An Acute Care Surgery Model Improves Outcomes in Patients With Appendicitis

Earley, Angela S.; Pryor, John P.; Kim, Patrick K.; Hedrick, Joseph H.; Kurichi, Jibby E.; Minogue, Amy C.; Sonnad, Seema S.; Reilly, Patrick; Schwab, C. William

doi:10.1097/01.sla.0000237756.86181.50

Cited by 128 publications

(165 citation statements)

References 15 publications

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“…Isto contribuiu para o maior acerto diagnóstico em relação ao gênero feminino (devido à ausência de patologias ginecológicas no primeiro grupo) e, consequentemente, diminuiu as complicações pós-operatórias 11 . Assim, no gênero feminino as chances de complicações pós-operatórias encontradas foram 1,93 vezes maiores que o gênero masculino.…”

Section: Discussionunclassified

Fatores de risco para as complicações após apendicectomias em adultos

Silva¹,

Almeida

Lima³

et al. 2007

Rev bras. colo-proctol.

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Section: Discussionunclassified

Fatores de risco para as complicações após apendicectomias em adultos

Silva¹,

Almeida

Lima³

et al. 2007

Rev bras. colo-proctol.

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“…However, the same was not true with those being transferred to the operating room, with the uninsured experiencing a 43-minute longer ED LOS. Although such delay could be associated with increased risk for surgical complications, [17][18][19][20] this result should be interpreted with caution, as the analysis did not correct for potential confounders. The likely primary confounder was that the analysis did not adjust for operative patients who were transferred from outside hospitals to this tertiary care center.…”

Section: Discussionmentioning

confidence: 99%

Identifying disparity in emergency department length of stay and admission likelihood

Dev

Mahan

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND:To assess whether insurance status has an effect on emergency department (ED) length of stay (LOS) and likelihood for admission or transfer to an operating room. METHODS:This was a retrospective cross-sectional study of all encounters from January 2011 through October 2013 at an urban, academic trauma center. Analysis included multi-variable linear regression for ED LOS and logistic regression for the likelihood of admission. RESULTS:Overall, 201 535 patients met the inclusion criteria, for which the mean age was 43.8 years, 55.9% were female, 23.4% were uninsured and 8% were of non-black race. Admission rate was 24.5% and operative rate was 1.4%. After adjusting for age, sex, triage acuity and race, the presence of insurance coverage was associated with an increased ED LOS of 575 (95%CI 552-598) vs. 567 (95%CI 543-591) minutes (P<0.01) among admitted patients and a decreased ED LOS of 456 (95%CI 381-531) vs. 499 (95%CI 423-575) minutes (P<0.01) among those transferred to an operating room. Adjusting for these same predictors, insured status remained a predictor for admission (odds ratio 1.24, 95%CI 1.20-1.28, P<0.01) and a negative predictor for transfer to the operating room (odds ratio 0.84, 95%CI 0.77-0.92, P<0.01). CONCLUSION:The insured experienced a clinically insignificant increase in ED LOS when admitted and a 43-minute decrease in ED LOS when being transferred to the operating room. The insured were more likely to be admitted and less likely to be transferred to an operating room.

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“…This is particularly topical given the increasingly common experience of ED overcrowding and its "emerging threat to patient safety and public health". [18][19][20][21] There is also recent suggestion that implementation of ACS services decrease ED length of stay for patients with appendicitis 22,23 and other general surgical diagnoses. 17,21 Upon review of the mature, multi-institutional Calgary ACS/ACESS experience with its first clinical care pathway, it became evident that the wait time between ordering and obtaining the CT scan was dramatically reduced.…”

Section: Discussionmentioning

confidence: 99%

The impact of an acute care surgery clinical care pathway for suspected appendicitis on the use of CT in the emergency department

et al. 2014

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Background:The natural evolution of an acute care surgery (ACS) service is to develop disease-specific care pathways aimed at quality improvement. Our primary goal was to evaluate the implementation of an ACS pathway dedicated to suspected appendicitis on patient flow and the use of computed tomography (CT) in the emergency department (ED).Methods: All adults within a large health care system (3 hospitals) with suspected appendicitis were analyzed during our study period, which included 3 time periods: preand postimplementation of the disease-specific pathway and at 12-month follow-up. Results:Of the 1168 consultations for appendicitis that took place during our study period, 349 occurred preimplementation, 392 occurred postimplementation, and 427 were follow-up visits. In all, 877 (75%) patients were admitted to the ACS service. Overall, 83% of patients underwent surgery within 6 hours. The mean wait time from CT request to obtaining the CT scan decreased with pathway implementation at all sites (197 v. 143 min, p < 0.001). This improvement was sustained at 12-month followup (131 min, p < 0.001). The pathway increased the number of CTs completed in under 2 hours from 3% to 42% (p < 0.001). No decrease in the total number of CTs or the pattern of ultrasonography was noted (p = 0.42). Wait times from ED triage to surgery were shortened (665 min preimplementation, 633 min postimplementation, 631 min at the 12-month follow-up, p = 0.040). Conclusion:A clinical care pathway dedicated to suspected appendicitis can decrease times to both CT scan and surgical intervention.Contexte : L'évolution naturelle d'un service de chirurgie d'urgence (SCU) consiste à mettre au point des plans d'intervention spécifiques aux maladies dans le but d'améliorer la qualité des soins. Notre objectif principal était d'évaluer l'impact de l'instauration au SCU d'un plan d'intervention spécifique à l'appendicite présumée sur le roulement des patients et sur l'utilisation de la tomodensitométrie (TDM) à l'urgence.Méthodes : Les dossiers de tous les patients adultes d'un important réseau de santé (3 hôpitaux) s'étant présentés pour une appendicite présumée ont été analysés durant la période de notre étude qui incluait 3 étapes : avant et après la mise en oeuvre du plan d'intervention spécifique, puis suivi à 12 mois.Résultats : Sur les 1168 consultations pour appendicite qui ont eu lieu durant notre étude, 349 se sont déroulées avant la mise en oeuvre du service, 392, après sa mise en oeuvre, et 427 étaient des visites de suivi. En tout, 877 patients (75 %) ont été admis au SCU. Globalement, 83 % des patients ont subi une chirurgie dans les 6 heures. Le temps d'attente moyen entre la demande de TDM et sa réalisation a diminué après l'application du plan d'intervention pour tous les sites (197 c. 143 min, p < 0,001). Cette amélioration se maintenait toujours au suivi de 12 mois (131 min, p < 0,001). Le plan d'intervention a permis de faire passer le nombre de TDM réalisées en moins de 2 heures de 3 % à 42 % (p < 0,001). On n'a noté aucune dimi...

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An Acute Care Surgery Model Improves Outcomes in Patients With Appendicitis

Cited by 128 publications

References 15 publications

Fatores de risco para as complicações após apendicectomias em adultos

Fatores de risco para as complicações após apendicectomias em adultos

Identifying disparity in emergency department length of stay and admission likelihood

The impact of an acute care surgery clinical care pathway for suspected appendicitis on the use of CT in the emergency department

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