Implementing a resident acute care surgery service: Improving resident education and patient care

A service led by acute care surgeons managing trauma, critically ill surgical, and emergency general surgery patients via an acute care surgery model of patient care improves hospital efficiency and patient outcomes at university-affiliated hospitals and American College of Surgeons–verified trauma centers. Our goal was to determine whether an acute care surgeon led service, entitled the Surgical Trauma and Acute Resuscitative Service (STARS) that implemented an acute care surgery model of patient care, could improve hospital efficiency and patient outcomes at a community hospital. A total of 492 patient charts were reviewed, which included 230 before the implementation of the STARS [pre-STARS (control)] and 262 after the implementation of the STARS [post-STARS (study)]. Demographics included age, gender, Acute Physiology and Chronic Health Evaluation 2 score, and medical comorbidities. Efficiency data included length of stay in emergency department (ED-LOS), length of stay in surgical intensive care unit (SICU-LOS), and length of stay in hospital (H-LOS), and total in hospital charges. Average age was 64.1 + 16.4 years, 255 males (51.83%) and 237 females (48.17%). Average Acute Physiology and Chronic Health Evaluation 2 score was 11.9 + 5.8. No significant differences in demographics were observed. Average decreases in ED-LOS (9.7 + 9.6 hours, pre-STARS versus 6.6 + 4.5 hours, post-STARS), SICU-LOS (5.3 + 9.6 days, pre-STARS versus 3.5 + 4.8 days, post-STARS), H-LOS (12.4 + 12.7 days, pre-STARS versus 11.4 + 11.3 days, post-STARS), and total in hospital charges ($419,602.6 + $519,523.0 pre-STARS to $374,816.7 + $411,935.8 post-STARS) post-STARS. Regression analysis revealed decreased ED-LOS—2.9 hours [ P = 0.17; 95% confidence interval (CI): -7.0, 1.2], SICU-LOS—6.3 days ( P < 0.001; 95% CI: -9.3, -3.2), H-LOS—7.6 days ( P = 0.001; 95% CI: -12.1, -3.1), and 3.4 times greater odds of survival ( P = 0.04; 95% CI: 1.1, 10.7) post-STARS. In conclusion, implementation of the STARS improved hospital efficiency and patient outcomes at a community hospital.

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Understanding the Trauma/Acute Care Surgery Workforce

The American Surgeon ◽

10.1177/000313481908500629 ◽

2019 ◽

Vol 85 (6) ◽

pp. 638-644 ◽

Cited By ~ 1

Author(s):

K. Michael Hughes ◽

Zachary T. Ewart ◽

Theodore D. Bell ◽

Stanley J. Kurek ◽

Krystal K. Swasey

Keyword(s):

Health Care ◽

Patient Care ◽

Work Environment ◽

Acute Care ◽

Professional Growth ◽

Health Care Systems ◽

Acute Care Surgery ◽

Care Systems ◽

Care Surgery ◽

Workforce Strategies

As the roles of trauma/acute care surgeons continue to evolve, it is imperative that health-care systems adapt to meet workforce needs. Tailoring retention strategies that elicit workforce satisfaction ensure continued coverage that is mutually beneficial to surgeons and health-care systems. We sought to elicit factors related to career characteristics and expectations of the trauma/acute care surgery (ACS) workforce to assist with such future progress. In this study, 1552 Eastern Association for the Surgery of Trauma members were anonymously surveyed. Data collected included demographics, career expectations, and motivators of trauma/ACS. Four hundred eight (26%) Eastern Association for the Surgery of Trauma members responded. Respondents were 78 per cent male and had a median age of 47.3 years. Forty-six per cent of surgeons reported earning $351K–$475K and 23 per cent >$475K. At this point in their career, 49 per cent of surgeons felt quality of life was “most important”, followed by 31 per cent career ambitions and 13 per cent salary. Prominent career satisfiers were patient care and teaching. Greatest detractors were burnout, bureaucracy, and work environment. Eighty per cent would change jobs in the final 10 years of practice, 31 per cent because of family/retirement, 29 per cent because of professional growth, 24 per cent because of workload, and 7 per cent because of salary. This study could be used to help develop trauma/ACS workforce strategies. This workforce remains mobile into late career; personal happiness and patient ownership overshadow financial rewards, and most prefer a total and shared patient care model compared with no patient ownership. Burnout, bureaucracy, and work environment are dominant detractors of job satisfaction among surveyed trauma/ACS surgeons.

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Mobile application-based guidelines to enhance patient care and provider education in trauma and acute care surgery

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000479 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000479

Author(s):

Nicholas A Hakes ◽

William C Kethman ◽

David Spain ◽

Aussama K Nassar

Keyword(s):

Patient Care ◽

Acute Care ◽

Mobile Application ◽

Care Center ◽

Healthcare Providers ◽

Acute Care Surgery ◽

Quality Improvement Initiative ◽

Provider Education ◽

Level Of Evidence ◽

Care Surgery

IntroductionProviding up-to-date, universally accessible care guidelines and education within a quaternary care center is challenging. At our institution, trauma and acute care surgery guidelines have historically been published using a paper-based format. Mobile application-based guidelines were developed to address the shortcomings of paper-based guidelines.MethodsWe assessed the utility, usability, and satisfaction of healthcare providers towards paper-based versus mobile application-based guidelines. A survey was administered to providers within the emergency department and intensive care unit.ResultsFifty of 137 providers responded (36.5% response rate). Nearly half (47.4%, 9 of 19) of those who received a copy of the paper-based guidelines lost the guidelines at least once. Regarding usage of the mobile application-based guidelines, 92.6% (25 of 27) were aware of the application; 92.6% (25 of 27) considered the application comprehensive, 85.2% (23 of 27) thought the application was organized, and 66.7% (18 of 27) thought the application was easy to use. Additionally, 88.9% (24 of 27) found the application moderately, very, or extremely helpful and 85.2% (23 of 27) judged the application moderately, very, or extremely necessary. Overall, 88.9% (24 of 27) were satisfied with the application and indicated likeliness to recommend to a colleague. Seventeen of 27 (63.0%) agreed or strongly agreed that the application improved their provision of trauma and acute care.ConclusionThis survey demonstrates positive usability, utility, and satisfaction among trauma healthcare providers with the mobile application-based guidelines. Additionally, this quality improvement initiative highlights the importance of having comprehensive, organized, and easy-to-use trauma and acute care surgery guidelines and targeted educational materials available on demand. The successful transition from paper to mobile application-based guidelines serves as a model for other institutions to modernize and improve patient care and provider education.Level of evidenceIV.

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Acute Care Surgery Billing, Coding and Documentation Series Part 3: Coding of Additional Select Procedures; Modifiers; Telemedicine Coding; Robotic Surgery

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000587 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000587

Author(s):

Thomas Esposito ◽

Robert Reed ◽

Raeanna C Adams ◽

Samir Fakhry ◽

Dolores Carey ◽

...

Keyword(s):

Complex System ◽

Robotic Surgery ◽

Acute Care ◽

Acute Care Surgery ◽

Formal Training ◽

Experienced Surgeon ◽

Care Surgery

This series of reviews has been produced to assist both the experienced surgeon and coder, as well as those just starting practice that may have little formal training in this area. Understanding this complex system will allow the provider to work “smarter, not harder” and garner the maximum compensation for their work. We hope we have been successful in achieving and that goal that this series will provide useful information and be worth the time invested in reading it by bringing tangible benefits to the efficiency of practice and its reimbursement. This third section deals with coding of additional select procedures, modifiers, telemedicine coding, and robotic surgery.

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