The Dedicated Emergency Surgeon: Towards Consultant-Based Acute Surgical Admissions

Sorelli, P; El-Masry, Nabil S.; Pm, Dawson; Theodorou, N. A.

doi:10.1308/003588408x242042

Cited by 34 publications

(30 citation statements)

References 5 publications

(5 reference statements)

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“…Parasyn and colleagues 11 demonstrated that emergency theatre use during the day increased from 57% to 69%, with an 11% reduction in acute care operating after hours (5 pm); furthermore, 26% fewer emergency cases were handled between midnight and 8 am. Sorelli and colleagues 12 also observed a significant increase in daytime operating from 57% in 2004 to 74% in 2005, and a significant decline in after-hours operating from 43% to 26%. Because the beneficial effects of ACCESS on after-hours operating were almost immediate, surgeon satisfaction and, consequently, surgeon participation in ACCESS, remained excellent.…”

Section: Discussionmentioning

confidence: 88%

“…It is clear that implementing ACCESS has significantly shifted the distribution of EGS to the daytime (from 21% to 9% post-ACCESS for night-time cases, a reduction of 57%), which correlates with other studies from around the world. [10][11][12] Britt and colleagues 10 observed a decline in emergency procedures performed after 5:30 pm, from 44.6% to 30% after the implementation of an ACS service. Parasyn and colleagues 11 demonstrated that emergency theatre use during the day increased from 57% to 69%, with an 11% reduction in acute care operating after hours (5 pm); furthermore, 26% fewer emergency cases were handled between midnight and 8 am.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of an acute care emergency surgical service: a cost analysis from the surgeon’s perspective

Anantha

Parry²,

Vogt

et al. 2014

cjs

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Background: Acute care surgical services provide comprehensive emergency general surgical care while potentially using health care resources more efficiently. We assessed the volume and distribution of emergency general surgery (EGS) procedures before and after the implementation of the Acute Care and Emergency Surgery Service (ACCESS) at a Canadian tertiary care hospital and its effect on surgeon billings.Methods: This single-centre retrospective case-control study compared adult patients who underwent EGS procedures between July and December 2009 (pre-ACCESS), to those who had surgery between July and December 2010 (post-ACCESS). Case distribution was compared between day (7 am to 3 pm), evening (3 pm to 11 pm) and night (11 pm to 7 am). Frequencies were compared using the χ 2 test.Results: Pre-ACCESS, 366 EGS procedures were performed: 24% during the day, 55% in the evening and 21% at night. Post-ACCESS, 463 operations were performed: 55% during the day, 36% in the evening and 9% at night. Reductions in night-time and evening EGS were 57% and 36% respectively (p < 0.001). Total surgeon billings for operations pre-and post-ACCESS were $281 066 and $287 075, respectively: remuneration was $6008 higher post-ACCESS for an additional 97 cases (p = 0.003). Using cost-modelling analysis, post-ACCESS surgeon billing for appendectomies, segmental colectomies, laparotomies and cholecystectomies all declined by $67 190, $125 215, $66 362, and $84 913, respectively (p < 0.001). Conclusion:Acute care surgical services have dramatically shifted EGS from nighttime to daytime. Cost-modelling analysis demonstrates that these services have costsavings potential for the health care system without reducing overall surgeon billing.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Implementation of an acute care emergency surgical service: a cost analysis from the surgeon’s perspective

Anantha

Parry²,

Vogt

et al. 2014

cjs

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“…2,3 The appointment of a dedicated emergency surgical consultant at one unit significantly shortened the hospital stay for emergency admissions. 7 Urgent consultant opinion (either in the ED or in clinic) would have prevented almost all unnecessary acute surgical admissions in another unit. 8 Our ASC is consultant-led, which may explain our low admission rates.…”

Section: Pidgeon Shariff Devine Menon a Report On An Acute In-hoursmentioning

confidence: 99%

A report on an acute, in-hours, outpatient review clinic with ultrasonography facilities for the early evaluation of general surgical patients

Pidgeon

Shariff

Devine

et al. 2016

annals

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Introduction In 2013 our hospital introduced an in-hours, consultant-led, outpatient acute surgical clinic (ASC) for emergency general surgical patients. In 2014 this clinic was equipped with a dedicated ultrasonography service. This prospective cohort study evaluated this service before and after the introduction of ultrasonography facilities. Methods Data were recorded prospectively for all patients attending the clinic during 2013 and 2014. The primary outcome was patient destination (whether there was follow-up/admission) after clinic attendance. Results The ASC reviewed patients with a wide age range and array of general surgical complaints. In 2013, 186 patients attended the ASC. After the introduction of the ultrasonography service in 2014, 304 patients attended. In 2014, there was a reduction in the proportion of patients admitted to hospital from the clinic (18.3% vs 8.9%, p=0.002). However, the proportion of patients discharged after ASC review remained comparable with 2013 (30.1% in 2013 vs 38.8% in 2014, p=0.051). The proportion of patients undergoing computed tomography (CT) scans also fell (14.0% vs 4.9%, p<0.001). Conclusions The ASC assessed a wide array of general surgical complaints. Only a small proportion required hospital admission. The introduction of an ultrasonography service was associated with a further reduction in admission rates and computed tomography.

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“…[6][7][8][9] However, the literature is dominated by uncontrolled pre-post studies, which cannot rule out secular trends and other confounders, such as adoption of new surgical practices, as explanations for the observed results. Very few studies have evaluated ACS consolidation on a regional level involving multiple institutions.…”

mentioning

confidence: 99%

Impact of a regional acute care surgery model on patient access and outcomes

Kreindler

Zhang²,

Metge³

et al. 2013

Can J Surg

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Background:The consolidation of acute care surgery (ACS) services at 3 of 6 hospitals in a Canadian health region sought to alleviate a relative shortage of surgeons able to take emergency call. We examined how this affected patient access and outcomes. Methods:Using the generalized linear model and statistical process control, we analyzed ACS-related episodes that occurred between 39 months prior to and 17 months after the model's implementation (n = 14 713).Results: Time to surgery increased after the consolidation. Wait times increased primarily for patients presenting at nonreferral hospitals who were likely to require transfer to a referral hospital. Although ACS teams enabled referral hospitals to handle a much higher volume of patients without increasing within-hospital wait times, overall system wait times were lengthened by the growing frequency of patient transfers. Wait times for inpatient admission were difficult to interpret because there was a trend toward admitting patients directly to the ACS service, bypassing the emergency department (ED). For patients who did go through the ED, wait times for inpatient admission increased after the consolidation; however, this trend was cancelled out by the apparently zero waits of patients who bypassed the ED. Regionalization showed no impact on length of stay, readmissions, mortality or complications. Conclusion:Consolidation enabled the region to ensure adequate surgical coverage without harming patients. The need to transfer patients who presented at nonreferral hospitals led to longer waits.Contexte : Le regroupement des services chirurgicaux d'urgence (SCU) dans 3 hôpitaux sur 6 d'une région sanitaire canadienne visait à contrer une relative pénurie de chirurgiens capables d'effectuer les interventions d'urgence. Nous en avons analysé l'impact sur l'accessibilité des services et sur les résultats chez les patients.Méthodes : À l'aide du modèle linéaire généralisé et d'un contrôle statistique des procédés, nous avons analysé les cas adressés aux SCU entre 39 mois précédant et 17 mois suivant l'entrée en vigueur du regroupement des services (n = 14 713).

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The Dedicated Emergency Surgeon: Towards Consultant-Based Acute Surgical Admissions

Cited by 34 publications

References 5 publications

Implementation of an acute care emergency surgical service: a cost analysis from the surgeon’s perspective

Implementation of an acute care emergency surgical service: a cost analysis from the surgeon’s perspective

A report on an acute, in-hours, outpatient review clinic with ultrasonography facilities for the early evaluation of general surgical patients

Impact of a regional acute care surgery model on patient access and outcomes

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