Variations in the Delivery of Emergency General Surgery Care in the Era of Acute Care Surgery
Department of Surgery; Department of Quantitative Health Sciences
Emergency Medicine | Health Services Administration | Health Services Research | Surgery
BACKGROUND: Acute care surgery (ACS) was proposed to improve emergency general surgery (EGS) care; however, the extent of ACS model adoption in the United States is unknown. A national survey was conducted to ascertain factors associated with variations in EGS models of care, with particular focus on ACS use.
METHODS: A hybrid mail/electronic survey was sent in 2015 to 2,811 acute care hospitals with an emergency room and an operating room. If a respondent indicated that the approach to EGS was a dedicated clinical team whose scope encompasses EGS (+/- trauma, +/- elective general surgery, +/- burns), the hospital was considered an ACS hospital.
RESULTS: Survey response was 60.1% (n=1,690); 272 (16.1%) of these hospitals reported having used an ACS model of care for EGS patients. Teaching status and general hospital practices (for example, interventional radiology available within one hour) were associated with ACS use. In bivariate analyses, ACS use was associated with many EGS-specific practices (40.1% of ACS hospitals freed their surgeons of daytime clinical responsibilities after operating overnight vs. 4.7% of general surgeon on call (GSOC) hospitals; p < 0.0001).
CONCLUSION: There are wide variations in EGS practices in the United States, with use of an ACS model of care being relatively low despite reported benefits of ACS models of care on EGS access, quality, and costs. Hospital factors associated with using ACS models are overall size and higher level of existing resources. These findings could be applied to the development of centers of excellence for EGS care. reserved.
DOI of Published Version
Jt Comm J Qual Patient Saf. 2018 Aug 6. pii: S1553-7250(17)30529-9. doi: 10.1016/j.jcjq.2018.04.012. [Epub ahead of print] Link to article on publisher's site
Joint Commission journal on quality and patient safety
Daniel VT, Ingraham AM, Khubchandani JA, Ayturk MD, Kiefe CI, Santry HP. (2018). Variations in the Delivery of Emergency General Surgery Care in the Era of Acute Care Surgery. Population and Quantitative Health Sciences Publications. https://doi.org/10.1016/j.jcjq.2018.04.012. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1225