A Twelve-Year Retrospective Analysis of a Journey Towards Rural Level I Trauma Center Verification

Area of Science:

• Trauma Surgery
• Healthcare Systems Improvement
• Rural Health

Background:

• Rural trauma centers face unique challenges in achieving higher verification levels.
• The Upper Mountain West region's trauma center sought to transition from Level II to Level I verification.
• Expansion of bed capacity from 280 to 305 occurred between 2011 and 2022.

Purpose of the Study:

• To describe the transformation process of a rural trauma center towards American College of Surgeons (ACS) Level I verification.
• To identify key areas for growth and implement targeted interventions.
• To serve a broader four-state region with advanced trauma care.

Main Methods:

• Retrospective analysis of 8947 trauma activations from 2011-2022 using institutional trauma registry.
• Structured gap analysis assessing alignment with ACS Level I principles.
• Implementation of targeted interventions including SICU establishment, surgical residency rotations, and research capacity building.

Main Results:

• Key growth areas identified: patient volumes, SICU absence, lack of surgical residency, and limited research infrastructure.
• Successful establishment of SICU, initiation of residency rotations, and enhanced research capacity.
• Increased severely injured patient volume (ISS ≥16) exceeding ACS thresholds, with rising mean patient age and geriatric/female patient proportions.
• Improved system capacity shown by decreased interfacility transfer rates (2.8% to 1.1%).

Conclusions:

• Strategic investments in infrastructure, workforce, education, and research were crucial for achieving Level I criteria.
• The transformation enabled the center to adapt to changing patient demographics and clinical demands.
• Implementation strategies can guide other resource-constrained rural trauma systems pursuing ACS Level I verification.