“…Since then, several developments have occurred because of the commitment of many AAST leaders, and marked progress has been made to solidify the specialty. [1][2][3][4][5][6][7][8][9][10][11] We have now a well-developed and growing fellowship training program; a formal seat at the American Board of Surgery for trauma burn and critical care was established; going from advisory council to component board, the name of our meeting changed to Annual Meeting of the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery; the name of the Journal of Trauma changed to Journal of Trauma and Acute Care Surgery, a comprehensive research agenda for all three domains was defined; a specific Emergency Surgery Course was developed in partnership with the European Society of Trauma and Emergency Surgery; and the practice model of acute care surgery spread rapidly throughout the country, with markedly improved response to patient needs and outcomes documented in the literature. 12 Despite all these advancements, emergency general surgery still lacked a robust continuous quality and performance improvement process, a data collection tool, and a set of standards to guide the organization of programs based on optimization of resources, processes, and measured outcomes.…”