Utilization of morning report by acute care surgery teams: results from a qualitative study

Pringle, Patricia L.; Collins, Courtney; Santry, Heena P.

doi:10.1016/j.amjsurg.2013.07.012

Cited by 12 publications

(10 citation statements)

References 38 publications

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“…One comprehensive study by Pringle et al described how the strategic implementation of MR could lead to better outcomes, but how variability in team member attendance and lack of structured protocol can lead to under-utilization and suboptimal benefit of the model. [23] In our own institution, we wanted to address a previously identified issue of deficiencies in the patient hand-off systems, resulting in a gap in resident education in these necessary skills. [24] Studies have shown that MR is a valid format for resident education in efficient and effective patient handoffs.…”

Section: Discussionmentioning

confidence: 99%

Morning report decreases length of stay in emergency general surgery patients

Gardner

Wolfe

Beck

et al. 2019

JHA

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Objective: Communication in the hospital setting is an easy target for quality improvement. Capturing this change via communication between providers during hand-offs is necessary to reduce delays and errors. While this process has been more widely characterized in medical specialties, we designed this study to address the knowledge gap in surgical specialties.Methods: Our institution’s division of Acute Care Surgery (ACS) implemented Morning Report (MR) in October of 2015. At MR, all admissions and service transfers were discussed from Trauma, Emergency General Surgery (EGS), and Surgical Critical Care services from the previous 24 hours. This study compared patients who underwent a surgical procedure during their hospital stay before and after protocol implementation.Results: 974 patients were included in this study. The average patient was 50.3 years of age, 65.4% were white, and 51.7% were male. The average length of stay (LOS) was 8.3 days with 1.75 days to procedure. The post-MR cohort LOS was 2.7 shorter and had 0.85 fewer days to procedure. In an adjusted regression analysis, days to procedure and LOS decreased by 33% (p < .01) and 17% (p < .01) respectively.Conclusions: Implementation of MR led to a decrease in the overall LOS and days to procedure for operative patients. Our results advocate for the standard use of structured hand-offs in surgical units.

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Section: Discussionmentioning

confidence: 99%

Morning report decreases length of stay in emergency general surgery patients

Gardner

Wolfe

Beck

et al. 2019

JHA

View full text Add to dashboard Cite

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“…Still, there are some programs that have found innovative ways to ensure appropriate handovers within newly emerging ACS teams. 24 Similarly, while trauma quality improvement hinges upon comprehensive, prospective data collection, and the feasibility of such registries has been documented, 34,37 only a quarter of our fully implemented ACS programs had a registry.…”

Section: Discussionmentioning

confidence: 99%

“…Our qualitative study representing 18 teaching hospitals from different geographic and practice settings where an ACS model had been implemented found many variations in care delivery (e.g., patient cohorting, continuity clinics), workforce (e.g., critical care certification), resource allocation (e.g., dedicated EGS OR, in-house call), communication (e.g., face-to-face morning report), and data collection (e.g., registries). 24,25 These variations in our sample suggest that ACS is being variably implemented on a national scale. Therefore, it is impossible to tell if the benefits of ACS described at single centers that may have unique approaches to ACS would be generalizable across US hospitals.…”

Section: Introductionmentioning

confidence: 94%

Variations in the implementation of acute care surgery

Santry¹,

Madore²,

Collins³

et al. 2015

Journal of Trauma and Acute Care Surgery

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BACKGROUND To date, no studies have reported nationwide adoption of Acute Care Surgery (ACS) or identified structural and/or process variations for the care of emergency general surgery (EGS) patients within such models. METHODS We surveyed surgeons responsible for EGS coverage at University HealthSystems Consortium hospitals using an 8-page postal/email questionnaire querying respondents on hospital and EGS structure/process measures. Survey responses were analyzed using descriptive statistics, univariate comparisons, and multivariable regression models. RESULTS 258 of 319 (81%) potential respondents completed surveys. 81 hospitals (31%) had implemented ACS while 134 (52%) had a traditional general surgeon on-call model (GSOC). 38 (15%) hospitals had another model (HYBRID). Larger bed, university-based, teaching hospitals with Level 1 trauma center verification status located in urban areas were more likely to have adopted ACS. In multivariable modeling, hospital type, setting, and trauma center verification predicted ACS implementation. EGS processes of care varied with 28% GSOC having block time vs 67% ACS (p<0.0001); 45% GSOC providing ICU care to EGS patients in a surgical/trauma ICU vs 93% ACS (p<0.0001); GSOC sharing call among 5.7 (+/− 3.2) surgeons vs 7.9 (+/−2.3) ACS surgeons (p<0.0001); and 13% GSOC taking in-house EGS call vs 75% ACS (p<0.0001). Among ACS hospitals there were variations in patient cohorting (25% EGS patients alone; 21% EGS+trauma; 17% EGS+elective; 30% EGS+trauma+elective), data collection (26% had prospective EGS registries), and patient handoffs (56% had attending surgeon presence), call responsibilities (averaging 4.8 (+/− 1.3) calls per month with 60% providing extra call stipend and 40% with no post-call clinical duties). CONCLUSION The potential of the ACS on the national crisis in access to EGS care is not fully met. Variations in EGS processes of care among adopters of ACS suggest that standardized criteria for ACS implementation, much like trauma center verification criteria, may be beneficial. LEVEL OF EVIDENCE Survey results, Level III

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“…Using exploratory data acquired from a qualitative study interviewing surgeons responsible for acute care surgery at 18 teaching hospitals (21, 22), we developed and tested a survey instrument in an iterative fashion creating an 8-page questionnaire that included items on resources allocated for EGS care at UHC hospitals. The survey was implemented using a hybrid postal and email methodology targeting a single senior surgeon at each hospital who would be able to respond to queries regarding the structures and processes for EGS care at their hospital as described previously (30).…”

Section: Methodsmentioning

confidence: 99%

The impact of acute care surgery on appendicitis outcomes

Madore

Collins²,

Aytürk³

et al. 2015

Journal of Trauma and Acute Care Surgery

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Background Acute appendicitis is the most common indication for emergency general surgery (EGS) in the US. We examined the role of acute care surgery (ACS) on interventions and outcomes for acute appendicitis at a national sample of university-affiliated hospitals. Methods We surveyed senior surgeons responsible for EGS coverage at University HealthSystems Consortium (UHC) hospitals, representing >90% of university-affiliated hospitals in the US. The survey elicited data on resources allocated for EGS during 2013. Responses were linked to UHC outcomes data by unique hospital identifiers. Patients treated at hospitals reporting hybrid models for EGS coverage were excluded. Differences in interventions and outcomes between patients with acute appendicitis treated at ACS hospitals vs. hospitals with a general surgeon on-call model (GSOC) were analyzed using univariate comparisons and multivariable logistic regression models adjusted for patient demographics, clinical acuity, and hospital characteristics. Results We found 122 hospitals meeting criteria for analysis where 2,565 patients were treated for acute appendicitis. 48% of hospitals had an ACS model (N =1414), and 52% had a GSOC model (N=1151). Hospitals with ACS models were more likely to treat minority patients with greater severity of illness than GSOC models. Patients treated at ACS hospitals were more likely to undergo laparoscopic appendectomy. In multivariable modeling of patients who had surgery (N=2,258), patients treated at ACS hospitals had 1.86 [95%CI 1.23,2.80] greater odds of undergoing laparoscopic appendectomy. Conclusion In an era when laparoscopic appendectomy is increasingly accepted for treating uncomplicated acute appendicitis, particularly in low risk patients, it is concerning that patients treated at GSOC model hospitals are more likely to undergo traditional open surgery despite having less severity of illness at the time of presentation. Furthermore, hospitals with ACS are functioning as safety net hospitals for vulnerable patients with acute appendicitis. Level of Evidence III

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Utilization of morning report by acute care surgery teams: results from a qualitative study

Cited by 12 publications

References 38 publications

Morning report decreases length of stay in emergency general surgery patients

Morning report decreases length of stay in emergency general surgery patients

Variations in the implementation of acute care surgery

The impact of acute care surgery on appendicitis outcomes

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