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Preparation and Achievement of American College of Surgeons Level I Trauma Verification Raises Hospital Performance and Improves Patient Outcome

DiRusso, Stephen MD, PhD; Holly, Cheryl RN, PHD; Kamath, Ranishanker MD; Cuff, Sara RN; Sullivan, Thomas BS; Scharf, Helga; Tully, Ted BA; Nealon, Peter BA; Savino, John A. MD

Journal of Trauma and Acute Care Surgery: August 2001 - Volume 51 - Issue 2 - p 294-300
Annual Meeting Articles

Objective The purpose of this study was to assess the impact on patient outcome and hospital performance of preparing for and achieving American College of Surgeons (ACS) Level I trauma verification.

Methods The center was a previously designated state regional trauma center located adjacent to a major metropolitan area. Preparation for ACS verification began in early 1996 and was completed in early 1998. Final verification took place in April 1999. Data were analyzed before (1994) and after (1998) the process. There was a marked increase in administrative support with trauma named one of the hospital’s six centers of excellence. Two full-time board-certified trauma/critical care surgeons were added to the current six trauma surgeons. Their major focus was trauma care. Trauma support staff was also increased with case managers, a trauma nurse practitioner, additional trauma registrars, and administrative support staff. Education and continuous quality improvement were markedly expanded starting in 1996.

Results There were 1,098 trauma patients admitted in 1994, and 1,658 in 1998. Overall mortality decreased (1994, 7.38%; 1998, 5.37%;p < 0.05). There was a marked decrease in mortality for severely injured (Injury Severity Score > 30) patients (1994, 44% mortality [38 of 86]; 1998, 27% [22 of 80];p < 0.04). Average length of stay also decreased (1994, 12.22 days; 1998, 9.87 days;p < 0.02). This yielded an estimated cost savings for 1998 of greater than $4,000 per patient (total saving estimate of $7.4 million).

Conclusion Trauma system improvement as related to achieving ACS Level I verification appeared to have a positive impact on survival and patient care. There were cost savings realized that helped alleviate the added expense of this system improvement. The process of achieving ACS Level I verification is worthwhile and can be cost effective.

From the Department of Surgery, New York Medical College and Westchester Medical Center (S.M.D., C.H., S.C., T.S., H.S., T.T., P.N., J.A.S.), Valhalla, New York, and University Hospital, University of Missouri Hospital-Columbia (R.K.), Columbia, Missouri.

Submitted for publication October 30, 2000.

Accepted for publication April 10, 2001.

Supported, in part, by an unrestricted grant from the Institute of Trauma and Emergency Care, New York Medical College, Valhalla, New York, and a multiyear grant from the New York State Department of Health for a demonstration project on trauma quality assurance.

Presented at the 60th Annual Meeting of the American Association for the Surgery of Trauma, October 11–15, 2000, San Antonio, Texas.

Address for reprints: Stephen DiRusso, MD, PhD, Department of Surgery, New York Medical College, Valhalla, NY 10595;

© 2001 Lippincott Williams & Wilkins, Inc.