Initial Implementation of an Acute Care Surgery Model: Implications for Timeliness of Care
Received 31 March 2009; received in revised form 25 June 2009; accepted 25 June 2009. published online 20 August 2009.
Background
In July 2007, we introduced an acute care surgery service to an academic department of surgery staffed in a prearranged, dedicated rotation by critical care-trained surgeons to address all emergency department, inpatient, and transfer consultations. This study is designed to evaluate the impact on patient care and describe the case-mix experienced.
Study Design
A retrospective review was done of a prospectively collected database encompassing all patients evaluated. Diagnosis, operations performed, and times of operations were recorded.
Results
Eight hundred sixty-one patients were evaluated. Four hundred ten patients (47.6%) had 500 operations; 368 (72.8%) were performed in the operating room and 132 (26.2%) at the bedside. Respiratory failure and malnutrition (n = 130), soft-tissue infection (n = 115), abdominal pain (n = 97), biliary (n = 94), bowel obstruction (n = 78), diseases of the colon (n = 49), and appendicitis (n = 46) were the most common diseases seen. The most common operations performed included incision and drainage (n = 61); tracheostomy or percutaneous gastrostomy, or both (n = 125); cholecystectomy (n = 53); appendectomy (n = 41); colectomy (n = 34); and complex abdominal wound care (n = 43). In the year before implementation, 55.4% of emergent procedures were performed between 7:30 am and 5:30 pm, compared with 70% after implementation (p = 0.0002). Procedures performed after 5:30 pm decreased from 44.6% to 30%.
Conclusions
Implementation of an acute care surgery service has been positive in terms of facilitating the ability to provide more timely care by increasingly using the daytime operating room and providing a breadth of consultative and operative experience to the participating academic surgeons and trainees.
Department of Surgery, Eastern Virginia Medical School, Norfolk, VA
Correspondence address: Rebecca C Britt, MD, Department of Surgery, Eastern Virginia Medical School, 825 Fairfax Ave, Suite 610, Norfolk, VA 23507
ABSTRACT