Mitchell F L, Thal E R, Wolferth C C
Department of Surgery, University of Missouri, Columbia, USA.
Arch Surg. 1995 Jun;130(6):578-83; discussion 583-4. doi: 10.1001/archsurg.1995.01430060016003.
To identify the criteria deficiencies found during peer consultation of hospitals and the relationship to subsequent verification.
Between September 1987 and December 1992, 52 hospitals had consultation visits using American College of Surgeons criteria. Each report was studied for deficiencies, frequency of deficiencies, and relationship to verification.
There are 108 American College of Surgeons criteria. Thirty-five different criteria deficiencies were found. The number of deficiencies per hospital ranged from zero to 12. The more frequent deficiencies included a lack of the following: quality improvement, 35 (67%); trauma service, 20 (38%); trauma surgeon in emergency department, 20 (38%); 24-hour operating room availability, 17 (33%); trauma registry, 17 (33%); trauma continuing medical education, 16 (31%); trauma director, 15 (29%); computed tomography technician in hospital, 15 (29%); research, 14 (27%); trauma coordinator, 14 (27%); and neurosurgeon availability, 13 (25%). No hospital that lacked commitment of surgeons (n = 12) or hospital (n = 3) requested a verification visit. Twenty-four hospitals (46%) achieved verification by February 1994. Twenty-eight hospitals had six or fewer deficiencies, with 19 (68%) verified. Twenty-four hospitals had seven or more deficiencies, with only five (21%) subsequently verified. Verification visits followed consultation by 3 to 52 months. Two hospitals with nine deficiencies were verified after 30 and 48 months, although one failed its first verification visit.
American College of Surgeons consultation assists hospitals to identify their trauma center capability and appears to improve their ability to pass subsequent trauma center verification. Most criteria deficiencies are correctable. Lack of commitment by the surgeons or hospital is difficult to correct. There is an inverse relationship between the number of deficiencies and subsequent verification.
确定医院同行会诊期间发现的标准缺陷以及与后续核查的关系。
1987年9月至1992年12月期间，52家医院采用美国外科医师学会的标准进行了会诊访问。对每份报告进行研究，以确定缺陷、缺陷频率以及与核查的关系。
美国外科医师学会有108项标准。发现了35种不同的标准缺陷。每家医院的缺陷数量从0到12不等。较常见的缺陷包括缺乏以下方面：质量改进，35项（67%）；创伤服务，20项（38%）；急诊科创伤外科医生，20项（38%）；手术室24小时可用，17项（33%）；创伤登记，17项（33%）；创伤继续医学教育，16项（31%）；创伤主任，15项（29%）；医院有计算机断层扫描技术员，15项（29%）；研究，14项（27%）；创伤协调员，14项（27%）；以及有神经外科医生可用，13项（25%）。没有一家缺乏外科医生（n = 12）或医院（n = 3）承诺的医院要求进行核查访问。到1994年2月，24家医院（46%）通过了核查。28家医院有6项或更少的缺陷，其中19家（68%）通过了核查。24家医院有7项或更多的缺陷，随后只有5家（21%）通过了核查。核查访问在会诊后3至52个月进行。两家有9项缺陷的医院在30个月和48个月后通过了核查，尽管其中一家首次核查访问未通过。
美国外科医师学会的会诊有助于医院确定其创伤中心能力，并似乎提高了它们通过后续创伤中心核查的能力。大多数标准缺陷是可以纠正的。外科医生或医院缺乏承诺则难以纠正。缺陷数量与后续核查之间存在反比关系。
