The operational impact of an acute care surgical service on operating room metrics

Paine, Adam N.; Andritsos, Dimitrios; Fitzgerald, John F.; Norotsky, Mitchell; Malhotra, Ajai K.; Tsai, Mitchell H.

doi:10.1016/j.pcorm.2017.09.002

Cited by 8 publications

(3 citation statements)

References 7 publications

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“…The University of Vermont Medical Center (UVMMC), a 562-bed, Level-1 trauma center, implemented an ACS service in October, 2015. The organization of the ACS service and the specifics of its implementation are described in our previous work (15). In brief, the ACS service took over the Trauma-Critical Care (TCC) service, previously comprised of four surgeons taking rotating trauma call and covering the surgical intensive care unit (SICU).…”

Section: Methodsmentioning

confidence: 99%

“…In order to sustain the clinical benefits of the ACS model, it is imperative to develop generalizable financial frameworks for further analyses. In previous work at our institution, we demonstrated that following implementation of an ACS service in October, 2015, the GS service line had a significant drop in after-hours caseload while maintaining a stable normal-hours caseload (15). In an effort to generalize and promulgate the financial implications of an ACS service model, we sought to use the wRVU/FTE ratio to quantify the financial impact on the GS service of transferring EGS patient management to the ACS service.…”

mentioning

confidence: 88%

“…General Surgery (GS) service line mean monthly case volume two years before and two years after implementation of the Acute Care Surgery (ACS) service line which subsequently managed all emergency general surgery (EGS) patients (15). Error bars represent standard error.…”

Section: Figurementioning

confidence: 99%

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

Paine

Krompf

Borrazzo

et al. 2018

Perioperative Care and Operating Room Management

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BACKGROUND The Acute Care Surgery (ACS) model has been widely adopted by hospitals across the United States, with ACS services managing emergency general surgery (EGS) patients previously treated by general surgery (GS) services. We evaluated the operational and financial impact of an ACS service model on general surgeons at an academic medical center. METHODS Using WiseOR® (Palo Alto, CA), we compared surgical case volumes for the GS service two years before (October, 2013 - September, 2015) and two years after (October, 2015 - September, 2017) implementation of an ACS service at the University of Vermont Medical Center. From financial reports, we obtained monthly wRVUs, clinical FTEs, net patient revenue, and payer mix for the GS service and compared the two years before and after ACS model implementation. RESULTS There was a significant reduction in the average number of cases performed by the GS service following ACS service implementation (monthly mean ± SD, 139.1 ± 16.0 vs. 116.7 ± 14.0, p < 0.001). The normal-hours caseload remained stable, while a significant decrease in after-hours cases accounted for the reduction in overall volume. Despite the reduction in operative volume, the decrease in mean monthly wRVU/FTE for the GS service when comparing the pre- and post- ACS periods did not reach statistical significance (614.9 ± 82.9 vs. 576.3 ± 62.1, p = 0.08). There was a significant increase in average monthly clinic-derived wRVU/FTE for the GS service (106.3 ± 13.5 vs. 120.5 ± 16.4, p = 0.007). CONCLUSIONS Shifting EGS patient management from the GS to ACS service did not negatively impact the productivity of the GS service. Background

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Section: Methodsmentioning

confidence: 99%

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confidence: 88%