Effective May 1, 2007, the updated criteria for trauma center verification outlined in the Resources for Optimal Care of the Injured Patient: 2006 go into effect. In addition, the Committee on Trauma (COT) of the American College of Surgeons has made substantive changes to the outcomes of a verification site visit in order to better serve the trauma community. These changes also go into effect May 1, 2007, and are detailed below.
Previously, after completion of a verification or re-verification site visit a trauma center was either “verified” (certificate for three years) or “not verified.” One of the current missions of the Verification Review Committee (VRC) is to provide guidance and recommendations for trauma programs during the site visit process, while at the same time verifying that the essential criteria of a trauma center are in place. With this emphasis the COT has added a third category as an outcome to a verification site visit. This category is “verified” with a certificate of verification for one year. This category is further described below and in the attached outline entitled Verification Site Visit Outcomes.
One of the most significant changes is the identification of the essential requirements as Type I and Type II criteria (or deficiencies). Type I criteria must be in place at the time of the verification site visit in order to achieve verification. Type II criteria are also required, but are less urgent criteria. If three or less Type II deficiencies are present at the time of the site visit, a one year certificate of verification will be issued, during which time if the trauma center successfully corrects the deficiencies, the period of verification will be extended to three years from the date of the initial verification visit.
The format and the executive summary of the site visit report will not change. The final results of the site visit (including identification of Type I and Type II criteria or deficiencies) will be determined by the VRC. The findings will be noted in the VRC’s letter to the hospital after the report has been reviewed by the committee.
This new process will be continually evaluated and future revisions of specific criteria or requirements included in each category may be necessary.
Frank (Tres) L. Mitchell, III, MD, MHA, FACS
Chair, Verification Review Committee
| Level II |
Chapter |
Requirement by Chapter |
|
| ∙ |
2 |
2-1 Surgical commitment is essential for a properly functioning trauma center. |
TYPE I |
| ∙ |
2 |
2-3 A Level I trauma center must meet admission volume performance requirements (one of the following): a) Admit at least 1200 trauma patients yearly, b) 240 admissions with an Injury Severity Score (ISS) of more than 15, c) An average of 35 patients with an ISS of more than 15 for the trauma panel surgeons (general surgeons who take trauma all). |
TYPE I |
| ∙ |
2 |
2-4 The trauma director must have responsibility and authority for determining each general surgeon’s ability to participate on the trauma panel based on an annual review. |
TYPE I |
| ∙ |
2 |
2-5 General surgeon or appropriate substitute (postgraudate-year 4 or 5 resident) must be in house 24 hours a day for major resuscitations (must be present and participate in major resuscitations, therapeutic decisions, and operations). |
TYPE I |
| ∙ |
2 |
2-7 It is expected that the surgeon will be in the emergency department on patient arrival, with adequate notification from the field. The maximum acceptable response time is 15 minutes for Level I and II trauma centers and 30 minutes for Level III trauma centers, tracked form patient arrival. The program must demonstrate that the surgeon’s presence is in compliance at least 80% of the time. Demonstration of the attending surgeon’s prompt arrival for patients with appropriate activation criteria must be monitored by the hospital’s trauma PIPS program. |
TYPE I |
| ∙ |
2 |
2-8 The trauma surgeon on call must be dedicated to the trauma center while on duty. |
TYPE I |
| ∙ |
5 |
5-1 The hospital has the commitment of the institutional governing body and the medical staff to become a trauma center. |
TYPE I |
| ∙ |
5 |
5-4 The multidisciplinary trauma program continuously evaluates its processes and outcomes to ensure optimal and timely care. |
TYPE I |
| ∙ |
5 |
5-5 The trauma medical director is either a board-certified surgeon or an ACS Fellow. |
TYPE I |
| ∙ |
5 |
5-6 The trauma medical director participates in trauma call. |
TYPE I |
| ∙ |
5 |
5-9 The trauma director has the authority to correct deficiencies in trauma care or exclude from trauma call the trauma team members who do not meet specified criteria. |
TYPE I |
| ∙ |
5 |
5-12 Seriously injured patients are admitted or evaluated by an identifiable surgical service staffed by credentialed providers. |
TYPE I |
| ∙ |
5 |
5-13 There is sufficient infrastructure and support to the trauma service to ensure adequate provision of care. |
TYPE I |
| ∙ |
5 |
5-18 There is a multidisciplinary peer review committee chaired by the trauma medical director or designee, with representatives from appropriate subspecialty services. |
TYPE I |
| ∙ |
5 |
5-23 There must be a Trauma Program Operational Process Performance Improvement Committee. |
TYPE I |
| ∙ |
6 |
6-4 The trauma surgeon on call must be dedicated to the trauma service while on duty. |
TYPE I |
| ∙ |
6 |
6-6 An attendance threshold of 80% must be met for trauma surgeon presence in the emergency department. |
TYPE I |
| ∙ |
6 |
6-9 There is a multidisciplinary peer review committee with participation from general surgery, orthopaedic surgery, neurosurgery, emergency medicine, and anesthesia. |
TYPE I |
| ∙ |
7 |
7-1 The emergency department has a designated emergency physician director supported by an appropriate number of additional physicians to ensure immediate care for injured patients. |
TYPE I |
| ∙ |
7 |
7-2 Emergency department physicians must be present in the emergency department at all times. |
TYPE I |
| ∙ |
8 |
8-1 A neurosurgical liaison is designated. |
TYPE I |
| ∙ |
8 |
8-2 Neurotrauma care is promptly and continuously available for severe traumatic brain injury and spinal cord injury and for less severe head and spine injuries when necessary. SEE FAQ |
TYPE I |
| ∙ |
8 |
8-3 The hospital provides an on-call neurosurgical backup schedule with formally arranged contingency plans in case the capability of the neurosurgeon, hospital, or system to care for neurotrauma patients is overwhelmed. |
TYPE I |
| ∙ |
8 |
8-5 An attending neurosurgeon is promptly available to the hospital's trauma service when neurosurgical consultation is requested. |
TYPE I |
| ∙ |
8 |
8-10 Qualified neurosurgeons are regularly involved in the care of head - and spinal cord- injured patients and are credentialed by the hospital with general neurosurgical privileges. |
TYPE I |
| ∙ |
9 |
9-9 Level I and II centers provide sufficient resources, including instruments, equipment, and personnel, for modern musculoskeletal trauma care, with readily available operating rooms for musculoskeletal trauma procedures. |
TYPE I |
| ∙ |
9 |
9-2 Operating rooms are promptly available to allow for emergency operations on musculoskeletal injuries, such as open fracture debridement and stabilization and compartment decompression. |
TYPE I |
| ∙ |
9 |
9-4 There is an orthopaedic surgeon who is identified as the liaison to the trauma program. |
TYPE I |
| ∙ |
9 |
9-5 Plastic surgery, hand surgery, and spinal injury care capabilities are present at Level I trauma centers. |
TYPE I |
| ∙ |
11 |
11-1 Anesthesiology services are promptly available for emergency operations. |
TYPE I |
| ∙ |
11 |
11-2 Anesthesiology services are promptly available for airway problems. |
TYPE I |
| ∙ |
11 |
11-3 There is an anesthesiologist liaison designated to the trauma program. |
TYPE I |
| ∙ |
11 |
11-4 Anesthesia services in Level I trauma centers are available in-house 24 hours a day. |
TYPE I |
| ∙ |
11 |
11-5 When anesthesiology chief residents or CRNAs are used to fulfill availability requirements, the staff anesthesiologist on call is (1) advised, (2) promptly available or all times, and (3) present for all operations. |
TYPE I |
| ∙ |
11 |
11-11 All anesthesiologists taking call have successfully completed an anesthesiology residency. |
TYPE I |
| ∙ |
11 |
11-12 The anesthesia liaison has been identified. |
TYPE I |
| ∙ |
11 |
11-15 The operating room is adequately staffed and immediately available. In a Level 1 trauma center, this criterion is met by having a complete operating team in the hospital at all times, with individuals who are dedicated only to the operating room. SEE FAQ |
TYPE I |
| ∙ |
11 |
11-17 There is a mechanism for providing additional staff for a second operating room when the first operating room is occupied. |
TYPE I |
| ∙ |
11 |
11-20 The operating room has the essential equipment. |
TYPE I |
| ∙ |
11 |
11-21 Trauma centers have the necessary equipment for a craniotomy. |
TYPE I |
| ∙ |
11 |
11-24 The PACU has qualified nurses available 24 hours per day as needed during the patient's post-anesthesia recovery phase. |
TYPE I |
| ∙ |
11 |
11-26 (I, II, III) The PACU has the necessary equipment to monitor and resuscitate patients. |
TYPE I |
| ∙ |
11 |
11-28 Radiologists are promptly available, in person or by teleradiology, when requested, for the interpretation of radiographs, performance of complex imaging studies, or interventional procedures. |
TYPE I |
| ∙ |
11 |
11-36 Conventional radiography and CT are available in all trauma centers 24 hours per day. |
TYPE I |
| ∙ |
11 |
11-37 There is an in-house radiographer at Level I and II trauma centers. SEE FAQ |
TYPE I |
| ∙ |
11 |
11-38 In a Level I trauma center, there is an in-house CT technologist. |
TYPE I |
| ∙ |
11 |
11-40 Conventional catheter angiography and sonography are available 24 hours per day. |
TYPE I |
| ∙ |
11 |
11-43 There is a surgically directed ICU physician team. |
TYPE I |
| ∙ |
11 |
11-47 Physician coverage of critically ill trauma patients must be promptly available 24 hours per day. |
TYPE I |
| ∙ |
11 |
11-48 Physicians must be capable of a rapid response to deal with urgent problems as they arise in critically ill trauma patients. |
TYPE I |
| ∙ |
11 |
11-53 The trauma service retains responsibility for patients and coordinates all therapeutic decisions appropriate for its level. |
TYPE I |
| ∙ |
11 |
11-54 The trauma surgeon is kept informed of and concurs with major therapeutic and management decisions made by the ICU team. |
TYPE I |
| ∙ |
11 |
11-55 The patients in Level I facilities have in-house physician coverage for ICU at all times. SEE FAQ FOR 11.56 |
TYPE I |
| ∙ |
11 |
11-58 A qualified nurse is available 24 hours per day to provide care during the ICU phase. |
TYPE I |
| ∙ |
11 |
11-60 The ICU has the necessary equipment to monitor and resuscitate patients. |
TYPE I |
| ∙ |
11 |
11-61 Intracranial pressure monitoring equipment is available. |
TYPE I |
| ∙ |
11 |
11-63 Level I facilities must have a full spectrum of surgical specialists available. (orthopaedic surgery, neurosurgery, cardiac surgery, thoracic surgery, hand surgery, microvascular surgery, plastic surgery, obstetric and gynecologic surgery, ophthalmology, otolaryngology, and urology) |
TYPE I |
| ∙ |
11 |
11-70 A respiratory therapist is available to care for trauma patients 24 hours per day. |
TYPE I |
| ∙ |
11 |
11-75 Laboratory services are available 24 hours per day for the standard analyses of blood, urine, and other body fluids, including microsampling when appropriate. |
TYPE I |
| ∙ |
11 |
11-76 The blood bank must be capable of blood typing and cross matching. |
TYPE I |
| ∙ |
11 |
11-77 The blood bank must have an adequate supply of red blood cells, fresh frozen plasma, platelets, cryoprecipitate, and appropriate coagulation factors to meet the needs of injured patients. |
TYPE I |
| ∙ |
11 |
11-78 The capability for coagulation studies, blood gases, and microbiology must be available 24 hours a day. |
TYPE I |
| ∙ |
12 |
12-2 The hospital must provide physical therapy services. |
TYPE I |
| ∙ |
15 |
15-1 Trauma registry data are collected and analyzed. |
TYPE I |
| ∙ |
16 |
16-1 The trauma center demonstrates a clearly defined PIPS program for the trauma population. |
TYPE I |
| ∙ |
16 |
16-2 The PIPS program is supported by a reliable method of data collection that consistently gathers valid and objective information necessary to identify opportunities for improvement. |
TYPE I |
| ∙ |
16 |
16-5 The process of analysis occurs at regular intervals to meet the needs of the program. |
TYPE I |
| ∙ |
16 |
16-6 The results of analysis define corrective strategies. |
TYPE I |
| ∙ |
16 |
16-7 The results of analysis and corrective strategies are documented. |
TYPE I |
| ∙ |
16 |
16-8 The trauma program is empowered to address issues that involve multiple disciplines. |
TYPE I |
| ∙ |
16 |
16-9 The trauma program has adequate administrative support and defined lines of authority that ensure comprehensive evaluation of all aspects of trauma care. |
TYPE I |
| ∙ |
16 |
16-10 The trauma program has a medical director with the authority and administrative support to lead the program. |
TYPE I |
| ∙ |
16 |
16-11 The trauma medical director has sufficient authority to set the qualifications for the trauma service members. |
TYPE I |
| ∙ |
16 |
16-12 The trauma medical director has sufficient authority to recommend changes for the trauma panel based upon performance reviews. |
TYPE I |
| ∙ |
16 |
16-13 Identified problem trends undergo multidisciplinary peer review by the Trauma Peer Review Committee. |
TYPE I |
| ∙ |
16 |
16-14 The trauma center is able to separately identify the trauma patient population for review. |
TYPE I |
| ∙ |
16 |
16-15 There is a process to address trauma program operational issues. |
TYPE I |
| ∙ |
16 |
16-16 There is documentation reflecting the review of operational issues and, when appropriate, the analysis and proposed corrective actions. |
TYPE I |
| ∙ |
16 |
16-17 The process identifies problems. |
TYPE I |
| ∙ |
16 |
16-18 The process demonstrates problem resolution (loop closure). |
TYPE I |
| ∙ |
16 |
16-19 There is a trauma multidisciplinary peer review committee with participation by the trauma medical director or designee and representatives from general surgery, orthopaedic surgery, neurosurgery, emergency medicine, and anesthesia. |
TYPE I |
| ∙ |
16 |
16-25 Deaths are systematically categorized as preventable, non-preventable, or potentially preventable. |
TYPE I |
| ∙ |
16 |
16-26 When a consistent problem or inappropriate variation is identified, corrective actions are taken and documented. |
TYPE I |
| ∙ |
17 |
17-5 The Level I trauma center provides a continuous rotation in trauma surgery for senior residents that is part of an Accreditation Council for Graduate Medical Education- accredited program in any of the following disciplines: general surgery, orthopaedic surgery, or neurosurgery; or supports an acute care surgery fellowship consistent with the educational requirements of the American Association for the Surgery of Trauma. SEE FAQ |
TYPE I |
| ∙ |
6 |
6-1 The trauma medical director has responsibility and authority to ensure compliance with verification requirements. |
TYPE I |
| ∙ |
11 |
11-46 The trauma surgeon remains in charge of patients in the ICU. |
TYPE I |
