Holly B Cunningham, Joshua J Weis, Luis R Taveras, Steven Boll, Tarik D Madni, Jonathan B Imran, Meaghan Colletti, Maryanne L Pickett, Joseph P Minei, Michael W Cripps. University of Texas Southwestern
Introduction: The creation of an acute care surgery (ACS) service has been associated with improved hospital efficiency and clinical outcomes; however, specific guidelines for implementing this model have not been developed. As a result, there has been significant variation in how individual institutions apply the principals of an ACS model to their practice. We sought to evaluate the impact of an ACS model at a private, non-trauma hospital with no in-house, overnight attending.
Methods: A retrospective review of all general surgery (GS)/ACS admissions and consults was conducted at an academic, private, non-trauma hospital from July 2015 to July 2018. An ACS service was established in July 2016. Clinical, demographic, and financial variables were queried from the electronic medical record. Parametric and non-parametric analyses were used when appropriate. Prior to July 2016, the GS service was staffed during weekdays by a single surgeon who was responsible for managing consults as well as maintaining an elective GS practice. Weekend and night coverage was home-call shared between this surgeon and other surgical subspecialists. Within the ACS model, weekday elective cases and clinics were maintained by the GS staff while emergency GS consults were assigned to a separate, dedicated ACS surgeon. Overnight and weekend home-call was divided amongst ACS staff, many of whom were critical care boarded.
Results: In total, 3164 hospital account records (HARs) were reviewed. There were 1016 HARs in the pre-ACS group and 2148 HARs in the post-ACS group. During the pre-ACS time period, there were 505 admissions and 511 consults. Post-ACS implementation, there were 1135 admissions and 1013 consults. Groups were similar in age (p=.88), gender (pre-ACS 57.6% male, post-ACS 58.8% male), and race (70% white). Total hospital charges between groups were statistically similar (p=.51). Net revenue and contribution margins between groups were also similar (p=.44, p=.07, respectively). Analysis of total length of stay (LOS) and intensive care unit LOS revealed no difference (p=.96, p=.94, respectively). In subset analyses, no differences were seen in total LOS for cholecystectomies (4.25 vs 4.14 days, p=.84) or bowel obstructions (5.30 vs 4.95 days, p=.71).
Conclusions: The creation of an ACS service in a private, non-trauma hospital without concurrent institutional culture change does not result in the financial benefits or clinical outcome improvements previously reported. Guidelines for optimal implementation should be established. Further studies will aim to define appropriate measures of successful ACS implementation as well as predictors of success in various hospital settings.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95904
Program Number: P004
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster