The American College of Surgeons (ACS) recently released the second update of Resources for Optimal Care of the Injured Patient: 2022 Standards.
The new December 2023 revision of the resources manual tightens up one requirement, relaxes a few others and makes a number of important clarifications.
- To download the latest version of the ACS trauma center standards, visit Resources for Optimal Care of the Injured Patient (2022 Standards).
- To access the change log for the December 2023 revision, visit the 2022 Standards Resources Repository.
To find out exactly what changed in the newly updated ACS trauma standards, read the detailed summary below.
Not every IR case must begin within 60 minutes
Standard 4.15 requires Level I and II centers to be able to initiate an endovascular or interventional radiology (IR) procedure for hemorrhage control within 60 minutes of request.
The December 2023 update to this standard clarifies that centers must be capable of meeting this timeframe when a rapid intervention is needed, but centers are not required to start every IR case within 60 minutes.
Specifically, the following wording has been added to Standard 4.15: “It is not expected that every case undergoing intervention must be initiated within 60 minutes. The expectation is that if the clinical situation dictates the need for rapid intervention, that it can be initiated within 60 minutes.”
(More resources: Streamlining and Documenting the Specialist Response to Trauma)
Radiology reports will no longer be collected through the PRQ
Standard 5.26 requires timely CT scan reporting — final interpretation must be documented no later than 12 hours after scan completion.
In the December 2022 version of this standard, the measures of compliance were simply “radiology reports”.
In the new December 2023 update, the measures of compliance have been changed to “Radiology reports evaluated during the site visit process” and “Institutional policies that address timely CT scan reporting for trauma patients”.
However, trauma program leaders who only read the trauma standards will miss an important point. According to the change log for the December 2023 update, “Radiology reports will be evaluated during the site visit process and will no longer be collected through the PRQ.” [emphasis added]
Slight relaxation in board requirements for ED directors and ED coverage
The December 2022 version of Standard 4.6 required the ED medical director in a Level I or II center to be board-certified or board-eligible in either emergency medicine (EM) or pediatric EM.
Under the new December 2023 update, the ED director role in Level I or II centers may be filled by a physician who is board-certified in a different specialty (other than EM or pediatric EM) if the physician completed his or her primary training prior to 2016.
The ACS has also relaxed Standard 4.8, which requires a board-certified or board-eligible EM physician to be present in the ED at all times in Level I or II trauma centers. Similar to the change for ED directors, the December 2023 update now states that the requirement may be met “with a board-certified or board-eligible physician who completed primary training prior to 2016 in a specialty other than emergency medicine or pediatric emergency medicine.”
Combined adult/pediatric centers may share a CAISS
Standard 4.32 requires all trauma centers to have at least one trauma registrar who is a Certified Abbreviated Injury Scale Specialist (CAISS).
The new December 2023 update has added this qualifier: “Combined adult and pediatric programs (Level I/II adult trauma center with Level II pediatric trauma center) may share the CAISS certified registrar to meet this requirement.”
(More resources: How to prepare for the CAISS exam)
CAAs may no longer serve as anesthesia liaison in Level III trauma centers
In the December 2022 version of Standard 4.5, both certified registered nurse anesthetists (CRNAs) and certified anesthesiologist assistants (CAAs) were allowed to serve as the anesthesia liaison in a Level III trauma center in states where these providers are licensed to practice independently.
In the new December 2023 update, CAAs have been removed from the standard. Standard 4.5 no longer permits CAAs to serve as anesthesia liaisons in Level III centers.
Minor nuance added to registry staffing standard
Standard 4.31 establishes a minimum ratio of dedicated trauma registry staff to the number of patients entered in the registry — at least 0.5 FTE registrars per 200 to 300 annual patient entries.
The “additional information” section of this standard notes that chart abstraction is just one aspect of trauma registry work. When allocating registry staff, program leaders must also consider that trauma registrars are responsible for report generation, data analysis, data validation, and other tasks. Program leaders also need to assess the impact on registry staffing needs of newer software systems that enable automated data downloads and integration.
The December 2022 version of Standard 4.31 emphasizes that these software capabilities can create additional work for registrars:
“Electronic downloads into the trauma registry also create additional tasks, as does ongoing data validation before data acceptance. Additional staff will be required to perform these tasks to ensure the integrity and quality of registry data, which are used for prevention, PIPS, and other essential aspects of the trauma program.”
In the new December 2023 update, this wording has been replaced with:
“While electronic downloads or automated data integration might offer advantages, they might also require additional oversight, and trauma centers must conduct their own assessment as to the impact. Regardless of how data are obtained, staffing levels must be adequate to perform these tasks to ensure the integrity and quality of the data.”
The updated wording provides a more balanced view of automated data integrations, noting that they may create additional work for registrars but may also create registry work efficiencies.
The official ACS change log for the December 2023 update explains that this revision is intended “to clarify the misconception that data integration products will cause trauma centers to hire additional personnel, rather than realize the efficiencies that come from reduction in manual processes.”
Typo corrected: NSAs with ISS≤9 may be closed at primary review
The December 2022 version of Standard 7.8 stated that nonsurgical trauma admissions without an identified OFI can be closed in primary review if ISS<9.
This was a typographical error. In the new December 2023 update, this qualification has been corrected to read ISS≤9.