One hospital here has ramped up its trauma center to provide full-time care for patients with moderate to severe injuries, while another has opted out of trauma care altogether.

Both hospitals, which formerly accepted such patients on alternating weeks, say the changes will allow them to use their resources more efficiently.

As of Aug. 23, Spokane-area emergency medical responders will transport patients who have suffered moderate to severe injuries to Providence Sacred Heart Medical Center & Children's Hospital, while Deaconess Medical Center, formerly also a Level II trauma center, has dropped that designation.

Deaconess also chose not to seek designation as a Level III trauma center, which treats patients who have non-life-threatening or "single-system" injuries.

Dr. Andy Agwunobi, CEO at Sacred Heart, asserts that hospital's change to a year-round Level II trauma center will improve the quality of the trauma care it provides.

"It's inefficient to be one week on and one week off," he says. "We become better as a hospital when we focus attention on something seven days a week, 365 days a year."

Christine Varela, a spokeswoman for Deaconess, says executives at that hospital also considered expanding its trauma care to full time, but in the end decided not to duplicate trauma care being provided by its nearby competitor.

"It would have been difficult to ensure our community had the number of specialist physicians needed to cover Level II trauma calls 365 days a year" at two Spokane hospitals, she says. "Deaconess chose instead to refocus its resources and reassign affected staff members to other health-care services needed in our community."

Providence Holy Family Hospital and Valley Hospital & Medical Center remain full-time Level III trauma centers.

Sacred Heart and Holy Family are operated by Spokane-based Providence Health Care, a Catholic-sponsored nonprofit. Franklin, Tenn.-based Community Health Services, a for-profit corporation that owns 118 hospitals nationwide, bought Deaconess and Valley hospitals last year from Empire Health Services for $156 million.

Harborview Medical Center, in Seattle, a University of Washington teaching hospital, is the only Level I adult and pediatric trauma center in Washington state. Level I trauma centers, as defined by the U.S. Centers for Disease Control and Prevention, are considered regional resources and usually are connected with a research institution.

Ray Tansy, of the Spokane County Emergency Medical Service Trauma Care Council, says medical transport personnel helped develop protocols here to determine where trauma patients should be transported following the changes at Sacred Heart and Deaconess.

"We had a lot of pre-information on this, including in-person visits to hospital emergency rooms," he says. "All of the hospitals worked together. We're happy it worked out so well."

Depending on the availability of beds at Sacred Heart, some patients with non-life-threatening injuries will be transported there if that hospital is closer than the Level III trauma centers, he adds.

Agwunobi says Sacred Heart, as the sole Spokane-area Level II trauma center, will proceed with plans to expand its emergency department as part of its planned $175 million, six-year hospital facilities upgrade.

Although the Washington state Department of Health has denied Sacred Heart's request to add 152 acute-care beds as part of that expansion plan, the hospital doesn't need the state's approval to expand the emergency department, he says.

Sacred Heart, however, is appealing the state's ruling, and part of the appeal will include a modified request for 25 critical-care beds and other acute-care beds, Agwunobi says.

Meantime, the hospital has reconfigured its emergency department to provide more functional space, he says. As a temporary measure, Sacred Heart will convert six patient rooms to critical-care rooms to augment its trauma center, he says.

Sacred Heart doesn't expect to recoup the costs of increased trauma care, which the hospital subsidized last year at a cost of $1.5 million, an amount that's expected to increase, Agwunobi says.

"We're not doing this because of the financial ramifications," he says. "It's a service we feel as a Catholic institution we are obligated to provide to the community."

Trauma patients make up a small fraction of the emergency department's caseload, says Cathy Simchuk, Providence's vice president of trauma care for Sacred Heart and Holy Family hospitals.

In 2008, Sacred Heart registered 1,350 trauma patients out of a total emergency department visit count of 72,187. Providence Holy Family registered about 400 trauma patients out of a total emergency department visit count of 71,000.

Because Sacred Heart is now the only Level II trauma center in the Spokane area, it expects to treat about 400 additional trauma patients this year, Simchuk says.

To handle that increase, the hospital will fill 10 emergency department positions that have been vacant since the first of the year, she says.

Varela says Deaconess continues to operate its emergency department, which provides treatment for serious conditions such as heart attacks and strokes. She says no staffing cuts have resulted from Deaconess' decision not to provide trauma care.

Prior to the change in trauma care, about 1 percent of the total annual emergency visits at Deaconess involved trauma patients, Varela says.