Initial implementation of an acute care surgery model: implications for timeliness of care

J Am Coll Surg. 2009 Oct;209(4):421-4. doi: 10.1016/j.jamcollsurg.2009.06.368. Epub 2009 Aug 20.


Background: In July 2007, we introduced an acute care surgery service to an academic department of surgery staffed in a prearranged, dedicated rotation by critical care-trained surgeons to address all emergency department, inpatient, and transfer consultations. This study is designed to evaluate the impact on patient care and describe the case-mix experienced.

Study design: A retrospective review was done of a prospectively collected database encompassing all patients evaluated. Diagnosis, operations performed, and times of operations were recorded.

Results: Eight hundred sixty-one patients were evaluated. Four hundred ten patients (47.6%) had 500 operations; 368 (72.8%) were performed in the operating room and 132 (26.2%) at the bedside. Respiratory failure and malnutrition (n = 130), soft-tissue infection (n = 115), abdominal pain (n = 97), biliary (n = 94), bowel obstruction (n = 78), diseases of the colon (n = 49), and appendicitis (n = 46) were the most common diseases seen. The most common operations performed included incision and drainage (n = 61); tracheostomy or percutaneous gastrostomy, or both (n = 125); cholecystectomy (n = 53); appendectomy (n = 41); colectomy (n = 34); and complex abdominal wound care (n = 43). In the year before implementation, 55.4% of emergent procedures were performed between 7:30 am and 5:30 pm, compared with 70% after implementation (p = 0.0002). Procedures performed after 5:30 pm decreased from 44.6% to 30%.

Conclusions: Implementation of an acute care surgery service has been positive in terms of facilitating the ability to provide more timely care by increasingly using the daytime operating room and providing a breadth of consultative and operative experience to the participating academic surgeons and trainees.

MeSH terms

  • Emergency Service, Hospital / organization & administration*
  • Emergency Treatment / methods
  • General Surgery / education*
  • Humans
  • Internship and Residency*
  • Models, Organizational*
  • Retrospective Studies
  • Risk Adjustment
  • Surgery Department, Hospital / organization & administration*
  • Surgical Procedures, Operative / statistics & numerical data*
  • Time Factors
  • Traumatology / education
  • Traumatology / organization & administration
  • Virginia
  • Workforce