The association between self-declared acute care surgery services and critical care resources: Results from a national survey

J Crit Care. 2020 Dec;60:84-90. doi: 10.1016/j.jcrc.2020.04.002. Epub 2020 Jul 5.

Abstract

Purpose: We examined differences in critical care structures and processes between hospitals with Acute Care Surgery (ACS) versus general surgeon on call (GSOC) models for emergency general surgery (EGS) care.

Methods: 2811 EGS-capable hospitals were surveyed to examine structures and processes including critical care domains and ACS implementation. Differences between ACS and GSOC hospitals were compared using appropriate tests of association and logistic regression models.

Results: 272/1497 hospitals eligible for analysis (18.2%) reported they use an ACS model. EGS patients at ACS hospitals were more likely to be admitted to a combined trauma/surgical ICU or a dedicated surgical ICU. GSOC hospitals had lower adjusted odds of having 24-h ICU coverage, in-house intensivists or respiratory therapists, and 4/6 critical-care protocols.

Conclusions: Critical care delivery is a key component of EGS care. While harnessing of critical care structures and processes varies across hospitals that have implemented ACS, overall ACS models of care appear to have more robust critical care practices.

Keywords: Acute care surgery; Emergency surgery; ICU best practices; Surgical critical care.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Critical Care / methods*
  • Critical Illness
  • Delivery of Health Care / methods*
  • Emergency Service, Hospital*
  • Female
  • General Surgery / methods*
  • Hospitals, General / methods*
  • Humans
  • Intensive Care Units
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Surveys and Questionnaires*
  • Young Adult