, from treating a critically ill trauma patient or expediting care for a patient coming to the Emergency Department for a prescription refill, is guided by that unifying purpose. First and foremost, we are here for the community.”
— James Vosswinkel, MD, Chief of Trauma Surgery at Long Island Community Hospital

James Vosswinkel, MD, Chief of Trauma Surgery at Long Island Community Hospital, leads the team on the latest trauma care protocols and follows through on patient care.

Synergy Between Trauma, Emergency Medicine

With new trauma treatment capabilities come new emergency management protocols. A trauma activation system has changed the way the hospital offers trauma care. These protocols ensure uniform care for each patient, Dr. Lee explains.

“It’s not physician- or provider-based,” he says. “We’ve enhanced our structure with distinct criteria for activating different trauma levels. Now, everything is formalized and uses evidence-based protocols to improve patient outcomes in terms of morbidity and mortality.”

Dr. Lee discusses that day’s trauma patients with Christine Torre, RN, MSN, Emergency Department Director.

The new trauma and emergency protocols kick in well before patients arrive at the emergency room doors. Long Island Community Hospital has a longstanding relationship with local, volunteer emergency medical services (EMS) teams and fire departments. As their ability to treat more severe cases increases, these crews know they can take critically injured or ill patients to Long Island Community Hospital.

“We have been communicating with our EMS crews to ensure they are aware of our ACS certification,” Dr. Lee says. “They let us know when they have a patient coming in with a penetrating injury to the head, neck or thorax — it’s known as code T criteria — and we obtain critical information about the patient before they arrive.”

That’s when the hospital’s trauma care system is activated. The staff, from X-ray and CT technicians to trauma and vascular surgeons, is notified electronically or by cell phone about the situation. While an emergency physician is already on-site to stabilize the patient, the trauma surgeon is expected to arrive at the patient’s bedside within 30 minutes. This deeply integrated collaboration is key to providing rapid, expert service when it’s needed most.

Vascular Expertise for Emergency Care and Preventive Medicine

To add to the synergy between the trauma and emergency programs, Long Island Community Hospital’s new Vascular and Endovascular Surgery Services Program is also increasing the range of injuries that can be treated in the ED. Apostolos Tassiopoulos, MD, Professor of Surgery, Chief of the Division of Vascular Surgery and Vice Chair of the Department of Surgery at Stony Brook University and Director of Vascular Services at Long Island Community Hospital, came on board recently to help develop a vascular program at Long Island Community Hospital. What started as a simple conversation in 2017 has grown into an elaborate in-house vascular service program, fully staffed with physicians from Stony Brook Medicine, and offering the same high standard of care that Stony Brook Medicine is known for.

Drs. Tassiopoulos and Vosswinkel collaborate on cases that require both trauma and vascular surgical intervention.

“We wanted to bring our expertise in the diagnosis and management of vascular disease closer to the patient population in a hospital that sees a lot of emergencies,” Dr. Tassiopoulos says. “We also recognized that there were many patients with significant vascular disease in the area, and that making ourselves available in the hospital would facilitate care and follow-up visits.”

The resulting service line creates benefits for people across the community, and vascular surgeons are finding opportunities to round out Long Island Community Hospital’s Knapp Cardiac Care Center and Wound Care Center’s services, too. The vascular service team includes three surgeons with dual appointments at Stony Brook Medicine. They have been treating patients in the hospital since October 2018 and just began seeing outpatients in January.

Nicholas Sikalas, MD, Assistant Clinical Professor at Stony Brook University and Director of the Limb Preservation Center at Stony Brook Medicine, provides leadership for the on-site team, along with Pamela Kim, MD, and Mohsen Bannazadeh, MD. His goal is to achieve round-the-clock, daily vascular coverage for the hospital and the surrounding community, he says. Secondarily, he wants to see the existing vascular lab enhanced and a community education program established to raise awareness about vascular disease.

Nicholas Sikalas, MD, and Mohsen Bannazadeh, MD, vascular specialists at Long Island Community Hospital, work together on a patient case.

Already, with the goal of managing patients locally, the vascular service team offers numerous minimally invasive procedures and interventions, including treatments for carotid artery disease, aneurysm and peripheral arterial disease. Its presence as an in-house service also improves the quality of care for patients who may have vascular complications as a result of a different procedure or intervention, allowing patients to be treated promptly on-site, rather than being transferred.

A self-prevention program is also developing, Dr. Tassiopoulos says, similar to the well-established one at Stony Brook Medicine. The program for the prevention of vascular disease will offer screenings as well as education for patients and physicians.

“Early identification of vascular disease can help patients focus on managing their risk factors early on,” Dr. Tassiopoulos says. “It can prevent the disease from progressing to situations that pose significant threats to patients’ health and lives.”

In emergency care specifically, the availability of the Vascular Service means more patients are treated locally, which avoids delays in care that could otherwise result in loss of life or extremity.

“Since we’ve been on call for the past three months, patients who have conditions such as thoracic dissection or ruptured aortic aneurysms can be evaluated expeditiously at Long Island Community Hospital,” Dr. Sikalas says. “Already, we’ve seen multiple instances of patients with lower extremities at risk for limb loss who would formerly have been transferred to another hospital and now can receive care at their local hospital.”

Such rapid availability of emergency care could potentially prevent loss of limb, Dr. Sikalas adds.

“Even a few minutes’ delay in getting a specialist to the bedside can make a difference,” he says. “The presence of vascular care here at Long Island Community Hospital is an invaluable service to the community.”

Community-Centered Expertise

In an age when many patients find their hospital experience to be one of care — even excellent care — at the hands of strangers, one tradition at Long Island Community Hospital may seem unique. Family medicine physicians make their rounds in the hospital and visit their patients, giving them the reassurance of a familiar face and voice, and ensuring care will proceed seamlessly after discharge. As the hospital’s emergency capabilities grow, the possibility of this experience is expanded so that an ever-widening circle of patients can benefit. Receiving treatment for even the most serious injuries at Long Island Community Hospital means trauma patients can see their primary physician in the hospital, closing the circle of compassionate, community care even for patients with extreme injuries.

The Long Island Community Hospital and Stony Brook Medicine Vascular & Endovascular Services team, including Dr. Tassiopoulos, Olympia Christoforatos, RN, MS, Nurse Navigator, Dr. Kim, Dr. Bannazadeh and Dr. Sikalas.

“Long Island Community Hospital is unique in that many of our primary care physicians hold office hours and still come to the hospital to see their patients,” Dr. Sikalas says. “Our goal is to allow patients in the surrounding areas — patients whose primary care physicians and cardiologists already work with Long Island Community Hospital — to have their surgical procedures, including emergency procedures, in continuity with their other care.”

The community connection is evident in other areas, too. Newly arrived Stony Brook physicians are holding meet-and-greets with colleagues and community members. Stony Brook Medicine’s academic faculty hosts CME presentations, which have included recent events on stroke and aortic injury, Dr. Vosswinkel says. From his point of view, the connections strengthen the care the hospital can offer.

“Everyone I work with at Long Island Community Hospital is a pleasure to deal with,” he says. “The physician groups and the hospital have benefited enormously from the relationships we’re forging, but the ultimate beneficiaries are the patients.”

Together, the emergency, trauma and vascular surgeons of Long Island Community Hospital are preserving deep community relationships and forging new ones, so that patients can receive expert-level treatment close to home, surrounded by providers they know and trust.

For more information, visit licommunityhospital.org.