Acute Care Surgery: A New Training and Practice Model in the United States

Hoyt, David B.; Kim, Hubert D.; Barrios, Cristobal

doi:10.1007/s00268-008-9576-y

Cited by 60 publications

(36 citation statements)

References 28 publications

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“…6 In such instances, establishing an ACS service entailed either re-expansion of the trauma surgeon's clinical and operative domain 7,8 or the creation of an emergency surgery service that excluded care of trauma patients. 9 In large community hospitals that do not serve as trauma centres, surgical hospitalist practices are emerging to meet the hospitals' emergency surgery coverage needs. These later models tend not to include surgical critical care.…”

Section: Discussionmentioning

confidence: 99%

Implementation of an acute care emergency surgical service: a cost analysis from the surgeon’s perspective

Anantha

Parry²,

Vogt

et al. 2014

cjs

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Background: Acute care surgical services provide comprehensive emergency general surgical care while potentially using health care resources more efficiently. We assessed the volume and distribution of emergency general surgery (EGS) procedures before and after the implementation of the Acute Care and Emergency Surgery Service (ACCESS) at a Canadian tertiary care hospital and its effect on surgeon billings.Methods: This single-centre retrospective case-control study compared adult patients who underwent EGS procedures between July and December 2009 (pre-ACCESS), to those who had surgery between July and December 2010 (post-ACCESS). Case distribution was compared between day (7 am to 3 pm), evening (3 pm to 11 pm) and night (11 pm to 7 am). Frequencies were compared using the χ 2 test.Results: Pre-ACCESS, 366 EGS procedures were performed: 24% during the day, 55% in the evening and 21% at night. Post-ACCESS, 463 operations were performed: 55% during the day, 36% in the evening and 9% at night. Reductions in night-time and evening EGS were 57% and 36% respectively (p < 0.001). Total surgeon billings for operations pre-and post-ACCESS were $281 066 and $287 075, respectively: remuneration was $6008 higher post-ACCESS for an additional 97 cases (p = 0.003). Using cost-modelling analysis, post-ACCESS surgeon billing for appendectomies, segmental colectomies, laparotomies and cholecystectomies all declined by $67 190, $125 215, $66 362, and $84 913, respectively (p < 0.001). Conclusion:Acute care surgical services have dramatically shifted EGS from nighttime to daytime. Cost-modelling analysis demonstrates that these services have costsavings potential for the health care system without reducing overall surgeon billing.

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Section: Discussionmentioning

confidence: 99%

Implementation of an acute care emergency surgical service: a cost analysis from the surgeon’s perspective

Anantha

Parry²,

Vogt

et al. 2014

cjs

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“…(3) In response, numerous accomplishments were achieved; these included changes in prehospital care and paramedic training, development of emergency management systems and standardised approaches to trauma patients, which are now commonplace worldwide. (4) A landmark study showed that the consequence of such system development in Level I trauma centres is a significant reduction in trauma-related mortality. (5) However, the last 15 years have seen the rise of new challenges that put the future of trauma surgery in question.…”

Section: The Evolution Of Acute Care Surgerymentioning

confidence: 99%

“…(9,10) ACS needed to address the impending crisis, be viable and produce an attractive lifestyle. (4) The product of this vision, 'the acute care surgeon', is a subspecialist in the provision of ESAT and critical care. This American model of care has reinvigorated the management of ESAT patients.…”

Section: The Evolution Of Acute Care Surgerymentioning

confidence: 99%

Changing models of care for emergency surgical and trauma patients in Singapore

Mathur

Goo

Tan

et al. 2015

smedj

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The last 15 years have seen changing patterns of injury in emergency surgery and trauma patients. The ability to diagnose, treat and manage these patients nonoperatively has led to a decline in interest in trauma surgery as a career. In addition, healthcare systems face multiple challenges, including limited resources, an ageing population and increasing subspecialisation of medical care, while maintaining government-directed standards and managing public expectations. In the West, these challenges have led to the emergence of a new subspecialty, 'acute care surgery', with some models of care providing dedicated acute surgical units or separating acute and elective streams with the existing manpower resources. The outcomes for emergency surgery patients and efficiency gains are promising. In Singapore, Khoo Teck Puat Hospital has implemented its first dedicated acute surgical unit. This article outlines the evolution of acute care surgery and its relevance to Asia.

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“…Hoyt et al in 2008 point out that trainees themselves question the integrity of the training system with 'concerns of maintenance of adequate operative experience'. 8 Leadership within the trauma community has recognized these concerns over the last two decades and spearheaded the development of parallel programs to enhance training. Certainly, the concern and effort is real.…”

Section: Introductionmentioning

confidence: 99%

Can We augment the US Trauma Fellow's Operative Training? The PTS Fellowship: A US Surgical Critical Care Fellow's Experience in Colombia

Aboutanos¹,

Peck²,

Paula³

et al. 2014

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Objective: To send an American fellow surgeon to a Panamerican country and quantify operative skills acquisition. Materials and methods:A second year surgical critical care fellow from a Level One Urban Trauma Center was sent to Cali, Colombia from April 1 to 21, 2013. The operative experience was evaluated. Total cases, first time cases, and first time procedures, defined as technical portions within trauma cases, were recorded. Results:In 20 operative days, 172 total cases were performed in the following categories: burn 112, trauma 19, emergent general 16, elective general 14, plastics 8, and laparoscopic bariatric 3. First exposure operations included 46/112 burn cases, 8/8 trauma/burn reconstructive cases, 1/16 emergent general cases, 11/14 elective general cases, and 3/3 laparoscopic bariatric cases. Of the 19 total trauma operations (not including 2 amputations), 3 left anterolateral thoracotomies, 2 clamshell thoracotomies, 1 diagnostic laparoscopy, 1 open pericardial window, 10 exploratory laparotomies and 2 relaparotomies were performed. The 19 trauma operations consisted of 26 (not including the 2 amputations) procedures. Twenty-three percent were first time performed trauma procedures (6/26, not including amputations).Nearly 9 (8.6) operations were performed per day. In five 12-hour shifts of trauma call, 19 operations were performed within 60 hours. One trauma operative case was performed for every 3.15 hours worked. Conclusion:In the current era of American trauma training in which penetrating trauma and total number of operative cases is concentrated to specific centers in the United States, additional methods in education and experience should be sought for the American trauma fellow. This is the first reported international trauma fellow rotation in Cali, Colombia, with an operative experience very different than standard and current opportunities. Our experience serves as a potential template for future endeavors in surgical education. Conclusión: En la era actual de la formación trauma estadounidense en la que el trauma penetrante y el número total de casos quirúrgicos se concentra a centros específicos en los Estados Unidos, los métodos adicionales en la educación y la experiencia debe buscarse la American Trauma Fellow. Este es el primer informe de compañero de trauma rotación internacional en Cali Colombia, con una experiencia operativa muy diferente a la estándar y oportunidades actuales. Nuestra experiencia sirve como plantilla potencial para futuros esfuerzos en la educación quirúrgica.Palabras claves: Communion trauma panaerica, Communion operative internacional, Rotacion trauma.

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Acute Care Surgery: A New Training and Practice Model in the United States

Cited by 60 publications

References 28 publications

Implementation of an acute care emergency surgical service: a cost analysis from the surgeon’s perspective

Implementation of an acute care emergency surgical service: a cost analysis from the surgeon’s perspective

Changing models of care for emergency surgical and trauma patients in Singapore

Can We augment the US Trauma Fellow's Operative Training? The PTS Fellowship: A US Surgical Critical Care Fellow's Experience in Colombia

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