Analysis of American College of Surgeons trauma consultation program
F. L. Mitchell, E. R. Thal and C. C. Wolferth
Department of Surgery, University of Missouri, Columbia, USA.
OBJECTIVE: To identify the criteria deficiencies found during peer
consultation of hospitals and the relationship to subsequent verification.
METHODS: Between September 1987 and December 1992, 52 hospitals had
consultation visits using American College of Surgeons criteria. Each
report was studied for deficiencies, frequency of deficiencies, and
relationship to verification. RESULTS: There are 108 American College of
Surgeons criteria. Thirty-five different criteria deficiencies were found.
The number of deficiencies per hospital ranged from zero to 12. The more
frequent deficiencies included a lack of the following: quality
improvement, 35 (67%); trauma service, 20 (38%); trauma surgeon in
emergency department, 20 (38%); 24-hour operating room availability, 17
(33%); trauma registry, 17 (33%); trauma continuing medical education, 16
(31%); trauma director, 15 (29%); computed tomography technician in
hospital, 15 (29%); research, 14 (27%); trauma coordinator, 14 (27%); and
neurosurgeon availability, 13 (25%). No hospital that lacked commitment of
surgeons (n = 12) or hospital (n = 3) requested a verification visit.
Twenty-four hospitals (46%) achieved verification by February 1994.
Twenty-eight hospitals had six or fewer deficiencies, with 19 (68%)
verified. Twenty-four hospitals had seven or more deficiencies, with only
five (21%) subsequently verified. Verification visits followed consultation
by 3 to 52 months. Two hospitals with nine deficiencies were verified after
30 and 48 months, although one failed its first verification visit.
CONCLUSIONS: American College of Surgeons consultation assists hospitals to
identify their trauma center capability and appears to improve their
ability to pass subsequent trauma center verification. Most criteria
deficiencies are correctable. Lack of commitment by the surgeons or
hospital is difficult to correct. There is an inverse relationship between
the number of deficiencies and subsequent verification.