Hamad Medical Corporation (HMC) in Qatar recently received the Trauma Distinction Award of Excellence from Accreditation Canada International (ACI). HMC is the first trauma organization in the world to earn the recognition. The ACI program gives international trauma organizations access to evidence-based standards, in-depth performance indicators and on-site visits by expert evaluators.
“This accreditation represents years of hard work from an entire team to build a Level I Trauma Center and Trauma System for the State of Qatar, based on the highly regarded evidence-based North American models of care,” said Dr. Hassan Al Thani, MBBCh, chair of Trauma Surgery and Vascular Surgery at Hamad General Hospital in Doha.
Unique system focus
HMC is Qatar’s main public healthcare provider. Its flagship facility, Hamad General Hospital, is HMC’s only tertiary hospital and Qatar’s only designated Level I trauma center.
Hamad General Hospital initially sought trauma center verification from the American College of Surgeons (ACS). In fact, the ACS Committee on Trauma conducted a consultative review of the hospital in 2013. System leaders were informed, however, that the ACS does not have a process for verifying trauma centers outside the United States. HMC then approached ACI about participating in its nascent Trauma Distinction program.
Accreditation Canada introduced the Trauma Distinction Award in 2014 after the organization took over the Canadian national trauma accreditation program. The program is now offered to organizations worldwide through ACI, a non-governmental organization that provides comprehensive accreditation, education and advisory services internationally.
“There is close alignment between the ACI and the ACS in terms of trauma center standards and review processes,” said Holly Hepp, MSN, trauma program manager at Hamad General Hospital. “One major difference is that American College of Surgeons verification does not mandate compliance with trauma system standards.”
How the program works
ACI standards govern both trauma system organization and trauma center care. System standards focus on evidence-based protocols in patient management, triage, transport, transfer and rehabilitation. Trauma center standards cover protocols for areas such as trauma team activation, massive transfusion, radiology and surgical critical care.
Organizations seeking ACI recognition must collect and submit data on seven mandatory “core indicators,” four of which have minimum thresholds:
- Field triage (≥ 90%)
- Wait time for rehabilitation (≤ 8 days)
- Trauma team activation (≥ 90%)
- Emergency Department length of stay (≥ 90%)
- Length of stay in acute care
- Complications during hospital stay
- Trauma mortality
Organizations must meet minimum performance for at least three of the four threshold indicators. In addition, participating organizations must submit data on at least two out of nine “optional indicators.” All indicator data must be submitted every six months through an online portal.
The Trauma Distinction program includes a site visit from two ACI evaluators, who rate the trauma organization on all applicable standards. “A decision committee here at ACI then looks at all the ratings on the dashboard and makes a determination,” said Conny Menger, ACI’s executive director of client relations. Trauma Distinction status is in effect for two years, and site visits take place every four years. The program is currently available in English only, but more languages may be added in the future.
Strengths and opportunities
HMC began submitting indicator data to ACI at the beginning of 2014, and ACI evaluators visited Qatar for three days in November. One goal of the visit was to identify strengths and opportunities for improvement.
“The trauma system standards helped us objectively evaluate our entire system,” Hepp said. “We were then able to identify improvement opportunities and address them with the involvement of all services — from the pre-hospital system, through all acute care services, to rehabilitation with outpatient follow-up.”
According to Hepp, ACI evaluators noted the trauma center’s strong interdisciplinary communication, rapid access to diagnostics, and good data collection and quality assurance processes. System strengths include strong integration between pre-hospital and trauma center organizations and strong commitment to evidence-based care.
HMC’s opportunities for improvement include better integration of rehabilitation services. ACI evaluators also recommended that HMC take greater advantage of tele-health tools. At the trauma center level, the ACI encouraged HMC to focus on nursing empowerment. It also recommended a goal of reducing Emergency Department length of stay.
In addition to complying with standards and meeting performance thresholds, award candidates must display “excellence and innovation” by implementing an initiative that enhances the quality of care. HMC submitted two performance improvement projects. One initiative improved the paramedic intubation rate by 12%. The other decreased the trauma center’s missed injury rate to just 0.2%. (To find out more, read How HMC improved intubation success rates, cut missed injuries.)
Looking ahead
HMC received the Trauma Distinction Award during a January 29 ceremony attended by Sébastien Audette, ACI’s chief executive officer. The ceremony took place in Doha at Hamad General Hospital.
“Since we set out on this journey, we have seen dramatic improvement in trauma patient care,” Dr. Al Thani said. “Injury is the leading cause of death in Qatar and has a devastating effect on individuals, families and healthcare. This is why it is so important to have a world-leading trauma system for the country. We will continue to strive to improve and innovate to ensure the best possible care for our patients.”