Trauma Surgery to Acute Care Surgery: Defining the Paradigm Shift

Galante, Joseph M.; Phan, Ho H.; Wisner, David H.

doi:10.1097/ta.0b013e3181d76bf6

Cited by 25 publications

(20 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…General surgeons are in shortage, previously attributed to hours, call obligation, and workload without adequate compensation 31,32,33,34,35 . As acute care services have emerged there have been many studies looking the feasibility of established teams, particularly trauma, to handle the obligations of an ACS team 36,37,38 . When we examine the short changing of the RVU system in defining our true productivity and time spent, the ACS field is not competitive on paper when compared to specialties that are appropriately recognized for their work, and we are at risk of losing surgeons to other fields 39 .…”

Section: Discussionmentioning

confidence: 99%

Does relative value unit–based compensation shortchange the acute care surgeon?

Schwartz¹,

Hui

Velopulos³

et al. 2014

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

BACKGROUND Studies have demonstrated that relative value units (RVUs) do not appropriately reflect cognitive effort or time spent in patient care, but RVU continues to be used as a standardized system to track productivity. It is unknown how well RVU reflects the effort of acute care surgeons. Our objective was to determine if RVUs adequately reflect increased surgeon effort required to treat emergent versus elective patients receiving similar procedures. METHODS A retrospective analysis using The American College of Surgeons’ National Surgical Quality Improvement Program 2011 data set was conducted. The control group consisted of patients undergoing elective colectomy, hernia repair, or biliary procedures as identified by Current Procedural Terminology. Comparison was made to emergent cases after being stratified to laparoscopic or open technique. Generalized linear models and logistic regression were used to assess specific outcomes, controlling for demographics and comorbidities of interest. The RVUs, operative time, and length of stay (LOS) were primary variables, with major/minor complications, mortality, and readmissions being evaluated as the relevant outcomes. RESULTS A total of 442,149 patients in the National Surgical Quality Improvement Program underwent one of the operative procedures of interest; 27,636 biliary (91% laparoscopic; 8.5% open), 28,722 colorectal (40.3% laparoscopic, 59.7% open), and 31,090 hernia (26.6% laparoscopic, 73.4% open) operations. Emergent procedures were found to have average RVU values that were identical to their elective case counterparts. Complication rates were higher and LOS were increased in emergent cases. Odds ratios for complications and readmissions in emergent cases were twice those of elective procedures. Mortality was skewed toward emergent cases. CONCLUSION Our data indicate that the emergent operative management for various procedures is similarly valued despite increased LOS, more complications, higher mortality risk, and subsequently increased physician attention. Our findings suggest that the RVU system for acute care surgeons may need to be reevaluated to better capture the additional work involved in emergent patient care.

show abstract

Section: Discussionmentioning

confidence: 99%

Does relative value unit–based compensation shortchange the acute care surgeon?

Schwartz¹,

Hui

Velopulos³

et al. 2014

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

show abstract

“…1 This unique coupling of patient care activities fills in gaps between other surgical specialties, such as plastic, gastrointestinal, cardiac, thoracic, and general surgery. The fact that The Journal of Trauma is now entitled The Journal of Trauma and Acute Care Surgery captures this reality.…”

mentioning

confidence: 99%

“…In 2010, Galante et al 1 captured a snapshot of what modern trauma and ACS practice looked like under the ACS model. As part of conversations about this model, some have examined its administrative dynamics, 3Y10 while others have explored its academic and training implications.…”

mentioning

confidence: 99%

The modern acute care surgeon

Pottenger

Galante

Wisner

2015

Journal of Trauma and Acute Care Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Some of these benefits include a reduction in time to consultation in the emergency department for nontrauma patients (5) and improved relativevalue unit productivity of emergency surgeons (6)(7)(8), including actual operative volume (9). Some of these benefits include a reduction in time to consultation in the emergency department for nontrauma patients (5) and improved relativevalue unit productivity of emergency surgeons (6)(7)(8), including actual operative volume (9).…”

mentioning

confidence: 99%

Increased ICU Resource Needs for an Academic Emergency General Surgery Service*

Lissauer¹,

Galvagno²,

Rock³

et al. 2014

Critical Care Medicine

View full text Add to dashboard Cite

Emergency general surgery patients have increased ICU needs in terms of length of stay, ventilator usage, and continuous renal replacement therapy usage compared with other services, perhaps due to the higher percentage of transfers and emergent surgery required. These patients represent a distinct population. Understanding their resource needs will allow for better deployment of hospital resources.

show abstract

Trauma Surgery to Acute Care Surgery: Defining the Paradigm Shift

Cited by 25 publications

References 7 publications

Does relative value unit–based compensation shortchange the acute care surgeon?

Does relative value unit–based compensation shortchange the acute care surgeon?

The modern acute care surgeon

Increased ICU Resource Needs for an Academic Emergency General Surgery Service*

Contact Info

Product

Resources

About