A qualitative analysis of acute care surgery in the United States: it's more than just "a competent surgeon with a sharp knife and a willing attitude"
Department of Quantitative Health Sciences; Department of Surgery
Medical Subject Headings
Continuity of Patient Care; Emergency Medical Services; General Surgery; Humans; Interviews as Topic; Quality of Health Care; Registries; Specialties, Surgical; Surgery Department, Hospital; Trauma Centers; United States
Health Services Research | Surgery | Translational Medical Research | Trauma
BACKGROUND: Since acute care surgery (ACS) was conceptualized a decade ago, the specialty has been adopted widely; however, little is known about the structure and function of ACS teams.
METHODS: We conducted 18 open-ended interviews with ACS leaders (representing geographic [New England, Northeast, Mid-Atlantic, South, West, Midwest] and practice [Public/Charity, Community, University] diversity). Two independent reviewers analyzed transcribed interviews using an inductive approach (NVivo qualitative analysis software).
RESULTS: All respondents described ACS as a specialty treating "time-sensitive surgical disease" including trauma, emergency general surgery (EGS), and surgical critical care (SCC); 11 of 18 combined trauma and EGS into a single clinical team; 9 of 18 included elective general surgery. Emergency orthopedics, emergency neurosurgery, and surgical subspecialty triage were rare (1/18 each). Eight of 18 ACS teams had scheduled EGS operating room time. All had a core group of trauma and SCC surgeons; 13 of 18 shared EGS due to volume, human resources, or competition for revenue. Only 12 of 18 had formal signout rounds; only 2 of 18 had prospective EGS data registries. Streamlined access to EGS, evidence-based protocols, and improved education were considered strengths of ACS. ACS was described as the "last great surgical service" reinvigorated to provide "timely," cost-effective EGS by experts in "resuscitation and critical care" and to attract "young, talented, eager surgeons" to trauma/SCC; however, there was concern that ACS might become the "wastebasket for everything that happens at inconvenient times."
CONCLUSION: Despite rapid adoption of ACS, its implementation varies widely. Standardization of scope of practice, continuity of care, and registry development may improve EGS outcomes and allow the specialty to thrive.
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Citation: Surgery. 2014 May;155(5):809-25. doi: 10.1016/j.surg.2013.12.012 Link to article on publisher's site
Santry, Heena; Pringle, Patricia L.; Collins, Courtney E.; and Kiefe, Catarina I., "A qualitative analysis of acute care surgery in the United States: it's more than just "a competent surgeon with a sharp knife and a willing attitude"" (2014). UMass Center for Clinical and Translational Science Supported Publications. 27.