15 Years of TQIP Excellence Fuels a Future Driven by Teamwork

The 15th anniversary of the Trauma Quality Improvement Program (TQIP) and its Annual Conference held November 8–10 in Chicago, Illinois, commemorated the trauma community’s long-standing commitment to providing exceptional patient care and improving outcomes.

The conference—which featured impactful trauma survivor stories alongside expert presentations on implementing clinical best practices and advancing quality improvement initiatives—drew 2,640 registrants, with 2,161 in-person and approximately 500 for the virtual program. On-demand registration is open until April 10, 2026.

TQIP Update

What started as a pilot program 15 years ago, TQIP now includes 955 trauma centers, with more than 1.4 million records collected and analyzed every year. As it stands today, the program is a pillar of optimal trauma patient care.

“We officially started TQIP in 2010, with 65 hospitals—and we have learned a lot from all of you, specifically how your teams solve complex problems in order to provide the highest level of care for your patients,” said Avery B. Nathens, MD, PhD, MPH, FACS, FRCSC, Medical Director of ACS Trauma Quality Programs, to a packed opening ceremony crowd.

Prior to TQIP, the traditional approach to trauma quality improvement activities included identifying sentinel events, comparing the current year’s performance to the previous year, and a focus on case reviews—but these factors fell short of providing insights into maintaining quality of care, which at that time, simply reflected consistency rather than high levels of performance.

“This was the context under which we developed TQIP. Before that, these were patients who had no choice and no voice,” he said, noting that with valid, standardized data, risk-adjusted performance measurement, and other key components of TQIP, patient care was poised to improve.

“Our goal, when we started, was to really understand how we could help centers that were struggling to improve the quality of care they delivered,” he said, which included examining what Dr. Nathens called “unwitting innovators.”

“These were very high performing centers that had no idea they were doing something unique and special to enhance trauma care—and we made sure you had, and continue to have, access to that information so that you can do the best for your patients,” he explained.

Dr. Nathens introduced the conference theme, “Team Works,” by posing a question to the audience: “What do slime molds, starlings, and seals have in common?” He noted that slime molds (microscopic organisms) “demonstrate remarkable teamwork through decentralized, self-organized behavior in response to an adverse environment.”

Notably, these organisms do not have a leader. “So, it’s like having a team of players where each individual instinctively knows what to do. Imagine if we had trauma teams like that.”

Starlings are another example of teamwork in the form of a collective intelligence because they achieve complex, coordinated movements to evade predators through trust, the ability to adapt, and rapid flow of information (signaling) allowing them to move as a single, synchronized unit.

US Navy SEALs—an elite special operations force trained for sea, air, and land missions—exemplify trust built on shared challenging training experiences and a team-based approach that prioritizes character and commitment over individual performance.

“The individuals who are high performers with low trust are toxic individuals. It might be tempting to include them, but they are ultimately going to undermine overall team performance,” explained Dr. Nathens, citing evidence that supports trust in teams as a driver of resilience and, for patient care teams, improved patient outcomes.

“Slime molds, starlings, and SEALs all represent the fact that the whole is greater than the sum of its parts—they all have greater impact working together,” he said.

Dr. Nathens also focused on TQIP program updates, beginning with new developments concerning trauma activation fees. He noted that it costs approximately $10 million per year for a Level I trauma center to ensure preparedness and that trauma activation fees cover about 72% of the costs for these centers.

In June 2024, the ACS released a Statement on Trauma Activation Fees, which calls for these fees to be public and transparent and to be applied only to designated/verified trauma centers, among other stipulations.

In September 2025, the Office of Inspector General (OIG), with the US Department of Health and Human Services, issued a report examining hospital compliance with federal requirements for trauma activation fees. Dr. Nathens outlined future recommendations issued by the OIG and the response to each proposed action item from the Centers for Medicare & Medicaid Services (CMS).

The ACS Committee on Trauma (COT) is in agreement with two CMS responses: CMS will review guidance for trauma team activation, and the agency will review the need for additional education regarding federal requirements.

In the area of performance improvement and patient safety, he provided updates to the Trauma Protocols Repository (blunt splenic injury, nutritional support, and sedation/analgesia are all currently in development), the Mortality Reporting System, and the Best Practices Guidelines (BPG), including Chest Wall Injuries Management guidelines, released in November 2025, which address:

• Surgical stabilization of rib fractures
• Multimodal pain management
• Optimal timing for surgery
• Special Populations (including older adult trauma patients and patients who have sustained multiple traumatic injuries)
• Postoperative and rehabilitation care

A new BPG addressing transfusion in trauma is expected to be released in 2026.

A key priority for the ACS COT continues to be rural trauma care. Injury-related mortality is up to five times greater in rural communities, and rural patients are 40% more likely to die within the first 24 hours after surgery. “Where you live determines whether you live or die after injury,” said Dr. Nathens.

After conducting a rural needs assessment (interviews, focus groups, and a web-based survey), ACS COT leaders are focusing on three key areas: hospital standards/guidelines, performance improvement, and education. A key component of educating and supporting rural trauma providers will be the upcoming publication of the Rural Trauma Team Development Course, Fifth Edition, which emphasizes a systemic, team approach in the initial assessment and stabilization of the injured patient.

Peak Performance Takes Center Stage

This year’s annual conference featured presentations with different perspectives and approaches for achieving optimal performance and sustaining long-term wellness.

In his keynote address, coach Donnie Campbell—the real-life inspiration for the television character Ted Lasso—urged attendees to discover their "MVP," which is their mission, values, and principles, in order to harness the potential of both the individuals and teams with which they work.

With 36 years of coaching experience, Coach Campbell developed championship teams and mentored future NBA stars by exhibiting an authentic leadership style driven by empathy and the ability to hold others accountable for their actions both on and off the court.

“What does it mean to be a true coach or a true leader? For me, it’s someone who sees the potential in others and does everything they can to guide, inspire, and motivate the team to be successful,” said Coach Campbell. “When I first started coaching, I didn’t know that. I was focused on one thing only—winning. I want you to think of the toughest coach you ever had and multiply that by 10, because that was me. I worked those kids long and hard. No one was going to keep us from that state title. And after getting them so prepared for that first season, I led our team to a 3 and 18 record. That season didn’t go very well.”

The first step to finding success after failure, according to Campbell, is to act like a goldfish.

"You know what the happiest animal on Earth is? It's a goldfish. You know why? It's got a 10-second memory. Be a goldfish,” he said, quoting a line from Ted Lasso. “I did not invent this quote—they’ve got better writers than me on the show. But I always told my players to handle mistakes by recognizing them, admitting them, learning from them, and then moving on.”

Learning from past mistakes can enhance how trauma teams work together, as can developing shared values that are tethered to treating others with respect, he said.

“You can develop anybody in the ER to be really skilled at what they do, as I did with my basketball players, but that doesn’t mean they are going to work well together. If you develop your team to be good people first, then that will sustain success,” Campbell shared.

Strategic Team Building for Lasting Results

Developing a sustainable team framework is a wise investment that supports cost effective and quality-based trauma care.

“There are objective metrics that can help establish teamwork,” said Patricia L. Turner, MD, MBA, FACS, ACS Executive Director and CEO. “Team familiarity and the time the team has worked together, the number of words exchanged between teammates, and perception of teamwork, belonging, and satisfaction have all been assessed as markers for effective teamwork.“

After building an effective team, there are measurables that can help determine how well the team is actually performing, including:

• Time from patient presentation to OR
• Case length
• Team preparedness
• Complication rates
• Length of stay
• Costs

Dr. Turner outlined multiple scales that have been developed recently that provide quantifiable assessment of nontechnical skills in the OR, including Observational Teamwork Assessment for Surgery, Non-Technical Skills for Surgeons, Scrub Practitioners’ List of Intraoperative Non-Technical Skills, and others.

“Strong, healthy teams are essential for what we do. Everyone in our OR is a teammate, and everyone's role is critically important,” said Dr. Turner. “The more we acknowledge and lean into that kind of conversation, the better off we are.”

Paula Ferrada, MD, FACS, from Inova Fairfax Medical Campus in Woodburn, Virginia, described the impact that TeamSTEPPS—an evidence-based program designed to improve patient safety and care quality—has had at her institution.

“We know from the literature that blaming and shaming others is inversely proportional to accountability,” she said. “TeamSTEPPS is a proven system that builds a culture of safety where you're safe to speak up and say what you believe, feel, and think.”

The five principles of TeamSTEPPS are team structure, communication, leadership, situation monitoring, and mutual support. These principles are designed to enhance team collaboration and patient safety, particularly within healthcare settings.

“When you are in a setting where there's less judgment and more curiosity and more humility, we can help each other grow and keep the patient at the center. Alone, we can do so little. But together, we can do so much,” she said.

In a presentation that outlined strategies for building optimal trauma staffing models, Stephanie Bonne, MD, FACS, urged attendees to consider the “one size does not fit all approach to staffing,” and that all such models should be data driven.

Dr. Bonne noted that “divisional productivity should be the goal,” referring to a concept that optimizes the mix of medical professionals (i.e., surgeons, physicians, nurses and others) to effectively meet patient demand.

The final presentation approached sustainable team building through the recruitment and retention of advanced practice providers (APPs).

Kimberli Bruce, ACNP-BC, a trauma nurse practitioner, described the expanding role of APPs—nurse practitioners and physician assistants—in trauma programs, noting that 88% of US trauma centers now employ APPs. Read the October Bulletin article, “APPs Play Critical Role in Supporting Trauma Teams,” for more insight on this topic.

Bruce noted wide variation in this role’s integration, training, and professional development within the trauma setting, and called for enhanced, formalized onboarding policies and standardized trauma education and certification to ensure baseline competencies.

Beyond clinical duties, she advocated for APP involvement in leadership, education, and quality improvement to foster engagement and retention. “Once you account for recruiting fees, paying overtime to the rest of the crew, and other costs, replacing one APP can cost between $50,000 and $90,000, which is why investing in trauma-specific professional development for this role pays for itself,” said Bruce.

Trauma-Informed Care Through Patient Storytelling

This year’s trauma survivor address was presented by Bri Scalesse, a content creator, disability advocate, and fashion model who survived a motor vehicle crash at the age of 6 that killed her mother and left her with a complete T12 spinal cord injury.

“This is a story about my body,” said Scalesse. “From the moment my small body was pulled out of the car and transported to Connecticut Children’s Medical Center [in Hartford] in April 2001, my body was no longer mine—it was the hospital’s body. The 74 days that followed felt like an endless stream of men and women in colorful scrubs,” she said, noting that she “wished someone would pay attention to what she wanted, not simply what her body needed.” 

Through a combination of her own resilience and the unwavering support of her healthcare providers, Scalesse began to appreciate how her recovery was made possible.

“My favorite nurses were so gentle, kind, and silly,” she said, later adding that these individuals “tried to make it fun for me—which might sound trivial to people who do this kind of work every day—but being able to play my boom box, play with Barbies, have butterflies on the wall above me—all of those things were so meaningful to me as a 6-year-old girl who just needed a sense of play, some sense of normalcy.”

During the session Q&A—moderated by Brendan Campbell, MD, MPH, FACS, who was her physician for many years—Scalesse pointed out that adult trauma patients yearn for an emotional connection as much as pediatric patients do.

“Take a second and just breathe,” she said, addressing the trauma care providers in the room. “Say to yourself, ‘I’m going to take this moment with them. I’m going to show up. I’m going to try and understand where they are with all of this.’”

Unable to find any representation of disabled individuals like herself in the mass media, Scalesse eventually pursued a modeling career, and in 2020, participated in the Project Runway finale during New York Fashion Week. She has since appeared in advertisements for Nike, Skims, Victoria’s Secret, and other companies. She also holds a bachelor’s degree in English from Trinity College in Hartford, Connecticut, and a Master of Fine Arts degree in nonfiction from Columbia University in New York City.

Scalesse admitted her favorite experiences as a model have little to do with the allure and excitement of the fashion world: “One of my favorite moments was when a teenage girl wrote to me to tell me how much seeing one of my ads meant to her. ‘Your visibility is one of the biggest reasons why I started to feel a relationship with my disabled body. Representation isn’t just about inclusion. It’s about young people being able to see what is possible for their own lives.’”

Family-Centered Trauma Care

A panel featuring a mother and daughter who overcame a domestic violence situation was the focus of the other trauma survivor session. Organized in collaboration with the Trauma Survivors Network (TSN), this session offered strategies for how trauma teams can more effectively integrate patients’ families into care and recovery.

In September 2011, Erin Cobb was shot twice by her ex-husband. The bullets shattered her jaw and pierced her carotid artery, leaving a lung partially collapsed and causing paralysis from the chest down.

Erin’s mother, Janet Andersen, managed her daughter’s recovery, which included multiple jaw surgeries, pressure-related wounds, and an exhaustive rehabilitative care plan.

“When I first showed up at hospital, the doctor said, ‘We think she is paralyzed,’ and then he disappeared,” said Andersen. “My ex-husband and I looked at each other [in stunned silence]…we were left to figure things out on our own.”

While both mother and daughter relied heavily on each other for emotional support, trauma survivor peer support also helped them navigate the rehabilitation process.

“The whole trauma survivors system was such a gift,” added Andersen. “Although, it would have made a huge difference in the recovery of my daughter if had we had known about these services earlier. I think it would have cut off an entire year of her recovery.” Today, Andersen is a volunteer for the TSN and the Reeve Foundation Peer & Family Support Program.

Karen Macauley, DHA, Med, BSN, TCRN, CEN, director of the pediatric trauma program at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, described how trauma care providers, though acts of compassion, can empower patients and families to determine their goals for recovery.

“It takes less than 40 seconds to be kind,” she said, citing the book Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference. “The research shows that compassion improves patient outcomes, reduces healthcare costs, and helps prevent healthcare provider burnout.”

She also shared that compassionate behavior can be learned, and the art (compassion) and science (clinical care) of medicine function optimally when they are employed in tandem.

According to panelist Jessie Levy, LCDW, trauma support services program manager at Atrium Health in Charlotte, North Carolina, up to 48% of parents experience post-traumatic stress disorder after a child is injured, and as many as 42.6% of family members experience moderate to severe anxiety and depression after such an event.

In an effort to reduce caregiver stress, Levy said caregivers require an honest prognosis, daily updates, and reassurance and hope. She emphasized the benefits of peer-support connections brokered by TSN and other organizations that can help family members manage distress and adjust to their new roles as caregivers.

The 2026 TQIP Annual Conference will take place November 13–15, in Anaheim, California.

Tony Peregrin is the Managing Editor, Special Projects in the ACS Division of Integrated Communications in Chicago, IL.