ACS: Patient Need, Not Economic Advantage, Should Guide Trauma Center Designation


The American College of Surgeons (ACS) released a statement Thursday urging health system leaders to base trauma center designation decisions on the needs of injured patients. The statement includes recommendations for optimizing trauma center allocation within regional trauma systems.

The “Statement on Trauma Center Designation Based Upon System Need” was developed by the ACS Committee on Trauma and approved by the society’s board of regents. According to the statement:

  • Few regional trauma systems have developed the ability to allocate trauma center resources based strictly on population need.
  • Government trauma oversight agencies are often unable to make controversial designation decisions. Some have “abdicated their responsibility” for trauma center designation altogether.
  • In this environment, the economic ambitions of individual provider organizations often drive the trauma center designation process.

“The problem arises when a lead agency passively allows health care organizations and hospital groups to establish new trauma centers in areas that yield an economic advantage, while ignoring areas of true need,” the statement read. “Such uncontrolled growth of trauma centers — some of which may lack long-term commitment — has the potential to undermine the quality of trauma care within a region, creating areas of oversupply and adverse competition while ignoring underserved areas entirely.”

Planning guidelines
The statement repeated the ACS position that trauma center designation should be the responsibility of a government agency with authority for the regional trauma system. “The lead agency must have a strong mandate, clear statutory authority, and the political will to execute this responsibility.”

System leaders should use appropriate measures to assess regional trauma care needs, including measures of access, quality, population mortality and system efficiency, according to the statement. Specific measures could include:

  • Number of Level I and Level II trauma centers per 1 million population
  • Percentage of the population within 1 hour of a Level I or Level II trauma center
  • Emergency medical services (EMS) transport times
  • Percentage of severely injured patients who receive care at a trauma center

The ACS called on clinicians and system leaders to advocate for patient-focused regional trauma planning. Physicians, nurses, EMS providers and others have a “professional obligation” to work together to ensure that patient needs come before the interests of individual healthcare organizations. Read the Full Statement

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