Impact of American College of Surgeons Verification on Trauma Outcomes

Piontek, Frank; Coscia, Robert; Marselle, Christine S; Korn, Robert; Zarling, Edwin J.

doi:10.1097/01.ta.0000061107.55798.31

Cited by 63 publications

(47 citation statements)

References 27 publications

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“…The majority of studies were published in two years, 2003 [20,26-29] and 2009 [17,18,30,31], with five and four studies, respectively. One study was published in each of the following years: 1995 [32], 2004 [33], 2007 [34] and 2008 [35].…”

Section: Resultsmentioning

confidence: 99%

The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact

Greenfield

Pawsey

Hinchcliff

et al. 2012

BMC Health Serv Res

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BackgroundHealthcare accreditation standards are advocated as an important means of improving clinical practice and organisational performance. Standard development agencies have documented methodologies to promote open, transparent, inclusive development processes where standards are developed by members. They assert that their methodologies are effective and efficient at producing standards appropriate for the health industry. However, the evidence to support these claims requires scrutiny. The study’s purpose was to examine the empirical research that grounds the development methods and application of healthcare accreditation standards.MethodsA multi-method strategy was employed over the period March 2010 to August 2011. Five academic health research databases (Medline, Psych INFO, Embase, Social work abstracts, and CINAHL) were interrogated, the websites of 36 agencies associated with the study topic were investigated, and a snowball search was undertaken. Search criteria included accreditation research studies, in English, addressing standards and their impact. Searching in stage 1 initially selected 9386 abstracts. In stage 2, this selection was refined against the inclusion criteria; empirical studies (n = 2111) were identified and refined to a selection of 140 papers with the exclusion of clinical or biomedical and commentary pieces. These were independently reviewed by two researchers and reduced to 13 articles that met the study criteria.ResultsThe 13 articles were analysed according to four categories: overall findings; standards development; implementation issues; and impact of standards. Studies have only occurred in the acute care setting, predominately in 2003 (n = 5) and 2009 (n = 4), and in the United States (n = 8). A multidisciplinary focus (n = 9) and mixed method approach (n = 11) are common characteristics. Three interventional studies were identified, with the remaining 10 studies having research designs to investigate clinical or organisational impacts. No study directly examined standards development or other issues associated with their progression. Only one study noted implementation issues, identifying several enablers and barriers. Standards were reported to improve organisational efficiency and staff circumstances. However, the impact on clinical quality was mixed, with both improvements and a lack of measurable effects recorded.ConclusionStandards are ubiquitous within healthcare and are generally considered to be an important means by which to improve clinical practice and organisational performance. However, there is a lack of robust empirical evidence examining the development, writing, implementation and impacts of healthcare accreditation standards.

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Section: Resultsmentioning

confidence: 99%

The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact

Greenfield

Pawsey

Hinchcliff

et al. 2012

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…16 The existence of trauma teams, trauma manuals, and paging criteria have been shown to correlate well with improved trauma care when measured as mortality or length of stay in hospital. [17][18][19][20][21] The use of perceived quality of trauma care as an outcome measure is a limitation to this study. In an intervention taking place during a time span of 8 years, a simultaneous, independent development would be expected.…”

Section: Discussionmentioning

confidence: 98%

Effects of Nationwide Training of Multiprofessional Trauma Teams in Norwegian Hospitals

Wisborg

Brattebø

Brinchmann-Hansen

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…19 The authors used internal and external controls to validate the results and mitigate potential effects that may be seen as medical and trauma care improves over time. They demonstrated after achieving ACS verification a 22% reduction in severity adjusted O/E mortality ratios.…”

Section: Discussionmentioning

confidence: 99%

American College of Surgeons trauma center verification versus state designation

Brown

Watson

Forsythe

et al. 2013

Journal of Trauma and Acute Care Surgery

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Objectives Single center experience has shown that American College of Surgeons (ACS) trauma verification can improve outcomes. The current objective was to compare mortality between ACS verified and State designated centers in a national sample. Methods Subjects ≥16yr from ACS verified or State designated level I and II centers were identified in the NTDB 2007–08. A predictive mortality model was constructed using TQIP methodology. Imputation was used for missing data. Probability of mortality in the model determined expected deaths. Observed to expected (O/E) mortality ratios with 90%CI and outliers (90%CI above or below 1.0) were compared across ACS and State level I and II centers. The mortality model was repeated with ACS vs. State included. Results There were 900,274 subjects. The model had an AUC of 0.92 to predict death. Level I ACS centers had a lower median O/E ratio than State (0.95 [IQR 0.82–1.05] vs 1.02 [0.87–1.15], p<0.01), with no difference in level II centers. Level II State centers had more high O/E outliers (Table). ACS verification was an independent predictor of survival in level II centers (OR 1.26; 95%CI 1.20–1.32, p<0.01), but not in level I centers (p=0.84). Conclusions Level II centers have a disproportionate number of high mortality outliers and ACS verification is a predictor of survival. Level I ACS centers have lower O/E ratios overall but no difference in outliers. ACS verification appears beneficial. This data suggests that level II centers benefit most, and promoting level II ACS verification may be an opportunity for improved outcomes. Level of Evidence: III

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Impact of American College of Surgeons Verification on Trauma Outcomes

Abstract: This study suggests that the efforts and resources consumed achieving ACS Level II trauma center verification appear to result in desired outcomes as evidenced by decreased LOS, reduced in-hospital mortality rates, reduced cost, and improved contribution margins.

Cited by 63 publications

References 27 publications

The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact

The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact

Effects of Nationwide Training of Multiprofessional Trauma Teams in Norwegian Hospitals

American College of Surgeons trauma center verification versus state designation

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