Quality Benchmarking in Trauma: from the NTDB to TQIP
Purpose of Review
This review describes the evolution of quality improvement in trauma from the creation of the Committee on Trauma’s (COT) Optimal Hospital Resources for Care of the Injured Patient in 1976 to the National Trauma DataBank (NTDB) to the American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP).
The national standardization of data collection for trauma patients through the National Trauma Data Standard (NTDS) and TQIP has allowed trauma centers to benchmark with their peers and focus quality improvement initiatives on areas of opportunity. TQIP provides enrolled hospitals with the data and educational resources they need to improve trauma care.
This review describes the development of ACS TQIP and quality benchmarking in trauma. The ACS COT began its journey to improve the quality of trauma care by establishing standards for the optimal care of injured patients and verifying that centers had the necessary equipment, personnel, and processes in place. The standardization of data collection for seriously injured patients nationally now has allowed trauma centers to meaningfully measure patient outcomes. ACS TQIP has further advanced trauma care by providing participating centers with the resources they need to achieve quality improvement in trauma.
KeywordsInjury Trauma Registry Data Benchmarking Quality improvement
Compliance with Ethical Standards
Conflict of Interest
The authors declare no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Optimal hospital resources for care of the seriously injured. Bull Am Coll Surg. 1976;61(9):15–22.Google Scholar
- 2.Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2003). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Available from: www.cdc.gov/ncipc/wisqars. Accessed January, 2018.
- 8.Hospital and prehospital resources for optimal care of the injured patient. Committee on Trauma of the American College of Surgeons. Bull Am Coll Surg. 1986;71(10):4–23.Google Scholar
- 14.What Is the NTDS? 2017; https://www.facs.org/quality-programs/trauma/ntdb/ntds/about-ntds. Accessed Jan 22 2018.
- 15.•• Shafi S, Nathens AB, Parks J, Cryer HM, Fildes JJ, Gentilello LM. Trauma quality improvement using risk-adjusted outcomes. J Trauma. 2008;64(3):599–604. discussion 604–596. This citation highlights the variation in outcomes in ACS verified trauma centers, suggesting that the process of verification alone to confirm structures and processes of care does not assure consistent outcome. CrossRefPubMedGoogle Scholar
- 17.• Hemmila MR, Cain-Nielsen AH, Wahl WL, Vander Kolk WE, Jakubus JL, Mikhail JN, et al. Regional collaborative quality improvement for trauma reduces complications and costs. J Trauma Acute Care Surg. 2015;78(1):78–87. This citation provides insights into the impact of a regional collaborative on accelerating performance improvement related to trauma. CrossRefPubMedGoogle Scholar
- 18.National Trauma Data Standard Data Dictionary. 2018; https://www.facs.org/quality-programs/trauma/ntdb/ntds/data-dictionary. Accessed December 27th 2017.
- 21.•• Newgard CD, Fildes JJ, Wu L, Hemmila MR, Burd RS, Neal M, et al. Methodology and analytic rationale for the American College of Surgeons Trauma Quality Improvement Program. J Am Coll Surg. 2013;216(1):147–57. This citation provides the methodology that supports risk adjustment for ACS TQIP. CrossRefPubMedGoogle Scholar
- 27.Using the Surgeon Specific Registry for CMS MIPS. 2017; https://www.facs.org/quality-programs/ssr/mips. Accessed January 31 2018.