Becker's Hospital Review

37 37 CEO/STRATEGY Fewer people are dying from gunshots in Chicago: Stroger Hospital is a big reason why By Jessica Kim Cohen, Morgan Haefner and Brian Zimmerman I n early August, a series of shootings in Chicago le 41 people wounded and seven dead in a single day. Most of the shootings were on the city's South and West sides, send- ing many of the wounded to Cook County Health & Hospitals System's flagship John H. Stroger Hospital. e violence spike forced the hospital's trau- ma center to limit visitation to immediate family. Dozens of trauma patient visitors lined up outside Stroger on the city's West Side. But in spite of the chaos and surge of wounded patients, Stroger's trauma team never diverted a single trauma patient to anoth- er hospital, the Chicago Sun-Times reported. e team's work on Aug. 5 was predicated on de- cades of experience. In 2017 alone, the 50 clini- cians in Stroger's trauma center treated more than 1,100 gunshot wound patients — roughly one- third of the people shot in Chicago that year — a stat that reveals why Stroger's trauma center is one of the busiest in the nation. Stroger is home to one of the city's five level 1 adult trauma centers — a network so pro- ficient at treating high volumes of gunshot wound victims that its lifesaving work oen is overlooked. is is a hospital that is a safety net in more than one sense of the word. Amid years of political turmoil within the Chicago Police Department, the city's trauma network has been hard at work: Data shows gun-related homicides declined from 1995 to 2015, while the number of shootings did not. A look at the inner workings of Stroger reveals the contradiction of world-class trauma care in communities mired in poverty and violence. "It's a weird thing to have as the bridge to community trust, to say, 'We were really good at taking care of your son, or your daugh- ter, or neighbor, when they got shot,'" John Jay Shannon, MD, CEO of the Cook Coun- ty health system, told Becker's. "At the same time, it is widely acknowledged as being one of the things that we do very, very, very well." When the Becker's editorial team asked Chi- cago hospitals in 2017 how many gunshot wound patients they had treated over the year, Stroger was the most forthcoming. Some declined to share figures or did not respond to Becker's request for information. One hos- pital's communication team stated it had no interest in being known as the Chicago hospi- tal treating the most gunshot wounds. It's unclear why some hospitals were un- willing or unable to share information on the number of gunshot wound patients they treated. But Harold Pollack, PhD, an urban public health researcher and co-director of the University of Chicago Crime Lab, sug- gested two possible obstacles: reputation con- cerns and the availability of data. "If they are major trauma centers, people would expect many gunshot wounds to be treated there," Dr. Pollack told Becker's. "Some hospitals treat markedly fewer gunshot trau- ma [cases] than one might expect. is is quite embarrassing. Others do not want to become known as safety-net providers. I would not rule out that many hospitals don't actually have this information in a sufficiently accurate form to go public with it." For this article, members of the Becker's edito- rial team spoke with several Stroger adminis- trators and providers, past and present. What follows is a look inside one of the nation's most storied trauma centers and its relationship with gun violence and the community. From the 1960s to today: Chicago's evolving trauma landscape Stroger's trauma center traces its comprehen- sive trauma care roots to the 1960s. Robert Baker, MD, and the late Robert Free- ark, MD — physicians at Cook County Hos- pital, Stroger's predecessor — imagined a single hospital unit to care for traumatically injured patients, beginning before the patient entered the hospital and extending to the out- patient and rehabilitation settings. e launch of such a unit in 1966 was not with- out controversy, as it marked a paradigm shi in the care of trauma patients. A major point of contention involved the role of prehospital care providers — such as emergency medical tech- nicians and paramed- ics — in determining whether a patient was taken to the nearest trau- ma center rather than the closest hospital. "at was incredibly complicated and very controversial, because surgeons in [Chicago] hospitals had managed trauma — they were general surgeons, but they did some trauma. We were essentially say- ing, 'We can do this better,'" said John Barrett, MD, who served as director of the trauma center at Cook County Hospital from 1982 to 2002. Born in Cork, Ireland, Dr. Barrett came to Chicago in 1975 with abundant interest in the treatment of gunshot wounds. He describes gun violence as a uniquely American problem, and since retiring from medicine in 2002, has advo- cated for gun control legislation in the U.S. During his time as head of trauma at Cook County Hospital, Dr. Barrett witnessed an evo- lution in the treatment of gunshot wounds as the caliber of ammunition and the velocity of weapons increased from the 1980s to the 1990s. e advances in weaponry made for more com- plex wound care. Dr. Barrett described 1995 as a year that stands out to him as particularly grue- some for Chicago gun violence. "It was a horrible, horrible year," he told Beck- er's in 2017. "It gradually began to get better, until [2016] and [2017] together." Policing strategies credited with driving "It's a weird thing to have as the bridge to community trust, to say, 'We were really good at taking care of your son, or your daughter, or neighbor, when they got shot.' At the same time, it is widely acknowledged as being one of the things that we do very, very, very well." — Dr. John Jay Shannon, CEO, CCHHS

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