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Trauma Systems Development: An ACS Perspective

523,780 patients 18 statesJ.Trauma 2004. 360,743 patients - CaliforniaJACS 2003. American College of Surgeons. American College of SurgeonsCOMMITTEE ON TRAUMA Consultation Program for Trauma Systems . facs.org . American College of Surgeons. American College of SurgeonsCOMMITTEE ON TRAUMA Consultation Program for Trauma Systems .

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Trauma Systems Development: An ACS Perspective

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    1. Trauma Systems Development: An ACS Perspective

    7. Leadership System Development Legislation Finances Injury Prevention & Control Human Resources workforce / education 1992 MTCSP: What a system IS.

    8. 2006 Model Trauma System Planning and Evaluation: What a system DOES.

    10. ACS-COT Trauma Systems Evaluation

    12. Trauma Systems: Common Problems Reluctance to use enabling legislation Inconsistent or non-integrated leadership Unauthorized leadership Absent or ineffective state (STACs) or regional advisory committees (RTCC) Trends towards exclusive systems no resources, commitment, interest lack of consistent specialty availability over-triage, over-transfer to designated centers

    13. Trauma Systems: Common Problems Lack of funding: system & under-compensated care No comprehensive trauma plan Limited (or non-existent) system-based PI Limited regional organization & participation by NTC facilities Ends of the spectrum poorly integrated (silo’ing) : prevention & rehabilitation in particular

    14. Trauma Systems: Common Problems Structure does not allow strong medical direction for state/regional trauma sys Incomplete, inadequate MOU between sending & receiving hospitals Limited, often inadequate public and legislative education RE trauma system importance & needs various others…

    15. Access: Obstacles in trauma system participation Physician staff commitment Lifestyle: long, irregular hours, sleep deprivation Practice: opportunity costs, restriction, reimbursement, malpractice Intimidating, verification / designation requirements Lack of knowledge / experience Financial risk: Under-funded care, contractual agreements Limited transfer $$: DSH, local tax subsidies On-call fees for physicians Lack of specific state/regional funding

    16. California trauma “system” Serving disaster-prone, dispersed population Provides coverage for very urban & very rural regions County –based & de-centralized Optional – but embraced by most counties Relies on local versus regional/State-wide oversight State & many local systems under-funded State/regional structures insufficiently authorized Comprehensive, state-wide plan pending Wide variations in county trauma system configurations & practices (“inconsistencies” State-wide trauma registry pending

    17. System development Educate & build legislative & public support Establish enabling legislation Fund the system exclusive from TCs Needs assessment (link to prevention) Write comprehensive trauma plan Adopt operational standards & verification Develop oversight structures Initiate system PI plan & oversight System development driven by PI / CQI Perform external consultative review

    19. “Get a plan” (G. Cooper, ~2004)

    20. Funding the system

    21. Oversight committees

    22. Other key elements

    23. Getting started - System-wide PI will drive development

    24. System-based (versus center-based) PI Old model designed for developing systems Relies more on shared center-derived PI issues (MAC model) Focus on provider vrs. system errors Limited use of system indicators Limited focus on PI process effectiveness

    25. System-wide PI will drive development system preventable deaths access to trauma system time to definitive care triage errors failed / delayed transfers provider errors (TAC/MAC) access to rehab prevention deficiencies benchmarking for TCs

    26. Adopt standards, analyze performance Develop P&Ps transfers, re-triage, Create ‘operational’ MOUs between centers Educational ‘give-backs’ PI driven outreach Link to state registry & prevention activities ID & monitor outcome measures & benchmarks

    27. World’s seventh largest economy: we can do this.

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