Gaps in Emergency General Surgery Coverage in the United States

Ingraham, Angela M.; Chaffee, Scott; Aytürk, Mehmet; Heh, Victor; Kiefe, Catarina I.; Santry, Heena P.

doi:10.1097/as9.0000000000000043

Cited by 5 publications

(6 citation statements)

References 33 publications

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“…10 Gaps in surgical coverage occur when hospitals are unable to provide around-theclock EGS service, with reasons including rural location, small bed size, non-teaching status, inconsistent surgeon coverage, lack of system for booking emergency cases and lack of anaesthesia availability overnight. 11 It is not surprising that these findings coincide with the triggers for interhospital transfers, [12][13][14] and highlights the relationship between interhospital transfers and EGS coverage gaps. Short of establishing unrealistic 24/7 surgical coverage at all healthcare facilities, interhospital transfers will continue to exist out of necessity despite poorer outcomes.…”

Section: Introductionmentioning

confidence: 80%

“…Introduction of ASU or equivalent structure to a healthcare facility is heavily dependent on hospital size, staff numbers, trauma subspecialisation and EGS patient throughput 10 . Gaps in surgical coverage occur when hospitals are unable to provide around‐the‐clock EGS service, with reasons including rural location, small bed size, non‐teaching status, inconsistent surgeon coverage, lack of system for booking emergency cases and lack of anaesthesia availability overnight 11 . It is not surprising that these findings coincide with the triggers for interhospital transfers, 12–14 and highlights the relationship between interhospital transfers and EGS coverage gaps.…”

Section: Introductionmentioning

confidence: 99%

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Factors influencing interhospital transfer delays in emergency general surgery: a systematic review and narrative synthesis

Young

Khoo

Trochsler

et al. 2022

ANZ Journal of Surgery

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Background: Emergency general surgery is an emerging public health issue globally, with substantial healthcare burden. Interhospital transfer of critically unwell surgical patients has been the mainstay of bridging gaps in surgical coverage in regional and rural locations, despite evidence of greater morbidity and mortality. Delays in transfer invariably occurs and compounds the situation. Our aim was to examine the factors influencing interhospital transfer delays in emergency general surgical patients. Methods: A systematic search of PubMED and EmBase, was performed by two researchers from 2020 to 23rd Feb 2021, for English articles related to interhospital transfer delays in emergency general surgical patients, with an age of >16. Articles were critically appraised and data were extracted into a pre-specified data extraction form. No data was suitable for statistical analysis and a narrative synthesis was performed instead. Results: Six relevant articles were identified from the search. All studies were retrospective cohort studies with moderate to high risk of bias. Lack of consultant surgeon input, after hours transfer, need for intensive care bed and poor transfer documentation may have a role in interhospital transfer delays. Patients with public health insurance, multiple comorbidities and nonemergency medical conditions experience longer transfer request time and may be at risk of precipitating interhospital transfer delays. Transfer delays are seen in transfers over longer distances. Conclusion: There is a paucity of knowledge on what and how factors influence interhospital transfer delays in emergency general surgical patients. Well-designed prospective cohort studies are required to bridge this knowledge gap.

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Section: Introductionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Factors influencing interhospital transfer delays in emergency general surgery: a systematic review and narrative synthesis

Young

Khoo

Trochsler

et al. 2022

ANZ Journal of Surgery

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“…Among 279 hospitals, 162 (58.1%) responded that the inability to provide RTC EGS care was due to a lack of general surgeon coverage. 26…”

Section: Discussionmentioning

confidence: 99%

“…In a national survey of 1,634 acute care hospitals that responded to a survey regarding their ability to provide round-the-clock (RTC) EGS care, 279 (17.1%) hospitals lacked RTC EGS care on average 35.7% (SD = 33.6) of the time. Among 279 hospitals, 162 (58.1%) responded that the inability to provide RTC EGS care was due to a lack of general surgeon coverage 26 …”

Section: Discussionmentioning

confidence: 99%

General surgeon involvement in the care of patients designated with an American Association for the Surgery of Trauma–endorsed ICD-10-CM emergency general surgery diagnosis code in Wisconsin

Ingraham¹,

Schumacher

Fernandes‐Taylor

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:The current national burden of emergency general surgery (EGS) illnesses and the extent of surgeon involvement in the care of these patients remain largely unknown. To inform needs assessments, research, and education, we sought to: (1) translate previously developed International Classification of Diseases (ICD), 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes representing EGS conditions to ICD 10th Revision, CM (ICD-10-CM) codes and (2) determine the national burden of and assess surgeon involvement across EGS conditions. METHODS:We converted ICD-9-CM codes to candidate ICD-10-CM codes using General Equivalence Mappings then iteratively refined the code list. We used National Inpatient Sample 2016 to 2017 data to develop a national estimate of the burden of EGS disease. To evaluate surgeon involvement, using Wisconsin Hospital Association discharge data (January 1, 2016 to June 30, 2018), we selected adult urgent/emergent encounters with an EGS condition as the principal diagnosis. Surgeon involvement was defined as a surgeon being either the attending provider or procedural physician. RESULTS:Four hundred and eighty-five ICD-9-CM codes mapped to 1,696 ICD-10-CM codes. The final list contained 985 ICD-10-CM codes. Nationally, there were 2,977,843 adult patient encounters with an ICD-10-CM EGS diagnosis. Of 94,903 EGS patients in the Wisconsin Hospital Association data set, most encounters were inpatient as compared with observation (75,878 [80.0%] vs. 19,025 [20.0%]). There were 57,780 patients (60.9%) that underwent any procedure. Among all Wisconsin EGS patients, most had no surgeon involvement (64.9% [n = 61,616]). Of the seven most common EGS diagnoses, surgeon involvement was highest for appendicitis (96.0%) and biliary tract disease (77.1%). For the other five most common conditions (skin/soft tissue infections, gastrointestinal hemorrhage, intestinal obstruction/ileus, pancreatitis, diverticular disease), surgeons were involved in roughly 20% of patient care episodes. CONCLUSION:Surgeon involvement for EGS conditions ranges from highly likely (appendicitis) to relatively unlikely (skin/soft tissue infections). The wide range in surgeon involvement underscores the importance of multidisciplinary collaboration in the care of EGS patients.

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“…8 This would help to combat a national crisis in emergency surgical care involving workforce deficiencies including the shortage of general surgeons and insufficient operating room access and staffing. 8,9 While there are not defined “EGS centers,” improved surgical outcomes of a larger teaching hospital for common EGS conditions may mimic the goals of regionalization. This study aims to determine if there is an advantage to admitting patients with a SBO to larger teaching hospitals and to a surgical service in regard to LOS, cost of stay, operative intervention, 30-day readmission, and 30-day mortality.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Small Bowel Obstructions by Admitting Specialty and Hospital Type

Sternick

Britt

2023

The American Surgeon™

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Background Small bowel obstructions (SBOs) account for a significant burden on the health care system. Should the ongoing trend of regionalizing medicine extend to these patients? We investigated if there is a benefit to admitting SBOs to larger teaching hospitals and to surgical services. Methods We performed a retrospective chart review of 505 patients admitted to a Sentara Facility between 2012 and 2019 with a diagnosis of SBO. Patients between the ages of 18 and 89 were included. Patients were excluded if they required emergent operation. Outcomes were evaluated based on patient’s admission either to a teaching or community hospital as well as the admitting service’s specialty. Results Of 505 patients admitted with a SBO, 351 (69.5%) were admitted to a teaching hospital. 392 (77.6%) patients were admitted to a surgical service. The average length of stay (LOS) (4 vs 7 days, P < .0001) and cost ($18,069.79 vs $26,458.20, P < .0001) were lower at teaching hospitals. The same trends in LOS (4 vs 7 days, P < .0001) and cost ($18,265.10 vs $29 944.82, P < .0001) were seen with surgical services. The 30-day readmission rate was higher in teaching hospitals (18.2% vs 11%, P = .0429), and no difference was seen in operative rate or mortality. Discussion These data would suggest that there is a benefit to admitting SBO patients to larger teaching hospitals and to surgical services with regard to LOS and cost, suggesting that these patients might benefit from treatment at centers with emergency general surgery (EGS) Services.

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Gaps in Emergency General Surgery Coverage in the United States

Cited by 5 publications

References 33 publications

Factors influencing interhospital transfer delays in emergency general surgery: a systematic review and narrative synthesis

Factors influencing interhospital transfer delays in emergency general surgery: a systematic review and narrative synthesis

General surgeon involvement in the care of patients designated with an American Association for the Surgery of Trauma–endorsed ICD-10-CM emergency general surgery diagnosis code in Wisconsin

Outcomes of Small Bowel Obstructions by Admitting Specialty and Hospital Type

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