Regionalization of Surgical Services in Central Florida: The Next Step in Acute Care Surgery

Block, Ernest F. J.; Rudloff, Beth; Noon, Charles; Behn, Bruce K.

doi:10.1097/ta.0b013e3181efbed9

Cited by 17 publications

(10 citation statements)

References 8 publications

(5 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In several jurisdictions in North America and the United Kingdom, these findings have contributed to the regionalization of care into specialized centers. [61][62][63] In the current study, we found that patients who had their operation performed by surgeon with annual volumes ≤35 procedures a year were more likely to be frail, live in rural areas, and receive their hip replacements from lower volume hospitals. This patient profile is consistent with previous descriptions of patients who utilize lower volume centers.…”

Section: Principal Findingsmentioning

confidence: 52%

Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study

Ravi

Jenkinson

Austin

et al. 2014

BMJ

224

160

View full text Add to dashboard Cite

Objectives To identify a cut point in annual surgeon volume associated with increased risk of complications after primary elective total hip arthroplasty and to quantify any risk identified.Design Propensity score matched cohort study. Setting Ontario, CanadaParticipants 37 881 people who received their first primary total hip arthroplasty during 2002-09 and were followed for at least two years after their surgery.Main outcome measure The rates of various surgical complications within 90 days (venous thromboembolism, death) and within two years (infection, dislocation, periprosthetic fracture, revision) of surgery.Results Multivariate splines were developed to visualize the relation between surgeon volume and the risk for various complications. A threshold of 35 cases a year was identified, under which there was an increased risk of dislocation and revision. 6716 patients whose total hip arthroplasty was carried out by surgeons who had done ≤35 such procedure in the previous year were successfully matched to patients whose surgeon had carried out more than 35 procedures. Patients in the former group had higher rates of dislocation (1.9% v 1.3%, P=0.006; NNH 172) and revision (1.5% v 1.0%, P=0.03; NNH 204).Conclusions In a cohort of first time recipients of total hip arthroplasty, patients whose operation was carried by surgeons who had performed 35 or fewer such procedures in the year before the index procedure were at increased risk for dislocation and early revision. Surgeons should consider performing 35 cases or more a year to minimize the risk for complications. Furthermore, the methods used to visualize the relationship between surgeon volume and the occurrence of complications can be easily applied in any jurisdiction, to help inform and optimize local healthcare delivery.

show abstract

Section: Principal Findingsmentioning

confidence: 52%

Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study

Ravi

Jenkinson

Austin

et al. 2014

BMJ

224

160

View full text Add to dashboard Cite

show abstract

“…Still, few of our respondents addressed this larger structural issue, even though others have written about regionalizing care for NTSEs, much like has been done for trauma as a result of policy initiatives [36–38]. In contrast, our respondents frequently referred to tension between acute care and community based general surgeons sharing the same patient population as a threat to the future of ACS.…”

Section: Discussionmentioning

confidence: 94%

Innovation or rebranding, acute care surgery diffusion will continue

Collins

Pringle

Santry

2015

Journal of Surgical Research

View full text Add to dashboard Cite

Background Patterns of adoption of acute care surgery (ACS) as a strategy for emergency general surgery (EGS) care are unknown. Methods We conducted a qualitative study comprising face-to-face interviews with senior surgeons responsible for ACS at 18 teaching hospitals chosen to ensure diversity of opinions and practice environment (three practice types [community, public/charity, university] in each of six geographic regions [Mid-Atlantic, Midwest, New England, Northeast, South, West]). Interviews were recorded, transcribed, and analyzed using NVivo (QSR International, Melbourne, Australia). We applied the methods of investigator triangulation using an inductive approach to develop a final taxonomy of codes organized by themes related to respondents’ views on the future of ACS as a strategy for EGS. We applied our findings to a conceptual model on diffusion of innovation. Results We found a paradox between ACS viewed as a healthcare delivery innovation versus a rebranding of comprehensive general surgery. Optimism for the future of ACS due to increased desirability for trauma/critical care careers and improved outcomes for EGS was tempered by fear over lack of continuity, poor institutional resources and uncertainty regarding financial viability. Our analysis suggests that the implementation of ACS, whether a true healthcare delivery innovation or an innovative rebranding, fits into the Rogers’ Diffusion of Innovation Theory. Conclusions Despite concerns over resource allocation and the definition of the specialty, from the perspective of senior surgeons deeply entrenched in executing this care-delivery model, ACS represents the new face of general surgery that will likely continue to diffuse from these early adopters.

show abstract

“…Depending on size, location, and practice setting, it may make sense from a quality and cost perspective to regionalize the care of EGS patients to centers with routine availability of dedicated EGS structures and processes. 32-34 In fact, that the proportion of EGS patients presenting in transfer was higher in ACS models, suggests that this phenomenon may already be occurring to a certain extent.…”

Section: Discussionmentioning

confidence: 99%

Variations in the implementation of acute care surgery

Santry¹,

Madore²,

Collins³

et al. 2015

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

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

show abstract

Regionalization of Surgical Services in Central Florida: The Next Step in Acute Care Surgery

Cited by 17 publications

References 8 publications

Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study

Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study

Innovation or rebranding, acute care surgery diffusion will continue

Variations in the implementation of acute care surgery

Contact Info

Product

Resources

About