Initial Implementation of an Acute Care Surgery Model: Implications for Timeliness of Care

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 = 4 1); 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. (J Am Coll Surg 2009;209:421-424. (C) 2009 by the American College of Surgeons)