Title
Adherence to 20 Emergency General Surgery Best Practices: Results of a National Survey
UMMS Affiliation
Department of Surgery; Department of Quantitative Health Sciences
Publication Date
2018-03-30
Document Type
Article
Disciplines
Surgery | Trauma
Abstract
OBJECTIVE: To examine national adherence to emergency general surgery (EGS) best practices.
BACKGROUND: There is a national crisis in access to high-quality care for general surgery emergencies. Acute care surgery (ACS), a specialty leveraging strengths of trauma systems, may ameliorate this crisis. A critical component of trauma care is adherence to clinical guidelines. We previously established best practices for EGS using RAND Appropriateness Methodology and pilot data.
METHOD: A hybrid (postal/electronic) questionnaire measuring adherence to 20 EGS best practices was administered to respondents overseeing EGS at all eligible adult acute care general hospitals across the US (N = 2811). Questionnaire responses were analyzed using bivariate methods and multiple logistic regression.
RESULTS: The response rate was 60.1%. Adherence ranged from 8.5% for having an EGS registry to 86.2% for auditing 30-day postoperative readmissions. Adherence was higher for practices not restricted to EGS (eg, auditing readmissions) compared to EGS-specific practices (eg, registry, activation system). Adopting an ACS model of care increased adherence to practices for deferring elective cases; tiering urgent operations; following National Comprehensive Cancer Network guidelines; reversing anticoagulants; auditing returns to intensive care, time to evaluation, time to operation, and time to source control; and having transfer agreements to receive patients, ICU admission protocols, as well as EGS-specific activation systems, outpatient clinics, morbidity and mortality conferences, and registries.
CONCLUSIONS: There is substantial room for performance improvement, and adopting an ACS model predicts better performance. This novel overview of adherence to EGS best practices will enable surgeons and policymakers to address variations in EGS care nationally.
Keywords
UMCCTS funding
DOI of Published Version
10.1097/SLA.0000000000002746
Source
Ann Surg. 2018 Mar 30. doi: 10.1097/SLA.0000000000002746. Link to article on publisher's site
Journal/Book/Conference Title
Annals of surgery
PubMed ID
29608545
Related Resources
Repository Citation
Ingraham AM, Ayturk MD, Kiefe CI, Santry HP. (2018). Adherence to 20 Emergency General Surgery Best Practices: Results of a National Survey. Population and Quantitative Health Sciences Publications. https://doi.org/10.1097/SLA.0000000000002746. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1176