Sustainability and success of the acute care surgery model in the nontrauma setting.
| Autor: | O'Mara MS; Department of Surgery, Grant Medical Center, Columbus, OH. Electronic address: shay.omara@ohiohealth.com., Scherer L; Department of Surgery, Mercy San Juan Medical Center, Carmichael, CA., Wisner D; Department of Surgery, The University of California Davis Medical Center, Sacramento, CA., Owens LJ; Department of Surgery, Sutter Medical Center Sacramento, Sacramento, CA. |
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| Jazyk: | angličtina |
| Zdroj: | Journal of the American College of Surgeons [J Am Coll Surg] 2014 Jul; Vol. 219 (1), pp. 90-8. Date of Electronic Publication: 2014 Mar 13. |
| DOI: | 10.1016/j.jamcollsurg.2014.02.022 |
| Abstrakt: | Background: The use of an acute care surgical model has been shown to improve patient care and efficiency. We propose that it is possible to apply this model to emergency general surgery patients at a nontrauma hospital. With this acute care surgery service, no change in the quality of care will occur, and improvements in quality, cost, and outcomes may be achieved and sustained. Study Design: A retrospective review was performed of all emergency surgery operations performed at a tertiary referral community hospital without a trauma service. Data were collected from 1 year before and each year up to 4 years after the implementation of an acute care surgical (ACS) service. Results: There were fewer overall complications with ACS (21% to 12%, p < 0.0001), and a shorter length of stay (6.5 days to 5.7 days, p = 0.0016). Hospital costs fell from $12,009 to $8,306 (p < 0.0001). Post-appendectomy complications decreased (13% to 3.7%, p < 0.0001), length of stay was shorter (3.0 to 2.3 days, p < 0.0001), and hospital costs decreased from $9,392 to $5,872 (p < 0.0001). Post-cholecystectomy complications decreased (21% to 9%, p = 0.012), length of stay was shorter (5.3 to 3.8 days, p = 0.0004), and hospital costs decreased from $12,526 to $9,348 (p < 0.0001). Conclusions: An acute care surgery service can be successfully implemented at a nontrauma hospital. The improvements seen in outcomes and finances are sustainable over time. This sort of coordinated, consistent care is successful and allows alignment of the goals of surgeons, hospitals, and patients. (Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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