Surgeons continue to advocate consolidating Edmonton's two trauma centres

CBC

28-01-2025

Edmonton has two trauma centres for adult care — a unique distinction for a Canadian city of its size.
But trauma surgeons have advocated for years to consolidate to a single site, which they argue would improve patient outcomes, reduce transfers of critically injured patients, more efficiently use resources and save money.
The image in the popular imagination of a hospital as a facility with 24-hour urgent care for a menu of multiple serious problems — from brain injuries to organ failure to complex bone fractures — doesn't apply to every hospital or emergency department, even in major cities.
That description is closer to what's known as a lead trauma centre: a designation for a hospital that has the facilities and specialized staff available at all times to treat the most serious and complex cases.
Edmonton's two trauma centres for adult care are Royal Alexandra Hospital (RAH) and University of Alberta Hospital (UAH). The only other cities in Canada with two adult trauma centres are Toronto, Montreal and Vancouver, which have significantly larger populations.
More comparable cities like Calgary, Ottawa, Quebec City and Winnipeg each have a single trauma centre.
(Pediatric hospitals are typically designated the lead trauma centre for pediatric trauma, as is the case in Edmonton with Stollery Children's Hospital.)
"It's a very natural thing to think that more is better," said Dr. Matt Strickland, a trauma surgeon and head of the trauma program at RAH.
"But I think we would see improved patient outcomes were we to move to a single trauma centre and actually be able to develop and foster the expertise that I, as an Edmontonian, would certainly want if I were injured."
Consolidation a longstanding issue
The designation of UAH and RAH as trauma centres dates back to the early 1990s, when the concept, imported from the U.S., gained popularity in Canada.
Years later, studies began finding that trauma centres with higher patient volumes also saw statistically better patient outcomes. One of the reasons is that medical teams that see more trauma cases are better able to develop and maintain a high level of expertise.
They're also more likely to see statistically rare types of cases, which provide added experience.
"The more we dilute it between two centres, the more our experience as individuals and as as teams kind of gets watered down," said Dr. Michael Kim, a trauma surgeon at UAH.
A 2019 performance review of Alberta Health Services conducted by Ernst & Young recommended that consolidation of Edmonton's two trauma centres to one site. The report noted that in the 2018-2019 fiscal year, Edmonton treated 991 major trauma cases across two sites, while Calgary saw 851 cases at its trauma centre at Foothills Medical Centre.
Trauma surgeons in Edmonton have likewise advocated consolidation, including laying out their arguments in documents sent to AHS Edmonton Zone leaders and obtained by CBC News.
In January 2024, seven senior medical personnel at RAH — including the heads of trauma, surgery, critical care and other sections — signed a letter advocating for that facility to be the city's sole trauma centre.
Another letter, sent in August 2024, was signed by all 12 trauma surgeons in Edmonton, including the section heads for both RAH and UAH.
"We, the trauma surgeons working as physicians and medical leaders within the Edmonton Zone's two trauma programs, are writing to express our unified and unequivocal recommendation to consolidate the two existing programs into a single, one-site model," the letter said.
A 13-page report detailing the need for consolidation was also submitted in January 2024. It cited numerous studies that "overwhelmingly" demonstrate the link between higher trauma case volumes and better patient outcomes.
The report's authors included the heads of trauma at RAH and UAH, and Dr. Damian Paton-Gay, who was then chief of trauma for the Edmonton Zone health region.
"The conversations about consolidating at one site have been going on ever since I started training here over 20 years ago," said Paton-Gay.
"Big organizations like this have a tremendous amount of inertia. You know, big moves are hard to make."
He said the report came about in part due to a request from leadership for a document outlining the case for consolidation.
Single centre would reduce costs, patient transfers
Another argument for consolidation is the cost of maintaining and staffing two trauma sites, which requires not only having a trauma surgeon and an operating room ready at all times, but also specialized nurses, anesthetists and other personnel.
Multiple trauma surgeons who spoke to CBC News described trauma patients needing to be transferred between the two hospitals because some surgical specialities are located at one and not the other.
"Visualize this: you've got someone with a brain injury who's got a bad pelvis fracture after a motorcycle crash," said Dr. Ram Anantha, a trauma surgeon at UAH who signed one of the letters to AHS.
"It's crazy to think you'd have a pelvis surgery done at the Alex, and then the neurosurgeons cannot come to the Alex to operate on their brain... now you have to get transported by ambulance across the river to the university hospital. You may have hours to live for you to get the surgery done."
Such transfers were "not an uncommon thing," he added.
CBC News reached out to AHS regarding trauma centre consolidation. An AHS spokesperson declined to comment.
A spokesperson for Alberta Health Minister Adriana LaGrange said she was unavailable for an interview. Her office instead provided a written statement.
"Alberta's government is aware that some groups have advocated for the consolidation of Edmonton's two designated trauma centres, however it is concerned about the potential disruption to services that could result from such a change," the statement said.
Strickland said trauma, which cuts across many disciplines, can be reflective of an overall acute care system.
"There's nothing more complex than trauma," he said.
"You can injure every part of your body. And so you may need a surgeon from every single ilk. You might need interventional radiology. You need advanced emergency department. You need a good blood bank. You really need a hospital top to bottom and you need it running really quickly for you. So to me, organizing trauma well is exactly what AHS should pride themselves on the most."
Consolidation would be disruptive
While accreditation for trauma centres was previously provided by the Trauma Association of Canada (TAC) and later by Accreditation Canada, for several years there has been no national standardized verification process.
Previously, a lead trauma centre would have had a designation of Level I or II under the TAC system, which would have required adherence to specific standards in order to maintain consistency across provinces.
TAC president Dr. Jag Rao said there is a shift underway toward adopting the American College of Surgeons Committee on Trauma (ACS-COT) standard. So far, only Toronto's trauma centres have been accredited, though other Ontario facilities have expressed interest.
AHS lists a total of 10 trauma centres in Alberta. The adult and pediatric facilities in Edmonton and Calgary were designated as Level I or II trauma centres under the TAC standard based on their ability to provide an advanced level of care. The other five are regional centres with a more limited capacity to handle complex trauma cases.
Consolidation would be a disruptive process, likely involving the shifting of other specialties as well. The trauma surgeons who spoke to CBC News agreed that, if consolidation were to happen, either UAH or RAH could serve as a sole trauma centre, with each candidate having its own pros and cons.
"So really what it fundamentally comes down to is, where do we as a zone want to organize that?" said Strickland
"These are big, 40-year decisions."
Kim pointed out that concentrating specialties at one facility is already common practice.
"If you need something like vascular surgery, you would go to the Grey Nuns Hospital. If you had high risk obstetrics, you'd go to the Royal Alexandra Hospital. If you had severe heart issues, you'd come to requiring surgery, you'd come to the Mazankowski Heart Institute," he said.