Innovation or rebranding, acute care surgery diffusion will continue

Abstract

Background Patterns of adoption of acute care surgery (ACS) as a strategy for emergency general surgery (EGS) care are unknown. Methods We conducted a qualitative study comprising face-to-face interviews with senior surgeons responsible for ACS at 18 teaching hospitals chosen to ensure diversity of opinions and practice environment (three practice types [community, public/charity, university] in each of six geographic regions [Mid-Atlantic, Midwest, New England, Northeast, South, West]). Interviews were recorded, transcribed, and analyzed using NVivo (QSR International, Melbourne, Australia). We applied the methods of investigator triangulation using an inductive approach to develop a final taxonomy of codes organized by themes related to respondents’ views on the future of ACS as a strategy for EGS. We applied our findings to a conceptual model on diffusion of innovation. Results We found a paradox between ACS viewed as a healthcare delivery innovation versus a rebranding of comprehensive general surgery. Optimism for the future of ACS due to increased desirability for trauma/critical care careers and improved outcomes for EGS was tempered by fear over lack of continuity, poor institutional resources and uncertainty regarding financial viability. Our analysis suggests that the implementation of ACS, whether a true healthcare delivery innovation or an innovative rebranding, fits into the Rogers’ Diffusion of Innovation Theory. Conclusions Despite concerns over resource allocation and the definition of the specialty, from the perspective of senior surgeons deeply entrenched in executing this care-delivery model, ACS represents the new face of general surgery that will likely continue to diffuse from these early adopters.

Disparities in access to emergency general surgery care in the United States

“…69,70 This model,however has been viewed largely from the perspective of the proponets of the acute care paradigm as an isolated, hospital-based service line; but, our prior research suggests that the resource intensiveness of a round-the-clock acute care surgery service may not be practical at all hospitals, in particular, the smaller hospitals lacking a trauma center caable of providing 24/7 coverge. 71,72 Therefore, this paradigm of acute care surgery should be understood, by surgeon leaders, hospital administrators, and regional public health officials alike, as a network for patients presenting for EGS care centered around an EGS Center of Excellence (i.e., the hospitals with an acute care surgery service).…”

Pro-con debate on regionalization of emergency general surgery: controversy or common sense?

“…In a national survey, only 272 hospitals out of 1690 (16%) had adopted an ACS model as of 2015 70. Qualitative studies reveal multiple surgeon concerns 71. One such concern is that the ACS model may be surgeon-centered rather than patient-centered.…”

The impact of an acute care surgery model on general surgery service productivity

“…Given the widespread adoption of the ACS model, studies evaluating clinical outcomes, cost-effectiveness, and the impact on hospital finances must continue (1). In today’s climate of unsustainable health care costs, the need to include economic analyses of such paradigm changes cannot be overemphasized.…”

“…The Acute Care Surgery (ACS) model has been widely adopted by health care organizations across the United States (1). Although substantial institutional variation exists with ACS model organization, the implementation of an ACS service line generally involves a paradigm shift with the ACS service managing emergency general surgery (EGS) patients previously treated by general surgery (GS) services (2, 3).…”