What ACS Looks for in Your PRQ: A Guide to Surviving (and Thriving) Verification
If the ACS Pre‑Review Questionnaire (PRQ) were a person, it would be that highly organized friend who alphabetizes their spice rack and labels their label maker. Thorough, detailed, and politely unforgiving, the PRQ is the backbone of every American College of Surgeons (ACS) trauma verification process. Understanding what ACS expects in this document isn’t just important—it is the difference between confidently welcoming the reviewers and panic‑printing policies at 2 a.m.
Let’s break down what the ACS is really looking for, with a balance of professionalism, precision, and just enough humor to keep you awake.
1. Demonstrated Understanding of Your Trauma Program’s Capabilities
The ACS uses the PRQ to gain an early snapshot of your trauma program—its structure, resources, outcomes, and alignment with standards (ACS, n.d.). The PRQ is not merely a questionnaire but a guided tour of your trauma center’s soul. Reviewers want to see:
What your center is capable of,
How you meet the required standards,
And whether you truly understand your own data (a surprisingly common pitfall).
The PRQ “allows the reviewers to have a better understanding of the existing trauma care capabilities and performance of the hospital and medical staff before beginning the review” (ACS, n.d.).
Translation? They want accuracy, completeness, and consistency—no creative writing allowed.
2. Compliance With the 2022 Standards (and Their Many Revisions)
The ACS 2022 Standards have seen multiple updates, clarifications, and revisions—most recently in July 2025—so the PRQ you complete must reflect current expectations (Fojut, 2025). These clarifications include more explicit language about specialist availability, pediatric credentialing, and interventional radiology response requirements.
Your PRQ must demonstrate:
Clear documentation of resources and staffing,
Precise insight into call schedules and specialist availability,
Updated policies and workflows aligned to the revised standards.
When ACS sharpens a requirement, they expect your documentation to sharpen with it.
3. Thorough Responses, Backed by Data and Attachments
The PRQ isn't just about checking boxes. Depending on the section, you may be asked to:
Upload attachments,
Complete tables,
Provide narrative descriptions,
Or offer policy excerpts demonstrating compliance.
The December 2022 revision of the PRQ includes instructions for each standard, specifying the format required—radio buttons, numbers, attachments, or text boxes (ACS, 2022).
If a question requires an attachment, ACS expects it—a missing upload can trigger a deficiency faster than you can say “Corrective Action Plan.”
4. Performance Improvement and Patient Safety (PIPS) Maturity
No element receives more scrutiny than your PIPS program. During site visits, chart audits and PIPS evaluation command center stage—and the PRQ is ACS’s first impression of how well you run your loop‑closure kingdom (ACS, n.d.).
Be ready to show:
How problems are identified,
How actions are taken,
And—most importantly—the evidence that the action worked.
PIPS is not a philosophy. It is a paper trail.
5. Data Surveillance and System Integration
The PRQ evaluates how well your trauma center participates in regional systems, maintains data accuracy, and uses trauma registries effectively. Levels of participation and evidence of integration are specifically addressed in PRQ structure (Emergency Medical Services Authority, n.d.).
ACS wants to see:
Active collaboration with regional trauma systems,
Accurate, validated registry data,
Utilization of data for ongoing improvement.
Yes, this is the portion where ACS quietly judges your definitions of “complete” and “timely.”
6. Documentation of Institutional Commitment
Institutional buy‑in is a non‑negotiable expectation in the PRQ. The ACS wants proof that your trauma program isn't a lonely garage start‑up operating in the basement of the hospital but a fully supported, resourced service with administrative backing (ACS, 2022).
This includes:
Budget support,
Administrative oversight,
And evidence that the C‑suite knows you exist (and ideally likes you).
7. Readiness for the Review—Demonstrated Through Completeness
The PRQ is due 45 days before your site visit, and ACS expects it to be both early and immaculate. Late submissions, inconsistent entries, or missing data suggest an unprepared program—never the impression you want to give (ACS, n.d.).
Mock visits, internal audits, and pre‑submission reviews are not just best practices—they may be the difference between:
✔ Verified for three years
and
✖ Verified for one year with a Corrective Action review
Conclusion
In short, what ACS looks for in your PRQ is simple: accuracy, completeness, alignment with standards, institutional support, and evidence of meaningful PIPS functioning. But in practice, delivering that requires coordination, vigilance, and occasionally emotional support snacks.
The PRQ is your story—an opportunity to showcase what your trauma center does brilliantly. Craft it carefully, review it thoroughly, and remember: the ACS isn’t looking for perfection—they’re looking for honesty, consistency, and a clear commitment to optimal trauma care.
And if all else fails, just remember: the PRQ is long, but verification lasts three years. Worth it.
References
American College of Surgeons. (n.d.). The Verification, Review, and Consultation Process. https://www.facs.org/quality-programs/trauma/quality/verification-review-and-consultation-program/process/
American College of Surgeons. (2022). PRQ for the 2022 Standards – December 2022 Revision. https://www.cotrauma.org/wp-content/uploads/2023/04/PRQ%20for%202022%20Standards_Updated%20for%20Dec%202022%20Revision.pdf
Fojut, R. (2025). ACS clarifies requirements in 10 trauma center standards. Trauma System News. https://trauma-news.com/2025/09/acs-clarifies-requirements-in-10-trauma-center-standards/
Emergency Medical Services Authority. (n.d.). Hospital Pre-Review Questionnaire (PRQ) Level III Trauma Center. https://emsa.ca.gov/wp-content/uploads/sites/71/2017/07/No_ACS_LevelIII_PRQ.pdf
