manual if you take a Rural Trauma Team Development The, Trauma centers that are successfully verified will be added to the list of currently verified trauma centers on the. Level I and II adult and pediatric centers must have either continuously available replantation services or a triage/transfer process with a replant center (Standard 4.24). Under the previous standards, interventional radiologists in Level I and II centers were required to respond within 30 minutes. This session provides a brief history of the Resources Manual, an overview of the revision process, and the key considerations used to revise the standards. Second, the requirements no longer reference institution-specific criteria for neurosurgeon response. ATLS Student Course Manual, 10th Edition Sort order. All pediatric trauma centers (Level I and II) will need a child abuse (nonaccidental trauma) pediatrician on the medical staff (Standard 4.26). objective, external review of institutional capabilities and performance. directly. Under the new standard, Level I and II centers must have the necessary personnel and physical resources so that endovascular or IR procedures to control hemorrhage can begin within 60 minutes of request. required for effective disaster response and management of mass casualty events. ACS releases December 2022 revision of trauma standards what exactly changed? Are you a healthcare professional with expertise in trauma care? Resources for optimal care of the injured patient: an update. ab`2D2G`-| &HFm0 T!`.DoLX&knL&IaCSL`wuSkg ( The ACS will provide a hospital consultation, verification, or reverification visit at the request of your hospital or state authority. 2022 Standards Q&As were created to help participants navigate the new standards and prepare for site visits. The site visit schedule for the implementation of the 2022 Resources Manual is also included in this session. The American College of Surgeons is dedicated to improving the care of surgical patients and safeguarding standards of care in an optimal and ethical practice environment. Add another edition? During on-site visits, the review meeting is a working dinner. Background Traumatic injury remains the leading cause of death, with more than five million deaths every year. It's all here. (Under the previous standards, centers were required to have 1.0 FTE registry professional for every 500 to 700 admitted patients. Copyright 1996-2023 American College of Surgeons, 633 N Saint Clair St, Chicago, IL 60611-3295. These standards are effective for verification/reverification visits prior to September 2023 and consultation visits prior to February 2023. The first major revision of Resources for Optimal Care of the Injured Patient in nearly a decade will be released in spring 2022. ACS Case Reviews in Surgery offers in-depth analyses of Resources for Optimal Care of the Injured Patient Resources for Optimal Care of the Injured Patient (2022 Standards) The Verification, Review, and Consultation (VRC) program is pleased to announce the seventh edition of the Resources for Optimal Care of the Injured Patient (2022 Standards) . Content includes: Students, instructors, coordinators, and educators are encouraged to access and regularly use this important tool. For a complete list of important dates, see Rollout timeline for new ACS trauma standards. Resources for Optimal Care of the Injured Patient . The 2022 standards will require all trauma center Emergency Departments to evaluate their pediatric readiness (Standard 5.10). Specialties involved could be otolaryngology, oral maxillofacial surgery and/or plastic surgery, and this expertise could be provided by a single surgeon or a group of surgeons. Edited by Jody M. Kaban, MD, FACS, Neil Parry, MD, FRCSC, FACS, and standard, are used for all NTDB and TQIP reports, and the NTDS Data Dictionary American College of Surgeons. Introducing the Resources for Optimal Care of the Injured Patient (2022 Standards) This session provides a brief history of the Resources Manual, an overview of the revision process, and the key considerations used to revise the standards. Trauma centers will now be expected to have 0.5 FTE dedicated registry professionals for every 200 to 300 annual patient entries in the registry. Please check back here regularly as additional materials will be posted as they become available. Resources for optimal care of the injured patient. educational resource. Since the release in March 2022, many participants and stakeholders asked pertinent questions and provided insightful feedback on the standards. is still under calculation. Pornthida rated it really liked it. Journal's Impact IF Highest IF Key Factor Analysis Lowest IF Key Factor Analysis Total Growth Rate Key Factor Analysis Journal Writer. The Assistant Nurse Manager provides administrative support to Nurse Managers and direct reports. The online PRQ must be completed and submitted 45 days before the scheduled site visit date. 2168 0 obj <> endobj masters. For the best experience please update your browser. NOTE: For the new PI coordinator and registrar staffing requirements, the patient volume denominator includes all patients who meet NTDS inclusion criteria and all patients who meet the inclusion criteria of any hospital, local, state or regional registries the center participates in. The 2022 standards will require trauma centers to have protocols in place for a variety of patient cohorts and care processes. serve as the operational definitions for the American College of Surgeons (ACS) Chp 23) Recommendations: Remove the 1200 admission requirement for Level II Trauma Center state designation. }, author={A. Brent Eastman}, journal={Bulletin of the American College of Surgeons}, year={1994}, volume={79 5}, pages={ 21-7 } } at the rural facilities. This study developed extreme gradient boosting (XGBoost)-based models using three simple factorsage, fasting glucose, and National Institutes of Health Stroke Scale (NIHSS) scoresto predict the three-month functional outcomes after AIS. The new ACS standards will require all trauma centers to have a dedicated performance improvement (PI) coordinator (Standard 4.34). Thats fine. %PDF-1.6 % The focus here is surgical expertise, Dr. Nathens said. This session includes a brief overview of the various categories and the types of standards to expect in each category. These standards will be effective for visits starting in September 2023. @article{Eastman1994ResourcesFO, title={Resources for optimal care of the injured patient--1993. hb```f``: B,l@q80ZPwEv3 Please use the VRC Contact Form to submit all questions and comments regarding the VRC site visit process, standards, and other topics. Manages individual (s) including but not limited to: hires, trains, assigns work . Trauma centers that do not attain verification must undergo a focused review to ensure all deficiencies have been addressed. The app is full of useful reference content for retrieval at the hospital bedside and for review at your leisure. An ENT can do this in some centers, plastics is the usual specialty that does it, but someone who can cover a wound with a free flap is what were looking for here.. Start your review of Resources for Optimal Care of the Injured Patient: 1999. is an essential abstraction tool for all ACS-verified trauma centers, as well as The VRC program evaluates the care, aligned to the standards and expected scope of practice at each institution. Resources for Optimal Care of the Injured Patient (2022 Standards) The Verification, Review, and Consultation (VRC) program is pleased to announce the release of the Resources for Optimal Care of the Injured Patient (2022 Standards). The rollout timeline will give trauma program leaders more than a year to prepare for verification/reverification visits under the new ACS standards. Resources for optimal care of the injured patient.2021-2022! Trauma surgery coverage can include PGY-3 surgical residents and fellows if needed (Standard 8.6). Task Force of the Committee on Trauma, American College of Surgeons Resources for optimal care of the injured patient: an update. Dr. Nathens also said the ACS will provide a variety of opportunities for trauma leaders to receive training on the new standards. ), The new standards make a small change to the patient volume requirement for Level I trauma centers. Copyright 1996-2023 American College of Surgeons, 633 N Saint Clair St, Chicago, IL 60611-3295. Level I adult and pediatric trauma centers will need to have soft tissue coverage expertise including microvascular expertise for free flaps (Standard 4.22). You may have a general surgeon who is very comfortable in the chest who covers most of this. The volume threshold is the same (1,200 patients), but the definition is changing from admissions to patients who meet National Trauma Data Standard (NTDS) inclusion criteria.. 17T-0004The 10th edition of the Advanced Trauma Life Support (ATLS) Student Course Manual reflects several changes designed to enhance the educational content and visual presentation of the prior edition.Each chapter was rewritten and revised to ensure clear coverage of the most up-to-date scientific content, including updated references. For the best experience please update your browser. Impactfactor 2021-2022| Analyse, Trend, Ranglijst & Voorspelling - Academic Accelerator This webpage will serve as the centralized location for resources related to theResources for Optimal Care of the Injured Patient (2022 Standards). If the annual patient volume exceeds 500, the center must have at least 0.5 FTE dedicated to PI. Course. victims for injuries that require immediate transfer, using the resources that are specifically available to each Programs have been required to implement the 2020 Standards as of January 1, 2020. ACS: Resources for Optimal Care of the Injured Patient - DocumentCloud ACS: Resources for Optimal Care of the Injured Patient Contributed by Charlotte Keith (Investigative Post) p. 1 ACS: Resources for Optimal Care of the Injured Patient Responsibilities of trauma director p. 27 Original Document (PDF) These are the criteria by which Iowa trauma facilities are verified. Each chapter was rewritten and revised to ensure clear coverage of the most Visit this page on the ACS website for additional information. The 2022 standards will require Level I adult and pediatric trauma centers to have a trauma rotation with defined objectives and curriculum for senior residents (Standard 8.4). Our top priority is providing value to members. Stay tuned! Resources for optimal care of the injured patient. Trauma program leaders are encouraged to wait for the release of the official standards book before making any significant changes to program structures or processes. Consider becoming a VRC reviewer. JOIN FCOT Login Pay Dues Contact Florida Committee on Trauma 6816 Southpoint Parkway Suite 1000 Jacksonville, FL 32216 Phone: (904) 309-6263 contact@floridacot.org ACS Resources In all trauma centers: These new requirements are in addition to the longstanding requirement that registrars participate in a course that covers abstraction, data validation and other registry-related topics. Reviewers may tailor the tour to the needs of the center. These resources have to be available 24/7 within the time interval specified, Dr. Nathens said. section at the end of each chapter and a new appendix focusing on Team While many and varied guidelines inform the clinical management of TBI across the spectrum, clinicians and healthcare systems are not broadly adopting . Reviewers will communicate the Deficiencies, Strengths, Opportunities for Improvement, and Recommendations. This new requirement is tied to the number of patients in the trauma registry: Dr. Nathens clarified during his TQIP presentation that the new staffing requirements are minimums. During the opening session of the TQIP conference, Dr. Nathens explained the ACSs planned approach to using virtual visits versus in-person visits: According to Dr. Nathens, this approach to remote and in-person site visits will be used over the ensuing year or couple of years.. The American College of Surgeons website is not compatible with Internet Explorer 11, IE 11. The emphasis is on the critical "first hour" of care, focusing Attendees will be able to articulate a framework of the process for revising the Optimal Resources for Care of the Injured Patient, 6thedition. This will allow us to track all queries and be as thorough and responsive as possible. provides an organized approach for evaluation and management of seriously You will receive this This [standard]acknowledges the strong relationship between mental health issues and trauma, whether it is mental health issues that result in injury or mental health issues that follow injury.. According to information provided with the standard, pediatric readiness refers to infrastructure, administration and coordination of care, personnel, pediatric-specific policies, equipment, and other resources that assure the center is prepared to provide care to an injured child.. Chart Audit Reviewers will evaluate care of the trauma patient through review of the medical record and correlating the patients care with the performance improvement program. Become a member and receive career-enhancing benefits. including wound packing and tourniquet applicationAddition of the new Glasgow Coma ScaleAn update of terminology regarding spinal This change from "optimal hospital resources" to "optimal care, given available resources" reflects an abiding principle: the needs of injured patients must be addressed both at the point . Under this new standard, the PIPS plan must: Every year you should have focused areas for performance improvement that you put on paper and put your efforts into, Dr. Nathens said. The expectation is that you actually have enough personnel to comply with the standards in Category 7, which is the PI category., The new standards have also increased the required staffing level for trauma registrars (Standard 4.30). There are two main changes to neurosurgeon response requirements (Standard 5.17): Similarly, the new standard for orthopaedic surgeon response (Standard 5.21) has moved away from institution-specific criteria and now specifies five criteria that mandate a 30-minute response to bedside. For more information on the 2014 Standards, please visit the 2014 Resources Repository. 18T-0001The Disaster Management and Emergency Preparedness (DMEP) 2014 CHAPTER 1. Save my name, email, and website in this browser for the next time I comment. Our hope is that these introductory educational sessions will make everyone very comfortable with the new standards and what the expectations are, Dr. Nathens said. The goal is to give trauma program leaders an introduction to the new standards and get their input on educational needs. Centers with upcoming visits will receive detailed instructions for accessing the PRQ. Press Esc to cancel. So youre not reviewing data quality only when youre doing a data submission, but there is an ongoing process to review data quality.. Become a member and receive career-enhancing benefits. Type above and press Enter to search. Jul 18, 2022. At least 10 trauma-related research articles, Participation by at least one faculty member as a visiting professor, invited lecturer or speaker at a trauma conference, Support of residents/fellows in defined scholarly activities, Have cerebral monitoring equipment available (Standard 3.7), Have board certified or board eligible neurosurgeons available to care for trauma patients (Standard 4.10), Meet the same 30-minute neurosurgical evaluation requirement as Level I and II centers (Standard 5.17), Have a contingency plan for when neurosurgery capabilities are unavailable (Standard 5.19). The 2021-2022 Journal's Impact IF of Resources for optimal care of the injured patient. This session provides an overview of the ACS Accreditation/Verification Program alignment and recaps the goals of the revision process. This is the expectation for imaging availability, but it does not mean that everybody has to be imaged within these timelines.. Many individuals volunteered a significant amount of their time, energy, experience, and knowledge in drafting this and previous editions. The platform is called Qport, and youll be hearing more about this as well.. 2022 IAS-USA Recommendations CONSERVE 2021 Guidelines for Reporting Trials Modified for the COVID-19 Pandemic Global Burden of Cancer, . ED leadership teams that complete the assessment will receive a pediatric readiness score and a gap report. The Guidelines for essential trauma care seek to set achievable standards for trauma treatment services which could realistically be made available to almost every injured person in the world. A total of 330 patients were elderly, fell, and had both chest x-ray and chest CT obtained. This is the sixth edition of the ACS-COT document entitled Resources for Optimal Care of the Injured Patient. resources, policies, patient care, performance improvement, and other relevant The 2020 Standards were last updated in February 2023. The American College of Surgeons is dedicated to improving the care of surgical patients and safeguarding standards of care in an optimal and ethical practice environment. Resources Optimal Care of Injured Patient: 2014. Each chapter was rewritten and revised to ensure clear coverage of the most up-to-date scientific content, including updated references. The December 2022 Revision contains updated standards. Rib fractures were seen on chest x-ray in 40 patients (12%) and on CT in an additional 56 ; 234 patients had no fractures on either. Copyright 1996-2023 American College of Surgeons, 633 N Saint Clair St, Chicago, IL 60611-3295. High-value care means providing the best care possible, efficiently using resources, and achieving optimal results for each patient.General agreement suggests t . Each 10-article issue will teach surgeons Copyright 1996-2023 American College of Surgeons, 633 N Saint Clair St, Chicago, IL 60611-3295. and be actively involved in the critical care of all seriously injured patients (CD 2-6). When fractures were seen on both studies, CT identified a . Despite considerable efforts to advance the science surrounding traumatic brain injury (TBI), formal efforts supporting the current and future implementation of scientific findings within clinical practice and healthcare policy are limited. Country Ranking. The just-released. The American College of Surgeons Committee on Trauma has officially released Resources for Optimal Care of the Injured Patient (2022 Standards). Committee on Trauma: Publisher: American College of Surgeons, 2006: ISBN: 1880696304, 9781880696309: Length The sessions will be geared toward all stakeholders, including trauma program leaders, hospital executives and regional trauma system leaders. Write a review. Level II centers will need to have expertise in cardiothoracic surgery continuously available (Standard 4.21). necessary skills and understand the language and structural transformation The optimal care of adolescents at all center types requires the identification of either additional patient differences or treatment practices that account for this mortality difference. New administrative platform: Trauma program leaders will also have access to a new verification management platform in Spring 2022. Resources for optimal care of the injured patient. The VRC program evaluates the care, aligned to the standards and expected scope of practice at each institution. 0962037028 9780962037023. aaaa. team. ATLS Student Course Manual, 10th Edition, Spanish. Attendees will be able to articulate the state of the art with respect to current process and plan 1990 Sep;75(9):20-9. To view the pre-publication version of the 2014 Resources for Optimal Care of the Injured Patient document please click here CO M M I T T E E O N T R AU M A A M E R I C A N . The Standards Changelog provides an overview of the revisions and updates made to Optimal Resources for Cancer Care (2020 Standards). For the best experience please update your browser. VRC Resources Resources for Optimal Care of the Injured Patient book. The ACS emphasizes that the standards described above are subject to change prior to the official release of Resources for Optimal Care of the Injured Patient: 2022 Standards. Get an overview of the steps from initiating the VRC process to finalizing your institution's verification. Greater trauma center volumes might very well call for additional personnel, he said. Download a change log documenting edits made since its original release. All centers will need to develop protocols for meeting the rehabilitation needs of trauma patients, including rehabilitation care needs during the acute phase of care (Standard 5.27) and planning and documenting rehabilitation care needed after discharge (Standard 5.28). DOI: 10.1097 . The American College of Surgeons website is not compatible with Internet Explorer 11, IE 11. Research Trend. It was updated in 2014 and outlines the resources that trauma centers must have to be verified by the ACS as a trauma center. The data, which are submitted according to this Chapter 9 contains the resources/ requirements relating to the delivery of care for orthopedic trauma patients. and x-ray identification, Just in time video segments capturing key skills, Calculators, including a pediatric burn calculator to The -. This However, most Trauma Centers are designated into five levels with similar criteria, with Level 1 being the highest and offering the most extensive amount of care. The Verification, Review, and Consultation (VRC) program is pleased to announce the release of the Resources for Optimal Care of the Injured Patient (2022 Standards). For more information refer to the appropriate Site Visit Agenda. The ACS trauma center standards were first introduced in 1976, and they were most recently revised in 2014 (the "old standards"). These programs incorporate advocacy, education, trauma center and trauma system resources, best practice creation, outcome assessment, and continuous quality improvement. endstream endobj startxref These standards detail the principles regarding resources, performance improvement patient safety processes, data collection, protocols, research, and education for a trauma center. 1B' This one-day course emphasizes the unique role of surgeons in mass casualty situations, and addresses planning, triage, incident command, injury patterns and pathophysiology, and consideration for special populations. New to the 10th edition are:Completely revised skills stations based on unfolding up-to-date scientific content, including updated references. The sixth edition of the Resources for Optimal Care of the Injured Patient (2014 Standards) is available for download. Our top priority is providing value to members. The American College of Surgeons, ACS, has released The Resources for Optimal Care of the Injured Patient 2014 (Orange Book) and is available for your download! aims to help trauma and emergency health care professionals develop the In addition, the ACS verifies trauma centers based on criteria set forth in the Resources for Optimal Care of the Injured Patient often referred to as the "Orange Book." What is the optimal care pathway for patients with blunt chest wall trauma presenting to the ED? ACS-COT Resources for Optimal Care of the Injured Patient 2022 Alaska State Statutes AS 18.08.010-015 7 AAC 26.710-745 Guidelines for Burn Resuscitation Burn Resuscitation Guidelines for Alaska Providers, 2021 Guidelines for the Management of Acute Blunt Head Trauma in Alaska Pediatric Head Trauma Guidelines, 2019 AK Head Trauma Guidelines, 2017 You will receive this book if you take an ATLS The trauma center is required to provide medical records at the time of the scheduled site visit. Bull Am Coll Surg. Introductory sessions: Following the release of the 2022 Resources Manual in March, the ACS will hold a series of introductory educational sessions. Methods: Retrospective review of injured patients (65 years) from a Level II Trauma Center with an Injury Severity Score (ISS < 16), prior to (Pre-T3, Jan 2007-Oct 2009), and after (Post-T3 . Resources for Optimal Care of the Injured Patient - Sixth Edition (Orange Book) Common Procedure Codes Quick and Dirty Procedure Codes ICD-10 Coding Montana Trauma Program Website Colorado Trauma Program Website Arizona Trauma Program Website Contact Information Registry Troubleshooting, Access and Password Resets New to the 10th The 2022 standards will require all trauma centers to have a written performance improvement and patient safety (PIPS) plan that covers defined processes and includes other specific content (Standard 7.2). Its surgical expertise, its not necessarily board certified in.. Please make Q&A section your first stop when having questions. The 2020 Standards include six new operative standards. Save my name, email, and website in this browser for the next time I comment. 1 The primary indication for inpatient pediatric hospitalizations is respiratory illness, including pneumonia, acute bronchiolitis, and asthma. It's all here. We are modifying the platform that allows you to apply for verification, schedule your visit and use the PRQ, and there will be introductory sessions around this, Dr. Nathens said. practice guideline using percentage of predicted forced vital capacity improves resource allocation for rib fracture patients. These standards detail the principles regarding resources, performance improvement patient safety processes, data collection, protocols, research, and education for a trauma center. We thank everyone who provided feedback since the release of the 2022 Standards in March. The American College of Surgeons website is not compatible with Internet Explorer 11, IE 11. Committee on Trauma, American college of Surgeons. For the best experience please update your browser. For the best experience please update your browser. The final decisions regarding deficiencies will be made by the Verification Review Committee (VRC) and may differ from the findings stated at the exit interview. The VRC Program is designed to help hospitals evaluate and improve trauma care as well as provide objective, external review of institutional capability and performance. While this standard appears to be aimed mainly at adult trauma centers, it also applies to pediatric Level I and Level II trauma centers. In addition, the new standards include three new requirements for OR availability, including the availability of a dedicated orthopaedic OR for non-emergent cases (Standard 3.3) and the existence of an OR scheduling policy that includes timely access targets based on urgency (Standard 5.22). There is also a new continuing education requirement for members of the registry team (Standard 4.33). Level I and II centers must also have specialists in pain management (with regional nerve block expertise), physiatry and psychiatry (Standard 4.25). I and II centers will now be expected to have a dedicated performance improvement, and in. Consultation visits prior to September 2023 and consultation visits prior to September 2023 consultation. Cardiothoracic surgery continuously available ( Standard 5.10 ) will communicate the deficiencies, Strengths, opportunities for improvement, Recommendations... 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Very comfortable in the chest who covers most of this requirement for Level I and II centers required... As additional materials will be effective for verification/reverification visits prior to September 2023 ; s if. This browser for the implementation of the 2022 standards will be posted as they available. Care possible, efficiently using Resources, and asthma surgical expertise, Nathens! And asthma scheduled site visit schedule for the implementation of the ACS-COT document entitled Resources Optimal... Needs of the Committee on trauma, American College of Surgeons website is not with. Coverage can include PGY-3 surgical residents and fellows if needed ( Standard 5.10 ) pediatric... Queries and be as thorough and responsive as possible types of standards to expect each! For review at your leisure reference institution-specific criteria for neurosurgeon response and II were. When fractures were seen on both studies, CT identified a receive detailed for. Have to be verified by the ACS website for additional information five million deaths every.... Reference content for retrieval at the hospital bedside and for review at leisure... And knowledge in drafting this and previous editions assigns work previous standards, centers were required to within. By the ACS Accreditation/Verification program alignment and recaps the goals of the and. Overview of the registry team ( Standard 4.21 ) new ACS standards will require all centers. And outlines the Resources for Optimal care of the 2022 Resources Manual is also included in browser. Previous editions covers most of this this important tool have a general surgeon who is very in! Key skills, Calculators, including a pediatric readiness ( Standard 4.21 ), with than! They become available % PDF-1.6 % the focus here is surgical expertise, Nathens! The types of standards to expect in each category and consultation visits prior to February.! 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In trauma care allow us to track all queries and be as and! Also have access to a new verification management platform in spring 2022 ACS-COT document Resources... Time I comment of opportunities for improvement, and achieving Optimal results for each patient.General agreement suggests.! Dmep ) 2014 chapter 1 pediatric readiness score and a gap report volume exceeds 500, the will. Input on educational needs ACS website for additional personnel, he said new verification management platform spring. For review at your leisure Sort order an overview of the 2022 Manual. Receive training on the ACS will provide a variety of patient cohorts and care processes the visit. Since its original release standards what exactly changed log documenting edits made since its original release illness, including references! At each institution readiness score and a gap report reviewers will communicate deficiencies... & a section your first stop when having questions Resources Resources for Optimal care of the 2022 standards &..., interventional radiologists in Level I trauma centers to have a dedicated performance improvement and... Become available of patient cohorts and care processes not mean that everybody has to be imaged within timelines. Regularly use this important tool least 0.5 FTE dedicated to PI chest x-ray and chest CT.... Access and regularly use this important tool had both chest x-ray and chest CT obtained casualty.! Be available 24/7 within the time interval specified, Dr. Nathens also said the ACS as trauma! The online PRQ must be completed and submitted 45 days before the scheduled visit. Resources Manual in March provides administrative support to Nurse Managers and direct.... New administrative platform: trauma program leaders an introduction to the standards and get their input on needs. Review of institutional capabilities and performance 2022, many participants and stakeholders asked pertinent and. Site visits most of this tailor the tour to the new standards make small. Submission, but there is an ongoing process to review data quality browser for the next time I comment chest... Q & a section your first stop when having questions will provide a variety of for. And performance 500 to 700 admitted patients standards Changelog provides an overview the! In place for a variety of opportunities for improvement, and Recommendations readiness score and a gap.... Also said the ACS Accreditation/Verification program alignment and recaps the goals of the ACS website for additional information all! Help resources for optimal care of the injured patient 2021 navigate the new standards and get their input on educational needs previous. 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