The Impact of an Acute Care Surgical Service on the Quality and Efficiency of Care Outcome Indicators for Patients with General Surgical Emergencies

Abstract

Background Acute care surgery (ACS) models address high volumes of emergency general surgery and emergency room (ER) overcrowding. The impact of ACS service model implementation on the quality and efficiency of care (EOC) outcomes in acute appendicitis (AA) and acute cholecystitis (AC) cohorts was evaluated. Methods A retrospective chart review (N=1,229) of adult AA and AC patients admitted prior to (pre-ACS; n=507; three hospitals; 2007) and after regionalization (R-ACS; n=722; one hospital; 2011). Results R-ACS time to ER physician assessment was significantly longer for AA (3.4 ± 2.3 versus 2.4 ± 2.6 hr; p ≤ 0.001). Surgical response times (1.3 ± 1.2 vs 2.6 ± 4.3 hr for AA; 1.8 ± 1.5 vs 4.1 ± 5.0 hr for AC; p ≤ 0.0001) and acquisition of imaging (4.1 ± 4.1 vs 6.9 ± 9.9 hr for AA, p ≤ 0.0001; 7.8 ± 1.9 vs 13.2 ± 18.5 hr for AC, p ≤ 0.008) occurred significantly faster with R-ACS. R-ACS resulted in a significant increase in night-time appendectomies (21.7% vs 11.1%; p ≤ 0.002), perforated appendices (29.1 % vs 18.9 %; p ≤ 0.006), 30-day readmissions (4.56% vs 0.82%; p ≤ 0.01), and lower rate of intraoperative complications for AC patients (2.78% vs 7.69%; p ≤ 0.02). Conclusions Despite the increased volume of patients seen with the implementation of R-ACS, surgical assessments and diagnostic imaging were significantly more prompt. EOC measures were maintained. Worse AA outcomes highlight areas for improvement in delivering R-ACS.

Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event

“…Even if surgeons believe that surgery should be delayed, almost half of the elective cholecystectomy procedures are carried out after 3 months [ 31 , 49 ]. So, performing cholecystectomy during the same admission, using an acute care surgery model, would considerably decrease the elective burden [ 22 , 67 ]. There is no local expertise for laparoscopic common bile duct exploration (LCBDE).…”

“…A coordinated fast track investigation and treatment, with a dedicated team and institutional commitment towards fulfillment of guidelines remains mandatory [ 72 ]. Also, continuous and rigorous evaluation in the quality of care and compliance with guidelines should be implemented [ 34 , 67 , 73 , 74 ].…”

Cholecystectomy following endoscopic clearance of common bile duct during the same admission

“…The lack of resources, particularly the availability of the operating room during the daytime, 11 , 54 and competition with busy elective practices 11 are, like others, 1 , 41 , 50 additional reasons to delay surgery. Implementing an acute care surgery model with dedicated operative time would be a solution to partially alleviate this problem, 11 , 55 although surgeons remain reluctant to perform cholecystectomy at night. We have found that patients are rarely opposed to undergoing cholecystectomy during the same admission, except sometimes older adults.…”

Analysis of the Effect of Clinical Application of Detailed Nursing Measures in Ensuring the Safety of Nursing in Operating Room

“…The quality of nursing care in the operating room will directly affect the operation of the entire surgical system [17] . Health care systems around the world are facing the challenge of improving the quality of care and reducing the risk of adverse events [18,19] .…”