The impact of an acute care surgery model on general surgery service productivity

Background Research productivity is critical to academic surgery and essential for advancing surgical knowledge and evidence-based practice. We aim to determine if surgeon affiliation with top US universities/hospitals (TOPS) is associated with increased research productivity measured by numbers of peer-reviewed publications in PubMed (PMIDs). Methods A bibliometric analysis was performed for PMIDs. Affiliated authors who published in trauma surgery (TS), surgical critical care (SCC), acute care surgery (ACS), and emergency general surgery (EGS) were evaluated for publications between 2015 and 2019, and lifetime productivity. Our analysis included 3443 authors from 443 different institutions. Our main outcome was PMIDs of first author (FA) and senior author (SA) in each field (2015-2019) and total lifetime publications. Results Significant differences exist between PMIDs from TOPS vs non-TOPS in FA-TS (1.34 vs 1.23, P = .001), SA-TS (1.71 vs 1.46, P < .001), total SA-PMIDs (44.10 vs 26.61, P < .001), and SA-lifetime PMIDs (90.55 vs 59.03, P < .001). There were no significant differences in PMIDs for FA or SA-SCC, FA or SA-ACS, FA or SA-EGS, FA-total PMIDs 2015-2019, or FA-lifetime PMIDs ( P > .05 for all). Conclusion There were significantly higher TS PMIDs among FAs and SAs affiliated with top US institutions in 2015-2019, along with higher total PMIDs (2015-2019) and lifetime PMIDs. These findings are of significance to future graduate medical applicants and academic surgeons who need to make decisions about training and future career opportunities.

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Acute Care Surgeons Spend More Time than General Surgeons on the Electronic Health Record (EHR)

The American Surgeon ◽

10.1177/00031348211061102 ◽

2021 ◽

pp. 000313482110611

Author(s):

Abigail Loszko ◽

Michael Watson ◽

Ahsan Khan ◽

Kyle Cunningham ◽

Bradley Thomas ◽

...

Keyword(s):

Electronic Health Record ◽

Acute Care ◽

General Surgery ◽

Unintended Consequences ◽

Acute Care Surgery ◽

Health Record ◽

Electronic Health ◽

Care Surgery ◽

Trauma Surgeons ◽

The Impact

Background The paradigm of Acute Care Surgery (ACS) emerged in response to decreasing operative opportunities for trauma surgeons and increasing need for surgical coverage in disciplines to which the expertise of trauma surgeons naturally extends. While the continued evolution of this specialty remains largely beneficial, unintended consequences may have arisen along the way. One aspect of ACS that remains to be thoroughly investigated is the impact of the electronic health record (EHR). The purpose of this study is to objectively quantify EHR usage for ACS and compare it to other general surgery specialties. Methods EHR user data were collected for fifteen ACS attendings and thirty-seven general surgery attendings from October 2014 to September 2019. Comparative analysis was conducted using two-tailed t-tests. Subgroup analysis was conducted for subspecialties included in the general surgery group. Results ACS attendings opened almost 3 times as many charts as general surgery attendings per month (180 vs 64 charts/month, P < .0001), and ultimately spent more time on the EHR as a result (10 vs 6.4 hours/month, P < .0001). Documentation was the most time consuming EHR task for both groups. Although ACS attendings spent less overall time per patient chart, the proportion of time spent on certain EHR tasks was similar to that of general surgery colleagues. Discussion The EHR imposes a disproportionate burden on ACS attendings compared to their general surgery counterparts, and additional study is warranted to improve usage. EHR usage burden has workforce implications for trainees considering a career in ACS.

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The impact of an acute care surgery team on general surgery residency

The American Journal of Surgery ◽

10.1016/j.amjsurg.2014.05.001 ◽

2014 ◽

Vol 208 (5) ◽

pp. 856-859 ◽

Cited By ~ 1

Author(s):

Quinton Hatch ◽

Derek McVay ◽

Eric K. Johnson ◽

Justin A. Maykel ◽

Bradley J. Champagne ◽

...

Keyword(s):

Acute Care ◽

General Surgery ◽

Acute Care Surgery ◽

General Surgery Residency ◽

Care Surgery ◽

The Impact

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Acute care surgery: the impact of an acute care surgery service on assessment, flow, and disposition in the emergency department

The American Journal of Surgery ◽

10.1016/j.amjsurg.2011.12.006 ◽

2012 ◽

Vol 203 (5) ◽

pp. 578-583 ◽

Cited By ~ 16

Author(s):

Chad G. Ball ◽

Anthony R. MacLean ◽

Elijah Dixon ◽

May Lynn Quan ◽

Lynn Nicholson ◽

...

Keyword(s):

Emergency Department ◽

Acute Care ◽

Acute Care Surgery ◽

Care Surgery ◽

The Impact

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Acute Care Surgery: Defining Mortality in Emergency General Surgery in the State of Maryland

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2014.12.051 ◽

2015 ◽

Vol 220 (4) ◽

pp. 762-770 ◽

Cited By ~ 15

Author(s):

Mayur Narayan ◽

Ronald Tesoriero ◽

Brandon R. Bruns ◽

Elena N. Klyushnenkova ◽

Hegang Chen ◽

...

Keyword(s):

Acute Care ◽

General Surgery ◽

The State ◽

Acute Care Surgery ◽

Emergency General Surgery ◽

Care Surgery

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Evaluation of a Regional Acute Care Surgery Service by Residents in General Surgery

Journal of Surgical Education ◽

10.1016/j.jsurg.2011.03.001 ◽

2011 ◽

Vol 68 (4) ◽

pp. 290-293 ◽

Cited By ~ 5

Author(s):

Ramin Kholdebarin ◽

Ramzi M. Helewa ◽

David J. Hochman

Keyword(s):

Acute Care ◽

General Surgery ◽

Acute Care Surgery ◽

Care Surgery

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The Implications of Transfer to an Acute Care Surgical Tertiary Service

The American Surgeon ◽

10.1177/000313481708301230 ◽

2017 ◽

Vol 83 (12) ◽

pp. 1422-1426 ◽

Cited By ~ 1

Author(s):

Rebecca Britt ◽

Pamela Davis ◽

Anjali Gresens ◽

Leonard Weireter ◽

T.J. Novosel ◽

...

Keyword(s):

Acute Care ◽

Surgical Care ◽

Acute Care Surgery ◽

Billing Data ◽

Free Standing ◽

Hospital Transfer ◽

Tertiary Hospitals ◽

Transfer Group ◽

Care Surgery ◽

The Impact

Tertiary hospitals are increasingly called on by smaller hospitals and free-standing emergency rooms (ERs) to provide surgical care for complex patients. This study assesses patients transferred to an acute care surgery service. The ER and transfer center logs, as well as billing data, were reviewed for 12 months for all cases evaluated by acute care surgery. The charts were reviewed for demographics, comorbidities, and outcomes. A total of 111 transferred patients with complete data were identified, with 59 transferred from another hospital and 52 from a free-standing ER. The hospital transfer patients were older with more comorbidities, had a longer length of stay, and were more likely discharged to skilled care. There was no difference in the percent of patients requiring a procedure; however, significantly more procedures in the hospital transfer group were done by nonsurgical specialties Better infrastructure to monitor the impact of hospital transfers is warranted in the setting of the complex patient population transferred to tertiary hospitals.

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Development of an acute care surgery service in Rwanda

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000332 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000332 ◽

Cited By ~ 1

Author(s):

Egide Abahuje ◽

Isaie Sibomana ◽

Elisee Rwagahirima ◽

Christian Urimubabo ◽

Robert Munyaneza ◽

...

Keyword(s):

Hospital Stay ◽

Acute Care ◽

Epidemiologic Study ◽

Length Of Hospital Stay ◽

Acute Care Surgery ◽

Level Of Evidence ◽

Midline Laparotomy ◽

Resource Setting ◽

Care Surgery ◽

The Impact

BackgroundAcute care surgery (ACS) encompasses trauma, critical care, and emergency general surgery. Due to high volumes of emergency surgery, an ACS service was developed at a referral hospital in Rwanda. The aim of this study was to evaluate the epidemiology of ACS and understand the impact of an ACS service on patient outcomes.MethodsThis is a retrospective observational study of ACS patients before and after introduction of an ACS service. χ2 test and Wilcoxon rank-sum test were used to describe the epidemiology and compare outcomes before (pre-ACS)) and after (post-ACS) implementation of the ACS service.ResultsData were available for 120 patients before ACS and 102 patients after ACS. Diagnoses included: intestinal obstruction (n=80, 36%), trauma (n=38, 17%), appendicitis (n=31, 14%), and soft tissue infection (n=17, 8%) with no difference between groups. The most common operation was midline laparotomy (n=138, 62%) with no difference between groups (p=0.910). High American Society of Anesthesiologists (ASA) score (ASA ≥3) (11% vs. 40%, p<0.001) was more common after ACS. There was no difference in intensive care unit admission (8% vs. 8%, p=0.894), unplanned reoperation (22% vs. 13%, p=0.082), or mortality (10% vs. 11%, p=0.848). The median length of hospital stay was longer (11 days vs. 7 days, p<0.001) before ACS.ConclusionsAn ACS service can be implemented in a low-resource setting. In Rwanda, ACS patients are young with few comorbidities, but high rates of mortality and morbidity. In spite of more patients who are critically ill in the post-ACS period, implementation of an ACS service resulted in decreased length of hospital stay with no difference in morbidity and mortality.Level of evidencePrognostic and epidemiologic study type, level III.

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