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Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery,...

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Trauma Systems Development: Trauma Systems Development: An ACS Perspective An ACS Perspective Robert C. Mackersie, M.D., Robert C. Mackersie, M.D., FACS FACS Professor of Surgery, UCSF Professor of Surgery, UCSF Director, Trauma Services, Director, Trauma Services, SFGH SFGH Past Chair, ACS-COT Trauma Past Chair, ACS-COT Trauma Systems Planning & Systems Planning & Evaluation Evaluation California Trauma System Summit - 2008 California Trauma System Summit - 2008
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Page 1: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

Trauma Systems Development: Trauma Systems Development: An ACS PerspectiveAn ACS PerspectiveTrauma Systems Development: Trauma Systems Development: An ACS PerspectiveAn ACS Perspective

Robert C. Mackersie, M.D., FACSRobert C. Mackersie, M.D., FACS

Professor of Surgery, UCSFProfessor of Surgery, UCSF

Director, Trauma Services, SFGHDirector, Trauma Services, SFGH

Past Chair, ACS-COT Trauma Past Chair, ACS-COT Trauma Systems Planning & EvaluationSystems Planning & Evaluation

Robert C. Mackersie, M.D., FACSRobert C. Mackersie, M.D., FACS

Professor of Surgery, UCSFProfessor of Surgery, UCSF

Director, Trauma Services, SFGHDirector, Trauma Services, SFGH

Past Chair, ACS-COT Trauma Past Chair, ACS-COT Trauma Systems Planning & EvaluationSystems Planning & Evaluation

California Trauma System Summit - 2008California Trauma System Summit - 2008California Trauma System Summit - 2008California Trauma System Summit - 2008

Page 2: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.
Page 3: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

523,780 patients 18 states

J.Trauma 2004

523,780 patients 18 states

J.Trauma 2004

26.7

17.3

56

41.5

22

36.5

0

10

20

30

40

50

60

%

ALL TRAUMA MAJOR TRAUMA

LEVEL 1

LEVEL 2

NTC

26.7

17.3

56

41.5

22

36.5

0

10

20

30

40

50

60

%

ALL TRAUMA MAJOR TRAUMA

LEVEL 1

LEVEL 2

NTC

Page 4: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

56

44

68.1

31.9

39.7

60.3

44

56

0

10

20

30

40

50

60

70

%

All pts deaths age >55 TBI > 55

Trauma Center Non- TC

56

44

68.1

31.9

39.7

60.3

44

56

0

10

20

30

40

50

60

70

%

All pts deaths age >55 TBI > 55

Trauma Center Non- TC

360,743 patients - California

JACS 2003

360,743 patients - California

JACS 2003

Page 5: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

American College of Surgeons

American College of Surgeons

COMMITTEE ON TRAUMA Consultation Program for Trauma Systems

American College of Surgeons

COMMITTEE ON TRAUMA Consultation Program for Trauma Systems

facs.org facs.org facs.org facs.org

Page 6: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

American College of Surgeons

American College of Surgeons

COMMITTEE ON TRAUMA Consultation Program for Trauma Systems

American College of Surgeons

COMMITTEE ON TRAUMA Consultation Program for Trauma Systems

Page 7: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

LeadershipLeadership System DevelopmentSystem Development LegislationLegislation FinancesFinances Injury Prevention & ControlInjury Prevention & Control Human ResourcesHuman Resources

workforce / educationworkforce / education

LeadershipLeadership System DevelopmentSystem Development LegislationLegislation FinancesFinances Injury Prevention & ControlInjury Prevention & Control Human ResourcesHuman Resources

workforce / educationworkforce / education PrehospitalPrehospital

EMS, transport, EMS, transport, communication, disastercommunication, disaster

Definitive CareDefinitive Care TCs, transfers, rehabTCs, transfers, rehab

Information systemsInformation systems EvaluationEvaluation Research Research

PrehospitalPrehospital EMS, transport, EMS, transport,

communication, disastercommunication, disaster Definitive CareDefinitive Care

TCs, transfers, rehabTCs, transfers, rehab Information systemsInformation systems EvaluationEvaluation Research Research

1992 MTCSP: What a system 1992 MTCSP: What a system IS.IS.

1992 MTCSP: What a system 1992 MTCSP: What a system IS.IS.

Page 8: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

2006 Model Trauma System Planning and Evaluation:2006 Model Trauma System Planning and Evaluation:

What a system DOES.What a system DOES.

2006 Model Trauma System Planning and Evaluation:2006 Model Trauma System Planning and Evaluation:

What a system DOES.What a system DOES.

AssessmentAssessment systems needs vrs. resourcessystems needs vrs. resources injury epidemiologyinjury epidemiology ‘ ‘burden of injury’ & system performanceburden of injury’ & system performance cost effectiveness cost effectiveness

Policy DevelopmentPolicy Development Comprehensive authorityComprehensive authority Trauma Plan & modificationsTrauma Plan & modifications Prevention public policyPrevention public policy Establishes evidence-based system guidelinesEstablishes evidence-based system guidelines Is driven by assessmentIs driven by assessment

AssuranceAssurance Use of laws, regulations, standardsUse of laws, regulations, standards System PI & oversight bodySystem PI & oversight body Integration of primary, secondary, tertiary Integration of primary, secondary, tertiary

preventionprevention Strategic planning (workforce, all-hazards Strategic planning (workforce, all-hazards

preparedness, etc) preparedness, etc)

AssessmentAssessment systems needs vrs. resourcessystems needs vrs. resources injury epidemiologyinjury epidemiology ‘ ‘burden of injury’ & system performanceburden of injury’ & system performance cost effectiveness cost effectiveness

Policy DevelopmentPolicy Development Comprehensive authorityComprehensive authority Trauma Plan & modificationsTrauma Plan & modifications Prevention public policyPrevention public policy Establishes evidence-based system guidelinesEstablishes evidence-based system guidelines Is driven by assessmentIs driven by assessment

AssuranceAssurance Use of laws, regulations, standardsUse of laws, regulations, standards System PI & oversight bodySystem PI & oversight body Integration of primary, secondary, tertiary Integration of primary, secondary, tertiary

preventionprevention Strategic planning (workforce, all-hazards Strategic planning (workforce, all-hazards

preparedness, etc) preparedness, etc)

Page 9: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

American College of Surgeons

COMMITTEE ON TRAUMA Consultation Program for Trauma Systems

American College of Surgeons

COMMITTEE ON TRAUMA Consultation Program for Trauma Systems

Page 10: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

ACS-COT Trauma Systems EvaluationACS-COT Trauma Systems EvaluationACS-COT Trauma Systems EvaluationACS-COT Trauma Systems Evaluation

Consultative, not verification (no one fails!) Multi-disciplinary structure Independently derived recommendations (ACS

integrity) Politically ‘inert’ Consensus-based process Basis = Inclusive trauma system (MTCSP) Basis = best interests of the patient Collaborative development:

(HRSA, NHTSA, CDC, NASEMSD, ACEP) based on national objectives (HRSA, NHTSA)

Consultative, not verification (no one fails!) Multi-disciplinary structure Independently derived recommendations (ACS

integrity) Politically ‘inert’ Consensus-based process Basis = Inclusive trauma system (MTCSP) Basis = best interests of the patient Collaborative development:

(HRSA, NHTSA, CDC, NASEMSD, ACEP) based on national objectives (HRSA, NHTSA)

Page 11: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.
Page 12: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

Trauma Systems: Common ProblemsTrauma Systems: Common ProblemsTrauma Systems: Common ProblemsTrauma Systems: Common Problems

Reluctance to use enabling legislationReluctance to use enabling legislation Inconsistent or non-integrated leadershipInconsistent or non-integrated leadership Unauthorized leadershipUnauthorized leadership Absent or ineffective state (STACs) or Absent or ineffective state (STACs) or

regional advisory committees (RTCC)regional advisory committees (RTCC) Trends towards exclusive systemsTrends towards exclusive systems

no resources, commitment, interestno resources, commitment, interest lack of consistent specialty availabilitylack of consistent specialty availability over-triage, over-transfer to designated centersover-triage, over-transfer to designated centers

Reluctance to use enabling legislationReluctance to use enabling legislation Inconsistent or non-integrated leadershipInconsistent or non-integrated leadership Unauthorized leadershipUnauthorized leadership Absent or ineffective state (STACs) or Absent or ineffective state (STACs) or

regional advisory committees (RTCC)regional advisory committees (RTCC) Trends towards exclusive systemsTrends towards exclusive systems

no resources, commitment, interestno resources, commitment, interest lack of consistent specialty availabilitylack of consistent specialty availability over-triage, over-transfer to designated centersover-triage, over-transfer to designated centers

Page 13: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

Trauma Systems: Common ProblemsTrauma Systems: Common ProblemsTrauma Systems: Common ProblemsTrauma Systems: Common Problems

Lack of funding: system & under-Lack of funding: system & under-compensated carecompensated care

No comprehensive trauma planNo comprehensive trauma plan Limited (or non-existent) system-based PILimited (or non-existent) system-based PI Limited regional organization & Limited regional organization & participation by NTC facilitiesparticipation by NTC facilities

Ends of the spectrum poorly integrated Ends of the spectrum poorly integrated (silo’ing) : prevention & rehabilitation in (silo’ing) : prevention & rehabilitation in particularparticular

Lack of funding: system & under-Lack of funding: system & under-compensated carecompensated care

No comprehensive trauma planNo comprehensive trauma plan Limited (or non-existent) system-based PILimited (or non-existent) system-based PI Limited regional organization & Limited regional organization & participation by NTC facilitiesparticipation by NTC facilities

Ends of the spectrum poorly integrated Ends of the spectrum poorly integrated (silo’ing) : prevention & rehabilitation in (silo’ing) : prevention & rehabilitation in particularparticular

Page 14: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

Trauma Systems: Common ProblemsTrauma Systems: Common ProblemsTrauma Systems: Common ProblemsTrauma Systems: Common Problems

Structure does not allow strong medical Structure does not allow strong medical direction for state/regional trauma sysdirection for state/regional trauma sys

Incomplete, inadequate MOU between Incomplete, inadequate MOU between sending & receiving hospitalssending & receiving hospitals

Limited, often inadequate public and Limited, often inadequate public and legislative education RE trauma system legislative education RE trauma system importance & needsimportance & needs

various others…various others…

Structure does not allow strong medical Structure does not allow strong medical direction for state/regional trauma sysdirection for state/regional trauma sys

Incomplete, inadequate MOU between Incomplete, inadequate MOU between sending & receiving hospitalssending & receiving hospitals

Limited, often inadequate public and Limited, often inadequate public and legislative education RE trauma system legislative education RE trauma system importance & needsimportance & needs

various others…various others…

Page 15: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

Access: Obstacles in trauma system Access: Obstacles in trauma system participationparticipation

Access: Obstacles in trauma system Access: Obstacles in trauma system participationparticipation

Physician staff commitmentPhysician staff commitment Lifestyle: long, irregular hours, sleep deprivationLifestyle: long, irregular hours, sleep deprivation Practice: opportunity costs, restriction, reimbursement, Practice: opportunity costs, restriction, reimbursement,

malpractice malpractice Intimidating, verification / designation Intimidating, verification / designation

requirementsrequirements Lack of knowledge / experienceLack of knowledge / experience Financial risk: Financial risk:

Under-funded care, contractual agreementsUnder-funded care, contractual agreements Limited transfer $$: DSH, local tax subsidiesLimited transfer $$: DSH, local tax subsidies On-call fees for physiciansOn-call fees for physicians Lack of specific state/regional funding Lack of specific state/regional funding

Physician staff commitmentPhysician staff commitment Lifestyle: long, irregular hours, sleep deprivationLifestyle: long, irregular hours, sleep deprivation Practice: opportunity costs, restriction, reimbursement, Practice: opportunity costs, restriction, reimbursement,

malpractice malpractice Intimidating, verification / designation Intimidating, verification / designation

requirementsrequirements Lack of knowledge / experienceLack of knowledge / experience Financial risk: Financial risk:

Under-funded care, contractual agreementsUnder-funded care, contractual agreements Limited transfer $$: DSH, local tax subsidiesLimited transfer $$: DSH, local tax subsidies On-call fees for physiciansOn-call fees for physicians Lack of specific state/regional funding Lack of specific state/regional funding

Page 16: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

California trauma “system”California trauma “system”California trauma “system”California trauma “system”

Serving disaster-prone, dispersed populationServing disaster-prone, dispersed population Provides coverage for very urban & very rural regionsProvides coverage for very urban & very rural regions County –based & de-centralizedCounty –based & de-centralized Optional – but embraced by most counties Optional – but embraced by most counties Relies on local versus regional/State-wide oversightRelies on local versus regional/State-wide oversight State & many local systems under-fundedState & many local systems under-funded State/regional structures insufficiently authorized State/regional structures insufficiently authorized Comprehensive, state-wide plan pendingComprehensive, state-wide plan pending Wide variations in county trauma system configurations & practices Wide variations in county trauma system configurations & practices

(“inconsistencies” (“inconsistencies” State-wide trauma registry pending State-wide trauma registry pending

Serving disaster-prone, dispersed populationServing disaster-prone, dispersed population Provides coverage for very urban & very rural regionsProvides coverage for very urban & very rural regions County –based & de-centralizedCounty –based & de-centralized Optional – but embraced by most counties Optional – but embraced by most counties Relies on local versus regional/State-wide oversightRelies on local versus regional/State-wide oversight State & many local systems under-fundedState & many local systems under-funded State/regional structures insufficiently authorized State/regional structures insufficiently authorized Comprehensive, state-wide plan pendingComprehensive, state-wide plan pending Wide variations in county trauma system configurations & practices Wide variations in county trauma system configurations & practices

(“inconsistencies” (“inconsistencies” State-wide trauma registry pending State-wide trauma registry pending

Page 17: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

System developmentSystem developmentSystem developmentSystem development

Educate & build legislative & public supportEducate & build legislative & public support Establish enabling legislationEstablish enabling legislation Fund the system exclusive from TCsFund the system exclusive from TCs Needs assessment (link to prevention)Needs assessment (link to prevention) Write comprehensive trauma planWrite comprehensive trauma plan Adopt operational standards & verificationAdopt operational standards & verification Develop oversight structuresDevelop oversight structures Initiate system PI plan & oversightInitiate system PI plan & oversight System development driven by PI / CQISystem development driven by PI / CQI Perform external consultative reviewPerform external consultative review

Educate & build legislative & public supportEducate & build legislative & public support Establish enabling legislationEstablish enabling legislation Fund the system exclusive from TCsFund the system exclusive from TCs Needs assessment (link to prevention)Needs assessment (link to prevention) Write comprehensive trauma planWrite comprehensive trauma plan Adopt operational standards & verificationAdopt operational standards & verification Develop oversight structuresDevelop oversight structures Initiate system PI plan & oversightInitiate system PI plan & oversight System development driven by PI / CQISystem development driven by PI / CQI Perform external consultative reviewPerform external consultative review

Page 18: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.
Page 19: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

““Get a plan” Get a plan” (G. Cooper, ~2004)(G. Cooper, ~2004) ““Get a plan” Get a plan” (G. Cooper, ~2004)(G. Cooper, ~2004)

System structure:System structure: lead agency, STAC, RTCCs, role of TCs & communitylead agency, STAC, RTCCs, role of TCs & community System leadership positions within structure (TMD, TPM)System leadership positions within structure (TMD, TPM) Regional structure: ‘X’ regions? (not 32 or 58) Regional structure: ‘X’ regions? (not 32 or 58)

System-wide needs assessmentSystem-wide needs assessment Injury epidemiology in the StateInjury epidemiology in the State Type, number, location of TCs & flow patternsType, number, location of TCs & flow patterns Human resource pipeline Human resource pipeline

System oversight responsibilities & PI planSystem oversight responsibilities & PI plan Disaster preparedness (current surge cap=~14%)\Disaster preparedness (current surge cap=~14%)\ Establish process/program for injury surveillance Establish process/program for injury surveillance

System structure:System structure: lead agency, STAC, RTCCs, role of TCs & communitylead agency, STAC, RTCCs, role of TCs & community System leadership positions within structure (TMD, TPM)System leadership positions within structure (TMD, TPM) Regional structure: ‘X’ regions? (not 32 or 58) Regional structure: ‘X’ regions? (not 32 or 58)

System-wide needs assessmentSystem-wide needs assessment Injury epidemiology in the StateInjury epidemiology in the State Type, number, location of TCs & flow patternsType, number, location of TCs & flow patterns Human resource pipeline Human resource pipeline

System oversight responsibilities & PI planSystem oversight responsibilities & PI plan Disaster preparedness (current surge cap=~14%)\Disaster preparedness (current surge cap=~14%)\ Establish process/program for injury surveillance Establish process/program for injury surveillance

Page 20: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

Funding the system Funding the system Funding the system Funding the system

SYSTEM = STATE, REGIONAL, COUNTYSYSTEM = STATE, REGIONAL, COUNTY Motor vehicle fees, fines, penalties (non-MV also)Motor vehicle fees, fines, penalties (non-MV also) 911 system surcharges911 system surcharges Intoxication / DUI offense feesIntoxication / DUI offense fees Controlled substance act or weapons violation feesControlled substance act or weapons violation fees “ “Play or pay” fees for non-participating hospitalsPlay or pay” fees for non-participating hospitals Tobacco & ETOH taxesTobacco & ETOH taxes Property tax supplementsProperty tax supplements Tribal gamingTribal gaming Hospital licensure linked to participation in TSHospital licensure linked to participation in TS Use of destination / activation fees Use of destination / activation fees

SYSTEM = STATE, REGIONAL, COUNTYSYSTEM = STATE, REGIONAL, COUNTY Motor vehicle fees, fines, penalties (non-MV also)Motor vehicle fees, fines, penalties (non-MV also) 911 system surcharges911 system surcharges Intoxication / DUI offense feesIntoxication / DUI offense fees Controlled substance act or weapons violation feesControlled substance act or weapons violation fees “ “Play or pay” fees for non-participating hospitalsPlay or pay” fees for non-participating hospitals Tobacco & ETOH taxesTobacco & ETOH taxes Property tax supplementsProperty tax supplements Tribal gamingTribal gaming Hospital licensure linked to participation in TSHospital licensure linked to participation in TS Use of destination / activation fees Use of destination / activation fees

Page 21: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

Oversight committees Oversight committees Oversight committees Oversight committees

Use experience of States with well established state-Use experience of States with well established state-wide trauma systems & organizationswide trauma systems & organizations

Expand the STACExpand the STAC Develop & fund positions for system oversight / Develop & fund positions for system oversight /

admin. admin. State Trauma Medical Director + State Program staff (SB261) State Trauma Medical Director + State Program staff (SB261) Regional program staff + admin staff (Romero SB261)Regional program staff + admin staff (Romero SB261)

Recruit system leadership (medicine, government, Recruit system leadership (medicine, government, business, law) business, law)

Using the TP, establish & authorize advisory cmtesUsing the TP, establish & authorize advisory cmtes Define role of RTCC relative to LEMSAs (“integrated”)Define role of RTCC relative to LEMSAs (“integrated”) Develop Develop systemsystem PI program tailored to regions PI program tailored to regions

Use experience of States with well established state-Use experience of States with well established state-wide trauma systems & organizationswide trauma systems & organizations

Expand the STACExpand the STAC Develop & fund positions for system oversight / Develop & fund positions for system oversight /

admin. admin. State Trauma Medical Director + State Program staff (SB261) State Trauma Medical Director + State Program staff (SB261) Regional program staff + admin staff (Romero SB261)Regional program staff + admin staff (Romero SB261)

Recruit system leadership (medicine, government, Recruit system leadership (medicine, government, business, law) business, law)

Using the TP, establish & authorize advisory cmtesUsing the TP, establish & authorize advisory cmtes Define role of RTCC relative to LEMSAs (“integrated”)Define role of RTCC relative to LEMSAs (“integrated”) Develop Develop systemsystem PI program tailored to regions PI program tailored to regions

Page 22: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

Other key elements Other key elements Other key elements Other key elements

Acute care access: assess Acute care access: assess adequacy of existing TCs – level & adequacy of existing TCs – level & locationlocation

Assess adequacy of existing Assess adequacy of existing resources, county-by-countyresources, county-by-county

Cultivate participation in Cultivate participation in state/regional trauma systemstate/regional trauma system institutional & provider incentivesinstitutional & provider incentives

Accessible, state-wide registry Accessible, state-wide registry

Acute care access: assess Acute care access: assess adequacy of existing TCs – level & adequacy of existing TCs – level & locationlocation

Assess adequacy of existing Assess adequacy of existing resources, county-by-countyresources, county-by-county

Cultivate participation in Cultivate participation in state/regional trauma systemstate/regional trauma system institutional & provider incentivesinstitutional & provider incentives

Accessible, state-wide registry Accessible, state-wide registry

Page 23: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

Getting started - Getting started - System-wide PI will drive System-wide PI will drive

developmentdevelopment

Getting started - Getting started - System-wide PI will drive System-wide PI will drive

developmentdevelopment

Page 24: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

System-based (versus center-based) System-based (versus center-based) PIPI

System-based (versus center-based) System-based (versus center-based) PIPI

Old model designed for developing Old model designed for developing systemssystems

Relies more on shared center-derived PI Relies more on shared center-derived PI issues (MAC model)issues (MAC model)

Focus on provider vrs. system errorsFocus on provider vrs. system errors Limited use of system indicatorsLimited use of system indicators Limited focus on PI process effectivenessLimited focus on PI process effectiveness

Old model designed for developing Old model designed for developing systemssystems

Relies more on shared center-derived PI Relies more on shared center-derived PI issues (MAC model)issues (MAC model)

Focus on provider vrs. system errorsFocus on provider vrs. system errors Limited use of system indicatorsLimited use of system indicators Limited focus on PI process effectivenessLimited focus on PI process effectiveness

Page 25: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

System-wide PI System-wide PI will drive will drive

developmentdevelopment

System-wide PI System-wide PI will drive will drive

developmentdevelopment

system preventable deathssystem preventable deaths access to trauma systemaccess to trauma system time to definitive caretime to definitive care triage errorstriage errors failed / delayed transfersfailed / delayed transfers provider errors (TAC/MAC)provider errors (TAC/MAC) access to rehabaccess to rehab prevention deficienciesprevention deficiencies benchmarking for TCsbenchmarking for TCs

system preventable deathssystem preventable deaths access to trauma systemaccess to trauma system time to definitive caretime to definitive care triage errorstriage errors failed / delayed transfersfailed / delayed transfers provider errors (TAC/MAC)provider errors (TAC/MAC) access to rehabaccess to rehab prevention deficienciesprevention deficiencies benchmarking for TCsbenchmarking for TCs

Page 26: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

Adopt standards, analyze Adopt standards, analyze performanceperformance

Develop P&PsDevelop P&Ps transfers, re-triage, transfers, re-triage,

Create ‘operational’ Create ‘operational’ MOUs between centersMOUs between centers Educational ‘give-backs’Educational ‘give-backs’ PI driven outreachPI driven outreach

Link to state registry & Link to state registry & prevention activitiesprevention activities

ID & monitor outcome ID & monitor outcome measures & benchmarksmeasures & benchmarks

Adopt standards, analyze Adopt standards, analyze performanceperformance

Develop P&PsDevelop P&Ps transfers, re-triage, transfers, re-triage,

Create ‘operational’ Create ‘operational’ MOUs between centersMOUs between centers Educational ‘give-backs’Educational ‘give-backs’ PI driven outreachPI driven outreach

Link to state registry & Link to state registry & prevention activitiesprevention activities

ID & monitor outcome ID & monitor outcome measures & benchmarksmeasures & benchmarks

RTCC tasksRTCC tasksRTCC tasksRTCC tasks

Page 27: Trauma Systems Development: An ACS Perspective Robert C. Mackersie, M.D., FACS Professor of Surgery, UCSF Director, Trauma Services, SFGH Past Chair, ACS-COT.

World’s seventh largest economy: World’s seventh largest economy: we can do this.we can do this.

World’s seventh largest economy: World’s seventh largest economy: we can do this.we can do this.


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