Writing Strong Narrative Responses in the ACS Trauma PRQ

Jan 6

Written By Claire Tahiro, DNP, RN, CEN, TCRN

If the ACS Trauma Pre‑Review Questionnaire (PRQ) feels like a multi‑system trauma, you’re not alone. Many trauma programs report that writing clear, compelling PRQ narratives can feel a bit like trying to chart during a mass‑casualty incident: you know what happened, but getting it onto the page coherently is another story altogether.

Fear not—this guide will help you craft strong, structured, reviewer‑friendly narratives that show your trauma center at its best.

Why Narrative Responses Matter

The PRQ is essentially the reviewers’ first pass at understanding your trauma center’s capabilities, resources, PI culture, and operational readiness. As the ACS states, the PRQ allows reviewers “to have a better understanding of the existing trauma care capabilities and the performance of the hospital and medical staff before beginning the review” (American College of Surgeons, n.d.).

In other words, it’s your chance to tell your story before anyone sets foot in your trauma bay. Strong narratives prevent misinterpretation, highlight strengths, and demonstrate that your program meets (or exceeds!) ACS standards.

1. Start Early—The PRQ Waits for No One

The new PRQ under the 2022 Standards is longer, denser, and more process‑heavy than ever. Trauma leaders warn that assembling the documentation—sometimes hundreds of pages of call schedules, PI records, policies, educational materials, and research documents—is a “beastly” task best started months in advance (Kernop, n.d.).

Further, the ACS requires that the completed PRQ be submitted 45 days before the site visit (American College of Surgeons, n.d.). In short: start early, stay organized, and treat the timeline like an absolute.

2. Answer the Question—Fully, Clearly, and Directly

Each narrative question maps to a standard. Your job is not to be poetic—it is to be precise. Avoid vague statements like “we comply” or “we follow the standard.” Instead:

Identify the exact processes in place.
Describe the responsible roles and committees.
Outline evidence of compliance (e.g., meeting minutes, call schedules, PI loop documentation).
Summarize improvements made since the last visit.

The ACS Resources for Optimal Care (2022 Standards) outline specific expectations for disaster involvement, PI structure, specialist availability, and state system participation (American College of Surgeons, 2022). Your narrative should clearly demonstrate how your center fulfills these.

3. Use Structure—Reviewers Love Order

Think of your narrative like a well‑organized trauma handoff:

SBAR for PRQ Narratives

Situation: What standard the question addresses.
Background: Relevant structures, policies, or resources.
Assessment: How your center meets or exceeds expectations.
Recommendation/Result: Demonstrated outcomes, PI improvements, or next steps.

Well‑structured narratives help reviewers quickly digest your content—especially helpful when they are reading dozens of pages per center.

4. Highlight Performance Improvement (PI) Like It’s Your Center’s Superpower

Among all PRQ sections, reviewers scrutinize PI with surgical precision. The ACS emphasizes PI as part of both the chart review and onsite assessment (American College of Surgeons, n.d.). Narrative responses should include:

How issues are identified
How PI meetings function
Examples of loop closure
Tracking of response times and variances
Multidisciplinary involvement

As trauma leaders point out, a strong PI narrative includes chart summaries, action plans, and clear documentation demonstrating ongoing improvement (Kernop, n.d.).

Think of your PI narrative as your “before and after” case study—but without the dramatic lighting.

5. Show Your Evidence—But Don’t Bury the Reader in It

Your attachments matter—policies, call schedules, PI forms, disaster committee minutes, and educational materials all serve as proof. However, narrative responses should summarize, not duplicate, the content. Use phrases like:

“See Attachment 4.15-A for IR response time audits”
“Refer to Disaster Committee Minutes (2024 Q3) for documentation of trauma surgeon involvement”

ACS resources also emphasize using supplemental documents, change logs, and updated templates (ACS, 2022 Standards Repository). Aligning your narrative with the most recent standards is essential.

6. Use the Most Current Standards Revisions (Yes, They Change Often)

The 2022 Standards have multiple revisions—December 2022, December 2023, and July 2025 (ACS, 2022 Standards Repository). When describing compliance, always verify:

Standard numbering
Definitions
Requirements for attachments
Updated timelines or expectations

Nothing says “we weren’t prepared” like referencing an outdated standard in your narrative.

7. Balance Professionalism With a Human Touch

A witty tone is welcome as long as it enhances clarity and stays professional. Imagine you're speaking to a group of seasoned trauma surgeons: concise, confident, competent—with just enough personality to keep them reading.

Avoid melodrama. Use polished, precise language. Let your program’s strengths speak for themselves.

8. Review, Edit, and Conduct a Mock Survey

Just like a trauma drill, practice makes perfect. Trauma consultants strongly recommend conducting a mock survey to identify gaps and narrative weaknesses (Kernop, n.d.).

Before submitting:

Have section leads verify accuracy
Conduct a crosswalk between narratives and attachments
Ensure consistency in terminology, data ranges, and processes
Validate PI examples and outcomes

Strong narratives reflect strong organizational function.

Conclusion

Writing strong ACS Trauma PRQ narratives is part storytelling, part compliance documentation, and part PI showcase. When done well, your narratives will reflect a trauma center that is organized, responsive, data‑driven, and deeply committed to optimal care.

Start early. Be clear. Be structured. Be compelling.
And above all—tell your trauma center’s story like the lives of your next verification cycle depend on it.