TMH passes ER inspection with zero deficiencies


The Memorial Hospital's emergency room aced a state inspection and once again received accreditation as a Level IV trauma center.

The certification was announced at a January meeting of officials from the Colorado Department of Public Health and Environment. The certification grants The Memorial Hospital's emergency room another three years as part of a statewide trauma system. It's the third time TMH has been certified since the state began designating trauma centers in 1998.

"What makes this one unique is that we passed this one with no deficiencies," said Marie Kettle, director of emergency and trauma services at TMH. Kettle is registered nurse and a 28-year veteran at TMH who has spent most of her time in the emergency department.

She has participated in inspections by the state health department and other agencies, such as the Joint Commission on Accreditation of Healthcare Organizations.

Often, officials will find areas for improvement or cite hospitals for noncompliance. But this year, TMH, along with several other Level IV hospitals, performed perfectly.

Kettle went to the January meeting, at which state health officials discussed the results of statewide inspections that had taken place in 2003. While the officials discussed the deficiencies of certain facilities and addressed plans for bringing them into compliance, they stopped to recognize six hospitals that passed the inspections with no deficiencies.

Kettle said she was asked to stand and accept the recognition on behalf of TMH.

There are five levels of trauma centers in the system. The first level includes metropolitan hospitals like Denver Health. St. Mary's Hospital and Medical Center in Grand Junction houses a Level II trauma center. Yampa Valley Medical Center in Steamboat Springs is a Level III.

The hierarchy guides doctors in deciding where to send critically injured patients. More severely injured patients are transferred to higher level facilities.

While TMH's emergency room can provide care for a number of different types of injuries, patients who suffer trauma to multiple systems or organs will be taken to more specialized facilities.

A car wreck victim who suffers head, chest and limb injuries may need three different specialists, for instance. Such patients get transported to Level I or II trauma centers.

Often, TMH sends patients to St. Mary's, Kettle said.

TMH's duty, in the trauma system, is to stabilize patients long enough to get them to the higher-level facilities.

Specialists advise, "You do the ABCs so we have something to work with when we get them," Kettle said.

ABC stands for airway, breathing and circulation, Kettle said.

Additionally, TMH can do lab work, start blood transfusions or prepare X-rays or CT scan images until a helicopter or airplane arrives to transport the patient.

Kettle stressed that the glowing review TMH received was a result of collaboration and teamwork among the emergency room's staff. Dr. David James provides leadership in the role of trauma director. James, Kettle and others meet to discuss possible areas of improvement.

One area the staff focused on was chest tube setups, which Kettle said is a low-volume, high-risk procedure. The staff doesn't perform the procedure every day, but when they do, it is critically important, Kettle said.

Also, TMH's nurses and the 11 doctors who trade shifts in the emergency room have to stay current with various training courses and certifications required by the state.

The inspection included an audit of TMH's records called a "chart review." Officials investigate the hospital's documentation of certain cases, especially admissions, transfers and deaths.

Although caring for the patients is of obvious importance, Kettle said the documentation is critical for state certification.

"They can tell by the chart how the patient was taken care of," Kettle said.

Jeremy Browning can be reached at 824-7031 or

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