Acute Care Surgery Services Provides Quicker Patient Care

The establishment of an acute care surgery service (ACSS) can help surgeons provide more timely care to patients who are transferred from the emergency room (ED) or smaller hospitals and who require an immediate operation.

Researchers at the Eastern Virginia Medical School (EVMS; Norfolk, USA) retrospectively reviewed a prospective database of 861 patients receiving consultations and procedures performed by an ACSS at EVMS; the service was staffed by six board-certified critical care surgeons and two surgical residents. All emergency department, inpatient, and transfer consultations for general surgery were directed to the ACSS (trauma service was separate from the ACSS). Data was reviewed for two periods, prior to implementation and following implementation, from July 2006 to March 2008.

The results showed that of the 410 patients who had 500 operations, 72.8% were performed in the operating room and 26.2% at the bedside. In the year before implementation of the acute surgery service, 55.4% of urgent and emergent procedures were performed between 7:30 a.m. and 5:30 p.m., compared with 70% after implementation. Procedures performed after 5:30 p.m. decreased from 44.6% to 30% following implementation of the service. The most common cases that required treatment by the ACSS were respiratory failure and malnutrition, soft-tissue infection, abdominal pain, biliary complications, and bowel obstruction. The most common operations performed included creating a surgical opening in the trachea or stomach for insertion of tubes, or both; incision and drainage; gallbladder removal; and complex abdominal wound care. The study was published in the October 2009 issue of the Journal of the American College of Surgeons (JACS).

"The results of this study suggest that an acute surgery service operating largely during daytime hours can provide more efficient emergency care without disrupting the treatment of patients undergoing scheduled operations,” said lead author Rebecca Britt, M.D., an assistant professor in the department of surgery. "These findings argue for the establishment of dedicated acute surgical teams separate from trauma services.”

Lack of access to high-quality acute surgical care is a growing problem due to numerous factors, including a shortage of surgeons and declining reimbursement associated with increasing numbers of uninsured patients. Further, general surgeons are increasingly sub-specializing, resulting in difficulty providing expert care for emergency cases outside the realm of the surgeon's specialty. With an increased demand for surgical services, usually in the face of fewer resources, new models are necessary to serve the needs of patients requiring nonscheduled, immediate surgical intervention.

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Eastern Virginia Medical School