by Tony Peregrin
Road to Recovery—the theme of the 2023 Trauma Quality Improvement Program (TQIP) Annual Conference—refers to the trauma patient’s care trajectory from the intensive care unit to post-discharge.
The conference, which took place December 1–3 in Louisville, KY, featured educational programming tethered to the meeting’s theme, including presentations describing clinical best practices, the value of ACS Quality Programs, and a powerful story of trauma survivorship.
"We have more than 1,800 attendees in the audience, and that just speaks to the commitment you have to the care of the injured patient," said Avery B. Nathens, MD, PhD, MPH, FACS, FRCSC, Medical Director of ACS Trauma Quality Programs. He gave an update on TQIP initiatives, including best practices and protocols, a renewed focus on rural trauma, the patient-reported outcomes pilot, and more.
The new Executive Session—developed with hospital quality thought-leaders in mind—highlighted the value of ACS Quality Programs, including the trauma center verification program, and provided insights on the ACS Power of Quality Campaign presented by ACS Executive Director and CEO Patricia L. Turner, MD, MBA, FACS.
"There are more than 1,200 hospitals participating in our Quality Programs that are already displaying the ACS Surgical Quality Partner (SQP) diamond plaques," said Dr. Turner. "By October 2024, we aim to have the SQP diamond in 2,500 US hospitals."
This session also outlined the value of ACS compared to Vizient with a look at clinical versus claims databases; examined the "halo effect" of a trauma center on the rest of the hospital’s quality improvement projects; and discussed best approaches for achieving hospital buy-in to support trauma programs.
Closing out the Executive Session, Dr. Turner quoted Aristotle: "Quality is not an act, it is a habit. This is something that all of you do. You are in many ways our best ambassadors."
Illustrating the collaborative role and function of the entire trauma care team, this year’s session featured Tate and his mother Nicole Reynolds, who shared the story of Tate’s remarkable recovery after leaping over the back of a couch and landing on a misplaced steak knife. Tate, 11 years old at the time, coded three times—his aorta sliced in half through a kidney, the knife lodged into his spine.
Anne Rizzo, MD, FACS, who was Tate’s attending surgeon at Inova Fairfax Hospital in Falls Church, VA, moderated the session and shared her perspective as a trauma care provider.
Dr. Rizzo described trauma surgery as "the ultimate puzzle" that requires all of the pieces to work together correctly. "It was just about at shift change. We had the crew that was basically getting ready to go home—they stayed. The new crew came in and they assisted as well so we actually had two crews of people working for hours to keep this boy alive."
"When Tate came in and I looked at his initial x-ray as we were rushing him to the operating room, I thought ‘Oh my god, I don't know that I can save this boy because that knife was in the center of his ability to live," said Dr. Rizzo in a video developed by the Inova Health Foundation and presented during the session.
Despite the severity of his injuries, Tate is alive today due to the optimal care he received from Dr. Rizzo and the entire trauma care team.
Panelists described the ACS QI Framework, which is a comprehensive tool designed to help team members plan, conduct, evaluate, and report on QI projects.
According to a study published in the Journal of the American College of Surgeons in 2022 that examined 50 ACS Quality Programs QI efforts, only 36% were fulfilled and 44% achieved none of their goals. Lillian Kao, MD, FACS, described how using the ACS QI Framework, which is organized into eight domains with 39 criteria items, can help QI teams identify problems, develop a strategic plan, and engage in project evaluation.
Three "Quality Framework in action" presenters shared how their hospitals used the ACS QI Framework to enhance performance and outcomes specifically regarding unplanned intensive care unit admissions; goals of care conversations with elderly trauma patients; and decannulation rates in trauma patients.
"There has been an exponential increase in traumatic brain injury (TBI) data since 2015," said J. Claude Hemphill, MD, MAS, referring to the year the TBI Best Practice Guidelines were originally published. The soon-to-be-released updated guidelines feature input from every specialty that manages TBI care, from triage to follow-up and recovery, and includes new or expanded content sections on the following topics: blood-based biomarkers, tiered management of intracranial pressure, prognostic assessment and family communication, pharmacological management, and more. Presenters also discussed strategies for implementing these (or any of the TQP Best Practices Guidelines) into trauma centers.
The 2023 TQIP Annual Conference on-demand content (General and Breakout Sessions) will be available to both in-person and on-demand registrants in mid-January 2024.
The 2024 TQIP Annual Conference will take place November 12–14, in Denver, CO.