Variations in the Delivery of Emergency General Surgery Care in the Era of Acute Care Surgery

Daniel, Vijaya T.; Ingraham, Angela M.; Khubchandani, Jasmine A.; Aytürk, Mehmet; Kiefe, Catarina I.; Santry, Heena P.

doi:10.1016/j.jcjq.2018.04.012

Cited by 22 publications

(24 citation statements)

References 40 publications

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“…Despite the proposed benefits, adoption of the ACS model across the USA has been slow. In a national survey, only 272 hospitals out of 1690 (16%) had adopted an ACS model as of 2015 70. Qualitative studies reveal multiple surgeon concerns 71.…”

Section: Introductionmentioning

confidence: 99%

Pro-con debate on regionalization of emergency general surgery: controversy or common sense?

Santry

Kao

Shafi

et al. 2019

Trauma Surg Acute Care Open

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More than three million patients every year develop emergency general surgical (EGS) conditions and this number is rising. EGS diseases range from straightforward to potentially life-threatening, and if severe or complex may require extensive resources. Given the looming surgeon shortage and concerns about access to care, regionalization of EGS care, in a manner similar to trauma care, has been proposed. We present a unique pro–con debate highlighting the salient arguments for and against regionalization of EGS care in the USA.

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Section: Introductionmentioning

confidence: 99%

Pro-con debate on regionalization of emergency general surgery: controversy or common sense?

Santry

Kao

Shafi

et al. 2019

Trauma Surg Acute Care Open

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“…[16][17][18] At the national level, a postal and email assessment of all American hospitals containing both an emergency department and operating theatre reached 1690/2811 (60 per cent) hospitals, with 16 per cent employing an ASU model. 2 Similarly, a UK online questionnaire enrolled ≥1 colorectal surgeon from 104/135 (77 per cent) acute nonspecialist National Health Service Trusts, and reported ASU uptake in 26 per cent of hospitals. 19 Taken together, ASU implementation rates in developed nations range from 8-29 per cent, similar to our findings.…”

Section: Discussionmentioning

confidence: 99%

“…1 In the United States of America (USA), they annually comprise >3 million admissions at a cost of >USD28 billion. 2,3 The number of emergency general surgery (EGS) patients is also rising relentlessly by >30 per cent each decade in Europe and the USA. 4,5 However, despite…”

Section: Introductionmentioning

confidence: 99%

Emergency general surgery models in Australia: A cross-sectional study

Kinnear

Han

Tran

et al. 2019

amj

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Background Emergency general surgery (EGS) patients experience superior outcomes when cared for within an acute surgical unit (ASU) model. However, the EGS structures in most Australian hospitals remain unknown. Aims This study aimed to describe the national spectrum of EGS models. Methods Surgical staff were contacted in all Australian public hospitals of medium (>2,000 patient separations perannum) or greater peer group. Primary outcomes were incidence of each EGS model. Secondary outcomes were the relationship of EGS model to objective hospital variables, and qualitative reasons for choice of model. An ASU allocated a general surgeon solely to EGS patients for ≥50 per cent of business hours. A Hybrid model did not have this feature, but provided either a doctor-in-training rostered solely to EGS for ≥50 per cent of business hours, or ≥2 protected theatre half-day EGS lists per week. Results One hundred and nineteen of 120 eligible hospitals participated (99 per cent). Sixty-four hospitals (54 per cent) reported utilising hybrid model. ASU implementation was significantly more common amongst hospitals of greater peer group (p<0.0001), bed number (p<0.0001), surgeon pool (p=0.0003) and trauma service sophistication (p=0.0002). Leading reported drivers for ASU commencement were aims to improve EGS patient care and decrease after-hours operating, while common barriers against ASU uptake were insufficient EGS patient load or surgeon on-call pool. Conclusion ASU or Hybrid models of care for EGS patients may be more widespread than currently reported. Introduction of such structures is heavily dependent on hospital and staff size, trauma subspecialisation and EGS patient throughput.

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“…This work had advocated the application of a quality improvement approach, founded upon the Donabedian Model, and introduction of accepted guidelines to EGS care. Despite this early optimism, more recent evidence [13] reveals both a lack of adoption of agreed-on criteria for the optimal care of EGS patients across a majority of acute hospitals, and extensive variation regarding the processes of care. These barriers can be primarily classified as related to both organisational and provider-level factors; for instance, issues aligned to inflexible hospital infrastructures and/or the presence or absence of a dedicated surgical team.…”

Section: The Pursuit Of Qualitymentioning

confidence: 99%

“…Additional significant components, recognised by Daniel et al [13], have the capacity to heighten risk and increase the likelihood that patients will be in receipt of suboptimal care. These comprise a lack of access to advanced imaging, absence of proactive EGS quality initiatives, lack of dedicated operating theatre time for unscheduled cases, and surgeons not freed of elective responsibilities while covering EGS services.…”

Section: The Pursuit Of Qualitymentioning

confidence: 99%

Time for metrics in emergency surgical care – the role of an emergency surgery registry

Parlour¹,

Johnson²,

Loughlin³

et al. 2019

ait

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One of the major challenges for health services worldwide is managing the variations in care delivery associated with emergency general surgery (EGS) [1, 2]. Frequently, the standards of care delivered to these patient groups are considered to be suboptimal and heuristic [3, 4]. Patients with emergency surgical conditions need prompt attention, early diagnosis, and excellence in treatment to ensure good outcomes. To achieve these goals, a system with adequate planning, resourcing, and monitoring has to be in place. There is abundant local, national, and international evidence that clinical decision-making in EGS is frequently sub-optimal,

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Variations in the Delivery of Emergency General Surgery Care in the Era of Acute Care Surgery

Cited by 22 publications

References 40 publications

Pro-con debate on regionalization of emergency general surgery: controversy or common sense?

Pro-con debate on regionalization of emergency general surgery: controversy or common sense?

Emergency general surgery models in Australia: A cross-sectional study

Time for metrics in emergency surgical care – the role of an emergency surgery registry

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