annual vrc reviewer update webinar november 16, …web4.facs.org/tqipfiles/2016 vrc reviewer...
TRANSCRIPT
![Page 1: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/1.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Annual VRC Reviewer Update
Webinar
November 16, 2016
![Page 2: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/2.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Rosemary Kozar, MD, Chair R. Todd Maxson, MD, Vice Chair Tammy Morgan, Manager, Trauma Center Programs Julia McMurray, Operations Manager Molly Lozada, Program Manager, Verification
![Page 3: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/3.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Program Staffing Updates
Program Updates: ◦ Program Growth ◦ Report Process ◦ Verification Education ◦ Clarification Document
New Reviewer Editors New Reviewer Process Pilot Study for Physician to Physician Contact Pediatric Collaboration Performance Improvement/Patient Safety
![Page 4: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/4.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Tammy Morgan, Manager, Trauma Center Programs
Julia McMurray, Operations Manager
Molly Lozada, Program Manager Verification
Megan Hudgins, Program Coordinator
Rachel Tanchez, Scheduling Coordinator
Anita Johnson, Program Assistant
![Page 5: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/5.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Program Updates
![Page 6: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/6.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
![Page 7: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/7.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Adult Level I 89 Adult Level I, Level I Peds 23 Adult Level II 170 Adult Level III 79 Level I Pediatric 25 Level II Pediatric 4 Level I/II Adult w/Level II Pediatric 34 TOTAL 424
![Page 8: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/8.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
0
50
100
150
200
250
1985 1990 1995 2000 2005 2010 2015 2020
Num
ber o
f Vis
its
Total Visits
Adult Visits
Pediatric Visits
![Page 9: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/9.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
2016 Visits Total scheduled–233 2017 Visits Pending–289 2018 Visits Pending-14
![Page 10: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/10.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Report Process
![Page 11: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/11.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
‣ Average turnaround time (1/1/2016 – 6/30/2016): 90 business days (14-16 weeks)
‣ Delays are due to the demand and current report structure process; however, times are improving due to the help of a temp. These % are for completed reports.
![Page 12: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/12.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Challenges ◦ Delays
Action Plan ◦ Additional resources
![Page 13: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/13.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
All medical cases must be standardized & grammatically correct. ◦ Tutorial coming
All Deficiencies, Strengths and Weaknesses must have
a: ◦ Reviewer comment or recommendation and match the
body of the report. ◦ Lead reviewer must review report for accuracy before
submitting to ACS office. ◦ Must go back into the hospital’s PRQ and modify
answers to match the report.
![Page 14: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/14.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Verification Education
![Page 15: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/15.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Report Writer – Tutorial
◦ Assist reviewers prepare the site visit report
◦ Launched 9/1/2016
◦ 144 registered, 61 have completed tutorial w/average
quiz score of 94% ◦ All reviewers must complete.
![Page 16: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/16.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Purpose: Help frame discussions about TQIP participation and results, and to foster consistent understanding among reviewers and hospitals about the components of TQIP
We need your input! ◦ Are the primers helpful? ◦ Areas for improvement?
![Page 17: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/17.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Monthly Q&A Verification webinars ◦ Launched June 2016 ◦ Help decreased volume of emails to Molly’s personal
inbox and redirect emails to [email protected]. ◦ Archives of recordings are available on the VRC
Repository webpage at: www.facs.org/quality-programs/trauma/vrc/resources. I will launch a newsletter for reviewers …what format is preferred.
![Page 18: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/18.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Standardize Medical Case Reviews Develop a New Reviewer Training
A Trauma Program Manager’s Guide to Becoming a
Verified Trauma Center
Work with the Info Tech Committee (Dr. Chris Dente) to develop an IEP process/repository for all trauma centers
![Page 19: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/19.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Clarification Document
Updates
![Page 20: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/20.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
![Page 21: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/21.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
www.facs.org/quality-programs/trauma/vrc/resources
![Page 22: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/22.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Must be present the day of chart review.
![Page 23: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/23.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
1. Completed a residency training program in anesthesia. Equivalency will be determined by the ASA representatives on the COT in conjunction with the ASA Committee on Trauma and Emergency Preparedness. In states such as CA where this is verified by the state, documentation of approval must be supplied and forwarded to the VRC.
2. ATLS; 3. 48 hours of trauma CMEs (IEP or external); 4. 50% of the trauma performance improvement meetings; 5. Membership/attendance trauma meetings; 6. M&M PIPS review by the TMD; 7. Licensed to practice medicine/unrestricted surgical privileges. 8. Not required to have an onsite visit by specialist reviewer.
![Page 24: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/24.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
There must be a representative (TMD or designee) from the adult program or from the pediatric program, attend the other program’s meeting, and ensure dissemination of communication is sent to the other panel members.
![Page 25: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/25.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
To meet the external CME requirement, will allow 33 hours of board certification or recertification to count as trauma or critical care external CME for all specialties:
◦ Trauma Surgeons ◦ Orthopaedic Surgeons ◦ Neurosurgeons ◦ Emergency Medicine
![Page 26: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/26.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
All Critical Care CME count.
IEP time must be equivalent to 16 hours annually or 48 hours in three years. ◦ Must be TRAUMA or CCM related (not cancer!!).
Proration ◦ All providers must have one year (16 hours) of CME. ◦ New centers, all providers must have one year (16
hours) minimum of CME.
![Page 27: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/27.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
May be used as an outreach activity.
![Page 28: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/28.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
New Reviewer Editors
![Page 29: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/29.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Trauma Surgeons: Dr. Roxie Albrecht Dr. Robert Letton Dr. Christoph Kaufmann
Nurse Reviewers: Alice Gervasini, PhD, RN Tracey McDonald, RN
![Page 30: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/30.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Evaluate the overall quality of the document. ◦ Critical information missing. ◦ Deficiencies or weaknesses not listed. ◦ Explain and support every criterion deficiency. ◦ Link each weakness and deficiency to a recommendation. ◦ Discrepancies between sections of the report or within
tables.
Grammar and spelling. Standardize the chart review format.
![Page 31: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/31.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Criteria for New Reviewers
![Page 32: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/32.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
1. Be a fellow in good standing of the ACS. 2. Be in active practice and have expertise in the areas of trauma
care, trauma center operations and trauma systems. 3. Display excellent integrity and communication skills. 4. Be an active medical staff in good standing at an ACS verified
trauma center. 5. Be a current or former trauma medical director or a current
assistant/associate TMD, Trauma PI leadership position, or hold some other leadership position within their facility in Acute Care Surgery such as division chief in an ACS verified trauma center.
6. Be a current or past member of the national Committee on Trauma, Regional, or local state Committee.
7. Obtain two letters of nomination: • One from a current Verification reviewer. • One from a national COT member, COT Region Chief, or COT State
Chair.
![Page 33: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/33.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
‣ Coming soon!
‣ Will work with liaisons to create appropriate criteria for neurosurgeon and orthopaedic surgeon reviewers.
![Page 34: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/34.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
CD 4-1: Direct physician to physician contact is essential (interhospital transfer).
Two Level II centers in Ohio requested permission for 6 month pilot to have APPs answer transfer calls.
APP speaks with transferring ED MDs, decide on activation level, and selectively include trauma MD at receiving center.
Update will be provided to VRC after 6 month study of comparing transferring centers satisfaction, triage accuracy, and time to transfer.
![Page 35: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/35.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Achieving successful pediatric verification in the absence of pediatric specialists while ensuring quality of care.
Pilot was approved with 3 Level II pediatric centers; will continue through next year.
Allow the collaborative relationship to be an alternative to
a pediatric surgeon on staff at the candidate hospitals.
New centers not in the program would receive the CD and then the recommendation would be to consider application to the pediatric collaborative.
![Page 36: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/36.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Performance Improvement/ Patient Safety
![Page 37: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/37.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
![Page 38: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/38.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
Taxonomy Stratification Cardiac Arrest Organ/Space Surgical
Site Infection Decubitus Ulcer Osteomyelitis
Deep Vein Thrombosis Pulmonary Embolism
Myocardial Infarction Severe Sepsis
![Page 39: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/39.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
https://www.facs.org/quality-programs/trauma/vrc/public-comment
![Page 40: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/40.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.
![Page 41: Annual VRC Reviewer Update Webinar November 16, …web4.facs.org/TQIPFiles/2016 VRC Reviewer Update.pdfAnnual VRC Reviewer Update Webinar November 16, ... All rights reserved Worldwide](https://reader034.vdocuments.net/reader034/viewer/2022051509/5b0456547f8b9a2d518d787e/html5/thumbnails/41.jpg)
© American College of Surgeons 2016. All rights reserved Worldwide.