Finding a general surgeon to be on-call for the emergency department (ED) is becoming increasingly difficult. A 2011 Robert Wood Johnson Foundation survey found that 75 percent of EDs had inadequate surgical call coverage, and estimates are that it is only going to get worse with ongoing shortages of qualified surgeons.
Not only do such shortages have the potential to impact patient care and already over-burdened ED staff, they also compound the challenges hospitals face in today’s era of value-based purchasing (i.e. meeting requirements for achieving high-quality surgical care, reducing complications and meeting pay-for-performance goals).
In response to these challenges, the acute care surgery model has emerged. It applies trauma surgery standards to emergency general surgery patients to reduce the time non-trauma ED patients have to wait for a surgeon.
Here are some reasons why hospital administrators are taking a new look at how they provide coverage for emergency general surgery:
- EDs are crowded with more patients than ever before. When patients need surgery and surgeons aren’t available, there are delays, complications, unhappy patients and families, and unnecessary expenses.
- Increasingly, surgeons in private practice are reluctant to be on call for emergency surgeries—creating administrative hassles and tension between hospital administrators and the medical staff.
- The traditional on-call method of handling emergency surgeries works against hospitals’ mandate to collaborate with physicians to deliver standardized care according to best practices. It is not possible to achieve this collaboration without cohesive teams of practitioners who are aligned with the hospital to achieve these common goals.
Hospital leaders are beginning to explore the acute care surgery model because it provides a programmatic approach to emergency general surgery through a dedicated team of unencumbered hospital-based surgeons available 24/7 to immediately respond to the ED. When this model is in place, it:
- Improves patient care and patient satisfaction
- Decreases surgical ED response time
- Standardizes patient care for emergency surgery patients
- Allows hospitals to reduce variation in emergency surgical care, achieve new levels of throughput efficiencies and decrease the cost per case
- Enables hospitals to better manage their patient demographic and position themselves for market success
More than just a solution for ED surgical call coverage, the acute care surgery model is a viable solution for hospitals facing difficulties recruiting and retaining qualified surgeons. By applying trauma surgery standards to emergency general surgery patients, an acute care surgery program improves performance and outcomes hospital-wide. It resolves the ongoing challenges of reducing patient complications, improving outcomes, lowering costs and increasing efficiency while helping hospitals to function more efficiently in value-based purchasing programs.
Recognizing the growing national need for acute care surgeons, there are now 18 fully accredited AAST Acute Care Surgery fellowship programs focusing on this track.
The benefits of an acute care surgery program are real and sustainable, as illustrated by the experience of one hospital over a five-year period of time. Sutter Medical Center, Sacramento, a tertiary referral community hospital, undertook a long-term retrospective review of all emergency surgery operations performed both before and after implementation of an acute care surgery program.
The program results, published in the July 2014 Journal of the American College of Surgeons, showed the model successfully resolved the problem of consistent on-call surgery coverage while simultaneously improving patient safety, quality and other outcomes, and significantly improving the hospital’s performance with cost savings of $2 million a year.
These documented results prove that the acute care surgery model improves clinical outcomes, drives throughput efficiencies and lowers cost per case. It delivers better care, increases operating margins and helps hospitals be better prepared for the new world of value-based purchasing and pay-for-performance measures, including ACO bundled payments.
Hospitals that seek better alignment and teamwork with their surgeons are implementing acute care surgery programs as a solution for their emergency general surgery coverage.
Leon J. Owens, M.D., FACS, is president and CEO of Surgical Affiliates Management Group Inc.