Impact of an acute care surgery service on timeliness of care and surgeon satisfaction at a Canadian academic hospital: a retrospective study

Abstract

IntroductionIn January 2012 an acute care surgery (ACS) model was introduced at St. Paul’s Hospital, Saskatoon, Saskatchewan. The goal of implementing an ACS service was to improve the delivery of care for emergent, non-trauma surgical patients. We examined whether the ACS model improved wait time to surgery, decreased the proportion of surgeries performed after hours, and shortened post-surgical length of stay. We also assessed whether the surgeons working in an ACS system had higher on-call satisfaction than surgeons working in a non- ACS system.MethodsA retrospective pre-post analysis was performed using data from the Discharge Abstract Database and the Organizing Medical Networked Information database. Surgeon satisfaction was evaluated using a questionnaire that was mailed to all general surgeons in Saskatoon.ResultsAn ACS service significantly reduced wait time to surgery for patients with all acute general surgery diagnoses from 221 minutes to 192 minutes (ρ = 0.015; CI = 5.8-52.2). Post-surgery length of stay for patients operated on for acute appendicitis, or acute cholecystitis was not reduced. On average, patients with bowel obstruction had increased length of stay following ACS service implementation. Most surgeries in our study were performed between 16:00 hours and 08:00 hours but the introduction of an ACS significantly reduced the number of afterhours surgeries (60.0% vs. 72.6%) (ρ < 0.0001). Our survey had a response rate of 75%. Overall, surgeons on an ACS service had greater satisfaction with the organization of their call schedule than surgeons not on an ACS service.ConclusionIntroduction of an ACS service in Saskatoon has decreased wait time to surgery and reduced the proportion of afterhours emergency surgeries, with no reduction in the length of post-surgery hospital stay. Satisfaction may be higher for surgeons in an ACS service.

Development of an Acute Care Plastic Surgery Service in the Saskatoon Health Region: Effects on flexor tendon management

“…In addition, a majority of general surgeons reported an improved balance between time spent on call and time available for their elective practices (5). In the SHR, the acute care model in general surgery has decreased surgical wait times, led to fewer after-hours surgeries and improved surgeon satisfaction (6). American studies have demonstrated similar findings (7,8).…”

General Surgeons Australia's 12‐point plan for emergency general surgery

“…This would also mean that urgent cases are more likely to be done in‐hours, hence reducing the piling up of emergency cases running through the night . A study in Canada found that the introduction of a dedicated half‐day ASU theatre resulted in shorter time to surgery …”

A day in the life of emergency general surgery in Canada: a multicentre observational study

“…Most studies on EGS have focused on processes and outcomes for appendicitis and cholecystitis. 8,[12][13][14] Although these conditions account for a substantial part of the activity of EGS services, they do not reflect the breadth, intensity or resource consumption of a modern EGS practice. In our national EGS sample, appendicitis and cholecystitis together accounted for only 26% of patients and only 10% of hospital stays.…”

“…There are limited data on the overall case mix of these novel EGS services and their varied structures, processes and outcomes. [6][7][8] The emergence of EGS systems represents an opportunity to understand and improve processes of care that serve this complex, resource-intensive surgical population. More research is required on the true acuity, complexity and diversity of EGS services and systems, as well as on the roles these services play in supporting surgical rescue within acute care health systems.…”