The American College of Surgeons Trauma Quality Improvement Program

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Why evolve? a history of trauma performance improvement and a place for ACS TQIP

Continuous quality improvement is an integral component of trauma center care. This striving for high-quality care is complex, given the nuances in defining quality. In 1966, Avedis Donabedian,1 the renowned public health pioneer, described 3 distinct aspects of quality in health care: outcome, process, and structure. Outcome measures were challenging as a sole indicator of quality, given that in many cases outcomes might not be modifiable. Alternatively, “a particular outcome might be

A case for ACS TQIP

The ACS TQIP was conceived in 2008 through a small working group assembled by the ACS Committee on Trauma. Its goal was to build on the foundations and infrastructure of trauma performance improvement as laid out in the ACS Optimal Resources Guide for Care of the Injured Patient and by the Committee on Trauma Subcommittees (Performance Improvement and Patient Safety, National Trauma Data Bank, Verification), local performance improvement activities, and national initiatives such as the Society

From ACS NSQIP to TQIP

Simply incorporating trauma patients into NSQIP was not possible. ACS NSQIP had created a data infrastructure where none previously existed. In addition, it required a well-trained surgical clinical reviewer to collect and submit data. By contrast, each trauma center had a trauma registry, a team of registrars to collect the data, and a means of aggregating these data through the National Trauma Data Bank. To avoid creating a parallel data infrastructure and costly duplication, it was decided

Challenges to the development and implementation of ACS TQIP

To be successful, a large national collaborative requires interested participants. The success of ACS NSQIP and the long-standing interest in performance improvement in the trauma community assured that there was a place for ACS TQIP. However, the 2 fundamental challenges in moving forward related to data quality and risk adjustment to address differences in case mix across centers. Each of these challenges and solutions are now described.

Current state of ACS TQIP

Now entering its third year, ACS TQIP has more than 120 participating centers. The components of ACS TQIP have evolved considerably through lessons learned in the pilot and the authors’ early experiences (Fig. 4). The authors have standardized inclusion criteria to ensure that case ascertainment is similar across the centers to include all adults (age ≥16 years) with an ISS of 9 or more, exclusive of patients with advanced directives to withhold life-sustaining interventions. Elderly patients

Future initiatives in ACS TQIP

The development and successful implementation of ACS TQIP has paved the way for several initiatives, including the identification and promulgation of best practices, and the creation of regional collaboratives.

Summary

ACS TQIP provides participating centers with risk-adjusted benchmarking data. The information received through quarterly reports is focused and directed, and thus actionable. The collaborative nature of the program allows for the sharing of best practices and the identification of novel approaches to care for the injured. Smaller, regional collaboratives will further enable the sharing of implementation strategies that are practical and translatable to the local environment.

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