TY - JOUR
T1 - Acute care surgery and emergency general surgery
T2 - Addition by subtraction
AU - Bruns, Brandon Robert
AU - Tesoriero, Ronald B.
AU - Narayan, Mayur
AU - O'Meara, Lindsay
AU - Lauerman, Margaret H.
AU - Eaton, Barbara
AU - Herrera, Anthony V.
AU - Scalea, Thomas Michael
AU - Diaz, Jose J.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Introduction: The formation of Acute Care Surgery services leads to decreased time to treatment and improved outcomes for emergency general surgery (EGS) patients. However, minimalwork has focused on the ideal care delivery system and team structure.We hypothesize that the implementation of a dedicated EGS team (separate fromtrauma and surgical critical care),with EGS-specific protocols and dedicated operating room (OR) time, will increase productivity and improve mortality. METHODS: This is a retrospective review of financial and EGS registry data from fiscal year (FY) 12 to FY15. Data are from an academic, university-based EGS team composed of two acute care surgery attending surgeons, advanced practitioners (APs), residents, and a fellow. In FY12, processes were implemented to standardize paging of consults, patient sign-out with attending surgeons' and APs' participation, clinical/billing protocols, OR availability, and quality improvement. Outcomes included relative value units (RVUs), surgical case volume, charges/payments, and number of patient encounters. The secondary outcome was mortality. The X2 test was used to compare mortality, and p < 0.05 was considered significant. RESULTS: Total patient encounters increased from 6,723 in FY 12 to 9,238 in FY 15 (+37%). Relative value units increased from 18,422 in FY 12 to 25,314 in FY 15 (+37%). Charges increased by 76%and payments increased by 60% from FY 12 to FY 15. Charges per encounter increased from $461 in FY 12 to $591 in FY 15 (+28%) Additionally, both inpatient and surgical case loads increased. Mortality remained stable throughout the study period (FY 12, 4.5%; FY 13, 5.2%; FY 14, 5.3%; FY 15, 3.2%: p = 0.177). CONCLUSIONS: Implementation of dedicated OR time, defined EGS team structure, practice protocols, and active attending surgeons'/APs' participation was temporally related to increased case volume, patients seen, and revenue, while mortality remained unchanged. Further study is necessary to establish the translatability of these data to other systems.
AB - Introduction: The formation of Acute Care Surgery services leads to decreased time to treatment and improved outcomes for emergency general surgery (EGS) patients. However, minimalwork has focused on the ideal care delivery system and team structure.We hypothesize that the implementation of a dedicated EGS team (separate fromtrauma and surgical critical care),with EGS-specific protocols and dedicated operating room (OR) time, will increase productivity and improve mortality. METHODS: This is a retrospective review of financial and EGS registry data from fiscal year (FY) 12 to FY15. Data are from an academic, university-based EGS team composed of two acute care surgery attending surgeons, advanced practitioners (APs), residents, and a fellow. In FY12, processes were implemented to standardize paging of consults, patient sign-out with attending surgeons' and APs' participation, clinical/billing protocols, OR availability, and quality improvement. Outcomes included relative value units (RVUs), surgical case volume, charges/payments, and number of patient encounters. The secondary outcome was mortality. The X2 test was used to compare mortality, and p < 0.05 was considered significant. RESULTS: Total patient encounters increased from 6,723 in FY 12 to 9,238 in FY 15 (+37%). Relative value units increased from 18,422 in FY 12 to 25,314 in FY 15 (+37%). Charges increased by 76%and payments increased by 60% from FY 12 to FY 15. Charges per encounter increased from $461 in FY 12 to $591 in FY 15 (+28%) Additionally, both inpatient and surgical case loads increased. Mortality remained stable throughout the study period (FY 12, 4.5%; FY 13, 5.2%; FY 14, 5.3%; FY 15, 3.2%: p = 0.177). CONCLUSIONS: Implementation of dedicated OR time, defined EGS team structure, practice protocols, and active attending surgeons'/APs' participation was temporally related to increased case volume, patients seen, and revenue, while mortality remained unchanged. Further study is necessary to establish the translatability of these data to other systems.
KW - Acute care surgery
KW - Emergency general surgery
KW - Systems
KW - Trauma service
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U2 - 10.1097/TA.0000000000001016
DO - 10.1097/TA.0000000000001016
M3 - Article
C2 - 26891159
AN - SCOPUS:84958811883
SN - 2163-0755
VL - 81
SP - 131
EP - 136
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 1
ER -