Bohler Technologies — Executive Dashboard

All Programs

Trauma · ACS

Burn · ABA

Cancer · CoC

Cardiac · ACC

Stroke · TJC

⚠ TM-42 overdue — MD Director Coverage documentation missing. Survey risk elevated. Remediate →

Overall Readiness

78^%

Standards Tracked

408^total

AI Risk Score

6.4^/10

Critical Gaps

Survey Window

83^d

Program Readiness

Details →

Trauma · ACS

82%

↑3%

Burn · ABA

64%

→

Cancer · CoC

76%

↑2%

Cardiac · ACC

88%

↑5%

Stroke · TJC

54%

↓2%

Risk Prediction AI

Details →

6.4

Moderate–High

range 5.1–7.8

LowModHigh

MD Coverage+2.1

Evidence Gaps+1.8

Registry QA+0.9

Trend Δ−0.4

Survey Countdown — All Programs

Manage →

83 days Trauma · ACS

Jun 8, 2026 · Re-Verification

82% Ready

TBD Burn · ABA

Date TBD · Re-Verification

64% Ready

214 days Cancer · CoC

Oct 17, 2026 · Annual Survey

76% Ready

306 days Cardiac · ACC

Jan 17, 2027 · Re-Accreditation

88% Ready

472 days Stroke · TJC

Jul 2, 2027 · Re-Certification

54% Ready

YTD Volumes by Program

Trauma Activations

1,847

↑ 6% vs last yr

Burn Admissions

312

↑ 3% vs last yr

Cancer Cases

204

→ Stable

Cardiac Encounters

891

↑ 9% vs last yr

Stroke Alerts

143

↓ 2% vs last yr

Total YTD

3,397

↑ 5% overall

Standards at Risk

View All →

Code	Standard	Risk	Evidence	Action
TM-42	Trauma Medical Director Coverage	Critical	3 / 8	Remediate
TM-17	PI Program Meeting Minutes	High	5 / 6	Upload
BN-08	Burn Nurse Competency Logs	High	4 / 10	Assign
ST-31	Stroke Alert Response Time Log	Medium	8 / 8	Review
TM-09	Outreach & Education Program	Medium	2 / 4	Upload

Standards Met by Program

TRAUMA

82%

172 / 209

BURN

64%

86 / 135

CANCER

76%

30 / 39

CARDIAC

88%

11 / 13

STROKE

54%

6 / 12

Evidence Library

Manage →

docs linked

Policies

Protocols

Logs

Meetings

⚠ 12 docs expiring within 30 days

Operational Metrics

Expand →

284

Activations / mo

↑ 12% vs last

18m

Door-to-CT

↑ 2m vs last

0.94

Risk-adj Mortality

↓ Trending

87%

Registry Complete

↑ 4% this mo

Priority Tasks

All Tasks →

Upload MD coverage schedule Q2

Dr. Rivera · TM-42

Overdue

Burn nurse competency logs ×6

K. Almeida · BN-08

Mar 28

Complete stroke protocol review

M. Chen · ST-18

Mar 20

Submit PI committee minutes

J. Fouts · TM-17

Done

Outreach program log — Feb

J. Fouts · TM-09

Overdue

Mock survey dry run scheduling

J. Fouts · Prep

Apr 15

Community Outreach Calendar

Events, education & community impact across all programs

Trauma

Burn

Cancer

Cardiac

Stroke

Multi

—

Events This Quarter

YTD Events

840

Community Touches YTD

Partner Organizations

ACS Standards

209^total

Survey Readiness

82^%

Open PI Items

Registry Complete

87^%

ACS Survey Readiness Checklist

Jun 8, 2026

Program Structure

Trauma Medical Director designated

TM-01 · Verified

✓

Trauma Program Manager credentialed

TM-02 · Verified

✓

MD Coverage schedule Q2 uploaded

TM-42 · Critical gap

Overdue

On-call roster current

TM-44 · Verified

✓

PI Program

PI committee meets monthly (minutes on file)

TM-17 · 12 months documented

✓

Loop closure documented for all filters

TM-18 · 3 open loops

Apr 1

Mortality / morbidity review process active

TM-21 · Verified

✓

Outreach & Education

Outreach log — Feb & Mar uploaded

TM-09 · 2 months missing

Overdue

Injury prevention program active

TM-11 · Verified

✓

ATLS / TNCC training current for team

TM-08 · 4 staff pending

May 1

Registry

NTDB submission current

TM-55 · Q4 2025 submitted

✓

Registry completeness ≥ 90%

TM-56 · Currently 87%

Apr 15

Data dictionary version current

TM-57 · NTDS 2025 active

✓

Meeting Calendar

TPRC

Ops

QSC

OTOM

ACS Standards Tracker 209 total

Full List →

Program Admin

91%

Clinical Resources

84%

PI Program

78%

Outreach & Ed

65%

Registry

87%

Trauma Activation

72%

Standards Requiring Action

Code	Standard	Status	Action
TM-42	MD Director Coverage Documentation	Critical	Fix
TM-09	Outreach & Education Log	High	Upload
TM-18	PI Loop Closure Documentation	High	Update
TM-08	ATLS Staff Training Currency	Medium	Assign
TM-56	Registry Completeness ≥ 90%	Medium	Review

PI / Performance Improvement Log

Full Log →

PI #	Issue / Filter	Status	Opened	Loop
PI-26-01	Door-to-CT > 30 min — 3 cases Q1	Open	Jan 14	Close
PI-26-02	Missed trauma activation — penetrating abdominal	Open	Feb 3	Close
PI-26-03	Delayed OR — orthopedic coverage gap	Open	Feb 18	Close
PI-26-04	Blood transfusion protocol deviation	Review	Mar 2	Review
PI-25-11	Rehab consult delay > 48hrs — 5 cases	Closed	Nov 10	✓
PI-25-12	Documentation gap — GCS on arrival	Closed	Dec 1	✓
PI-26-05	Alcohol screening rate below benchmark	Review	Mar 10	Review

1 Critical open 2 High open 2 In review 2 Closed

Registry Quality & Completeness

NTDB Report →

87%

Overall
Completeness

Demographics

99%

Injury Data

94%

Vitals / ED

91%

Procedures

83%

Discharge

78%

Complications

71%

Abstraction Timeliness

91%

Abstracted ≤ 60 days DC

↑ Goal ≥ 90%

94%

NTDB Submission Rate

Q4 2025 complete

0.94

IRR Agreement Score

↑ Above 0.90 target

⚠ Complications completeness 71% — NTDB benchmark requires ≥ 90%

Phases of Care — Response Times

Drill Down →

Metric	YTD	Goal	Status
Trauma surgeon response — Level I activation (≤15 min)	94%	≥95%	Watch
Anesthesia response — emergent OR (≤15 min)	97%	≥95%	Met
Neurosurgery response — emergent (≤30 min)	91%	≥90%	Met
ED Length of Stay — ISS ≥ 16	74 min	<90 min	Met
Door-to-CT (median)	18 min	<15 min	Miss
Time to OR — hemorrhagic shock	38 min	<60 min	Met

TQIP Benchmarked Outcomes

RISK-ADJ

0.94

Risk-adj Mortality

↓ Low outlier

1,847

Total Activations YTD

↑ 6% vs 2025

62%

ISS ≥ 16 (Major)

↑ Case mix

8.4d

Avg Hospital LOS

→ At benchmark

2.1d

Avg ICU LOS

↓ Below benchmark

1.4d

Avg Vent Days

↓ Below benchmark

TQIP Cohort Performance

Blunt MultisystemLow Outlier ✓

Penetrating InjuriesAverage ✓

Severe TBIWatch

Hemorrhagic ShockLow Outlier ✓

Elderly (≥ 65)Watch

TQIP Complications / Hospital Events

Detail →

Complication	Rate	Benchmark	Status
VTE (DVT / PE)	2.1%	2.4%	Met
Pneumonia (VAP)	1.8%	2.0%	Met
CAUTI	0.9%	1.1%	Met
Severe Sepsis	3.4%	2.8%	High
Acute Kidney Injury	2.2%	2.5%	Met
Unplanned Readmission	4.2%	4.1%	Watch
Alcohol Screening Rate	76%	≥80%	High

⚠ Severe Sepsis rate above national benchmark — open PI item PI-26-04

ABA Standards

135^total

Verification Readiness

64^%

Avg Daily Census

4.2

Open PRQ Items

Next Survey

TBD

⚠ 8 PRQ sections incomplete — Nurse competency logs (Sec 6), Therapy CEU documentation (Sec 7), and QI loop closure evidence (Sec 9) require immediate attention. Review All →

ABA PRQ — Section Readiness

2026 PRQ

#	PRQ Section	Status	Items	CD Lvl
1	Burn Center Administration	Ready	8 / 8	L1
2	Burn Center Volume	Ready	5 / 5	L1
3	Burn Center Director	Ready	15 / 15	L1
4	Burn Surgeons	In Progress	9 / 11	L1/2
5	Advanced Practice Providers	Ready	2 / 2	L1
6	Nursing	Gap	5 / 9	L1/2
7	Therapy	Gap	7 / 10	L1/2
8	Burn Team Members & Consultants	In Progress	9 / 11	L1/2
9	Quality Improvement	Gap	10 / 18	L1/2
10	Pre-Hospital Care	Ready	4 / 4	L1
11	Emergency Department	In Progress	3 / 5	L1/2
12	Intensive Care Unit (ICU)	Ready	5 / 5	L1/2
13	Operative Services & Anesthesia	Ready	5 / 5	L1/2
14–16	Rehab / Ambulatory / Community	In Progress	8 / 12	L1/2
17–19	Prevention / Advocacy / Disaster	In Progress	5 / 8	L1/2

Burn Center Volume (ABA Sec 2)

Full Table →

312

Total Admissions YTD

↑ 3% vs 2025

4.2

Avg Daily Census

↑ ABA min = 3.0

18%

Avg TBSA

→ Stable

TBSA > 20%

↑ 6 vs last yr

Inhalation Injury

→ Stable

2.1%

Transfer Out Rate

↓ ABA max = 5%

ABA Criteria Compliance by CD Level

CD Level 1

71%

↓

CD Level 2

55%

↓

⚠ CD Level 1 criteria are mandatory — deficiencies may result in non-verification

Critical PRQ Gaps — Action Required

All Gaps →

Sec 6: Nurse competency-based training documentation

Criteria 6.5 · CD Level 1 · Assign to Nurse Leader

Critical

Sec 9: QI loop closure documentation — 3 open items

Criteria 9.3, 9.10, 9.18 · CD Level 1

Critical

Sec 7: Therapy CEU documentation past 2 years

Criteria 7.7 · CD Level 2

High

Sec 4: Burn surgeon call schedule — 3 months attached

Criteria 4.6 · CD Level 1

High

Sec 9: BCQP / NBR data submission current year

Criteria 9.15 · CD Level 1

High

Sec 11: ED burn protocols — date of last review required

Criteria 11.1 · CD Level 1

High

Meeting Calendar — Burn Program

Ops

QSC

OTOM

Click a meeting date to view agenda

QI Program — ABA Section 9

Full Log →

M&M Monthly

✓

QI Qtly Mtg

✓

Loop Closures

40%

BCQP Submit

80%

Robust PI

50%

Open QI Items

Issue	Criteria	Status
Delayed therapy eval >24hr — 4 cases	9.3 / 7.1	Open
CAUTI rate — above benchmark Q1	9.13	Open
Nutrition consult >24hr — TBSA >20%	8.2 / 9.3	Review
Wound care protocol deviation — 2 cases	9.12	Closed

Clinical Outcomes — ABA Benchmarks

BCQP →

2.4%

Overall Mortality

↓ Below benchmark

14.2d

Avg LOS (all burns)

→ At benchmark

94%

Therapy within 24h

↑ Goal ≥ 90%

3.1%

Unplanned Readmit

↓ Below 5% target

1.8%

CAUTI Rate

↑ Above benchmark

2.1%

Transfer Out Rate

↓ ABA max = 5%

Mortality by Modified BAUX

BAUX < 40

BAUX 40–80

1.2%

BAUX > 80

24%

✓ Overall mortality below national BCQP benchmark — strong program performance

Team Credential & Training Status

Tables →

Certification & Training (ABA Sec 3–8)

Requirement	Status	Due
Burn Director — ABLS current	✓	2027
All burn surgeons — ABLS / equiv	3/4	Jun 26
Director — 50 adult pts/yr directed	✓	Annual
Each surgeon — 25 burn ops/yr	✓	Annual
Nurse Leader — burn CE biennial	✓	2026
Nurse competency docs on file	Gap	Overdue
Therapist CEU — burn-specific	Gap	Q2
Team M&M attendance ≥ 50%	✓	Monthly

Required Attachments Status

Admin support letter (Sec 1.2)Attached

Burn Director CV (Sec 3.1)Attached

All surgeon CVs (Sec 4.1)Attached

3-month call schedule (Sec 4.6)Missing

All APP CVs (Sec 5.1)Attached

Nurse Leader CV (Sec 6.1)Attached

Nurse competency docs (Sec 6.5)Missing

Triage/transfer guidelines (Sec 10.1)Attached

Mass casualty disaster plan (Sec 19.2)Attached