MSS10: IMPROVED OUTCOMES FOR TRAUMA PATIENTS IN A MILITARY TREATMENT FACILITY AFTER INITIATION OF AN AMERICAN COLLEGE OF SURGEONS VERIFIED TRAUMA PROGRAM
Thomas A O'Hara, DO; Cassandra L Cardarelli, MD; Ashley A Faircloth, RN; Byron J Faler; Dwight D. Eisenhower Army Medical Center
Objectives: The National Defense Authorization Act of 2017 indicated the need for a national strategy in improve trauma care amongst Military Treatment Facilities (MTF). Part of the proposed strategy to improve trauma outcomes was to convert identified MTFs into verified trauma centers. The American College of Surgeons (ACS) verifies trauma centers through an evaluation process based on available resources at a facility. It has been proven that trauma centers, specifically those verified by ACS, have improved trauma outcomes1,2. In 2017, we implemented steps to become a level III trauma program, according to the standards for designation by the state and verification through the ACS. The goal of this retrospective review is to evaluate the impact of this implementation with regards to both patient care and the MTF.
Methods: Outcome data from a single-MTF trauma registry from 2017 at the initiation of the trauma program to present were reviewed. Outcomes were selected based upon the ACS verification criteria. Specifically, emergency room length of stay (ER LOS), time to CT scan, non-surgical admissions, Injury Severity Score (ISS), diversion rates, and time to operating room were reviewed.
Results: ER LOS decreased after implantation of the trauma program, from an average of 6.5 hours in 2018 to 4.6 hours in 2020. Non-surgical admissions decreased from 57.8% in 2018 to 5.8% in 2020. ISS increased, with a 500% increase in ISS scores 16-24 and 200% increase in ISS scores 25-40 from 2019 to 2020. Diversion rates also decreased, from >5% in 2018 to 1.84% in 2020. Time to OR for trauma activations decreased from 78 minutes in 2018 to 58 minutes in 2020.
Conclusions: The establishment of a trauma program in accordance to the standards of the American College of Surgeons for verification improved metrics of care for trauma patients at our MTF. This implementation as part of the local trauma system may also lead to increased injury severity seen by the MTF which enhances readiness for its providers.
References:
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Schubert FD, Gabbe LJ, Bjurlin MA, Renson A. Differences in trauma mortality between ACS-verified and state-designated trauma centers in the US. Injury. 2019 Jan;50(1):186-191. doi: 10.1016/j.injury.2018.09.038. Epub 2018 Sep 21. PMID: 30266293.