The Impact of an Acute Care Emergency Surgical Service on Timely Surgical Decision-Making and Emergency Department Overcrowding

Qureshi, Adnan I; Smith, Andy; Wright, Frances W.; Brenneman, Fred; Rizoli, Sandro; Hsieh, Taulee; Tien, Homer

doi:10.1016/j.jamcollsurg.2011.04.020

Cited by 78 publications

(70 citation statements)

References 21 publications

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“…9,10 In our institution, the creation of a dedicated ACSS allowed for surgeons and the resident team to focus on the care of nontrauma emergency surgical patients, with an overall improvement of patient flow and improved efficiency.…”

Section: Resultsmentioning

confidence: 99%

“…[5][6][7][8] In a recent Canadian study on appendicitis, the creation of an ACSS resulted in faster time to surgery and decreased emergency department crowding. 9 Regardless of the different pressures that have led to the creation of both the American and Canadian ACSS models, there is a common goal of more efficient and effective care of the emergent surgical patient.…”

Section: Recherchementioning

confidence: 99%

“…This is in contrast to the findings of some ACSS services, indicating that in the context of acute appendicitis, the presence of an in-house acute care surgeon significantly decreased the time to operation. 6,9 When considering patients with acute cholecystitis, Lehane and colleagues 8 reported that an ACSS model decreased the median time to surgery; however, Ekeh and colleagues 7 found no improvement in time to surgery with the presentation of appendicitis in their ACSS model.…”

Section: Recherchementioning

confidence: 99%

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Effect of an acute care surgical service on the timeliness of care

Faryniuk

Hochman

2013

Can J Surg

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Section: Resultsmentioning

confidence: 99%

Section: Recherchementioning

confidence: 99%

Section: Recherchementioning

confidence: 99%

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Effect of an acute care surgical service on the timeliness of care

Faryniuk

Hochman

2013

Can J Surg

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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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“…This new practice model was adapted from the acute care surgery model that has gained popularity in general surgery and is quickly becoming the standard model for delivering emergency general surgery care across Canada (1). Results from the general surgery literature have shown this practice model to be effective in reducing time spent in the emergency department, decreasing time to consultation, reducing wait times for surgery and decreasing the length of hospital stay (2)(3)(4). In addition, a majority of general surgeons reported an improved balance between time spent on call and time available for their elective practices (5).…”

Section: Introductionmentioning

confidence: 99%