Implementation of acute care surgery service provides more timely patient care

Oct 09, 2009

A new study published in the October issue of the Journal of the American College of Surgeons shows that the establishment of an acute care surgery service can help surgeons at academic medical centers provide more timely care to the growing number of patients who are transferred from the emergency room or smaller hospitals and who require an immediate operation.

Lack of access to high-quality acute surgical care is a growing problem in the United States due to numerous factors, including a shortage of surgeons and declining reimbursement associated with increasing numbers of uninsured patients. Further, general surgeons are increasingly subspecializing, resulting in difficulty providing expert care for emergency cases outside the realm of the surgeon's specialty. With an increased demand for surgical services, usually in the face of fewer resources, a new model is necessary to serve the needs of patients requiring nonscheduled, immediate surgical intervention.

"The results of this study suggest that an acute surgery service operating largely during daytime hours can provide more efficient emergency care without disrupting the treatment of patients undergoing scheduled operations," said Rebecca C. Britt, MD, FACS, assistant professor, department of surgery, Eastern Virginia Medical School (EVMS), Norfolk. "These findings argue for the establishment of dedicated acute surgical teams separate from trauma services."

The authors retrospectively reviewed a prospective database of 861 patients receiving consultations and procedures performed by an acute care surgery service at EVMS. The service was staffed by six board-certified critical care surgeons and two surgical residents. All emergency department, inpatient and transfer consultations for general surgery were directed to the acute surgery service. Trauma service was separate from the acute care surgery service. Data was reviewed for two time periods, prior to implementation and following implementation, from July 2006 to March 2008.

Of the 410 patients who had 500 operations, 72.8 percent were performed in the operating room (n=368) and 26.2 percent at the bedside (n=132). In the year before implementation of the acute surgery service, 55.4 percent of urgent and emergent procedures were performed between 7:30 a.m. and 5:30 p.m., compared with 70 percent after implementation (p=0.0002). Procedures performed after 5:30 p.m. decreased from 44.6 percent to 30 percent following implementation of the service.

Researchers said that the shift in operations from after hours to daytime hours was accomplished by assigning an attending surgeon to cover those procedures that could wait until daytime (for example, gallbladder removal), without compromising the emergency coverage for those patients who required immediate operations. This approach allowed operations to proceed as openings in the daily operating room schedule developed, rather than as add-on procedures performed at the end of the day or into the night.

The most common cases that required treatment by the acute service were respiratory failure and malnutrition (n=130), soft-tissue infection (n=115), abdominal pain (n=97), biliary complications (n=94) and bowel obstruction (n=78). The most common operations performed included creating a surgical opening in the trachea or stomach for insertion of tubes, or both (n=125); incision and drainage (n=61); gallbladder removal (n=53); and complex abdominal wound care (n=43).

Source: Weber Shandwick Worldwide (news : web)

Explore further: Experts call for higher exam pass marks to close performance gap between international and UK medical graduates

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Obese British man in court fight for surgery

Jul 11, 2011

A British man weighing 22 stone (139 kilograms, 306 pounds) launched a court appeal Monday against a decision to refuse him state-funded obesity surgery because he is not fat enough.

2008 crisis spurred rise in suicides in Europe

Jul 08, 2011

The financial crisis that began to hit Europe in mid-2008 reversed a steady, years-long fall in suicides among people of working age, according to a letter published on Friday by The Lancet.

New food labels dished up to keep Europe healthy

Jul 06, 2011

A groundbreaking deal on compulsory new food labels Wednesday is set to give Europeans clear information on the nutritional and energy content of products, as well as country of origin.

Overweight men have poorer sperm count

Jul 04, 2011

Overweight or obese men, like their female counterparts, have a lower chance of becoming a parent, according to a comparison of sperm quality presented at a European fertility meeting Monday.

User comments : 0

More news stories