Preparation and achievement of American College of Surgeons Level I traumaverification raises hospital performance and improves patient outcome

Objective. The purpose of this study was to assess the impact on patient ou tcome and hospital performance of preparing for and achieving American Coll ege of Surgeons (ACS) Level I trauma verification. Methods. The center was a previously designated state regional trauma cente r located adjacent to a major metropolitan area. Preparation for ACS verifi cation began in early 1996 and was completed in early 1998. Final verificat ion took place in April 1999. Data were analyzed before (1994) and after (1 998) the process. There was a marked increase in administrative support wit h trauma named one of the hospital's six centers of excellence. Two full-ti me board-certified trauma/critical care surgeons were added to the current six trauma surgeons. Their major focus was trauma care. Trauma support staf f was also increased with case managers, a trauma nurse practitioner, addit ional trauma registrars, and administrative support staff. Education and co ntinuous quality improvement were markedly expanded starting in 1996. Results: There were 1,098 trauma patients admitted in 1994, and 1,658 in 19 98. Overall mortality decreased (1994, 7.38%; 1998, 5.37%; p < 0.05). There was a marked decrease in mortality for severely injured (Injury Severity S core > 30) patients (1994, 44% mortality [38 or 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 gre ater than $4,000 per patient (total saving estimate of $7.4 million). Conclusion. Trauma system improvement as related to achieving ACS Level I v erification 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 verificati on is worthwhile and can be cost effective.