Understanding the Trauma/Acute Care Surgery Workforce

2019 ◽  
Vol 85 (6) ◽  
pp. 638-644 ◽  
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.

scholarly journals Return to Normalcy? Principles on Resuming Surgical Services in the COVID-19 Era

OTO Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 2473974X2093665
Author(s):  
Taher S. Valika ◽  
Kathleen R. Billings
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Health Care Systems ◽  
Lessons Learned ◽  
Drastic Reduction ◽  
The Public ◽  
Surgical Services ◽  
Outpatient Visits ◽  
Care Systems ◽  
Full Capacity

The rapidly changing health care climate related to coronavirus disease 2019 (COVID-19) has resulted in numerous changes to health care systems and in practices that protect both the public and the workers who serve in hospitals around the country. As a result, these past few months have seen a drastic reduction in outpatient visits and surgical volumes. With phased reopening and appropriate guidance, health care systems are attempting to return to normal. Our institution has had the unique opportunity to already return operations back to full capacity. The experiences and lessons learned are described, and we provide guiding principles to allow for a safe and effective return to patient care.

Implementation of an Acute Care Surgery Service in a Community Hospital: Impact on Hospital Efficiency and Patient Outcomes

2016 ◽  
Vol 82 (1) ◽  
pp. 79-84 ◽  
Author(s):  
Michael Kalina
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
Acute Care ◽  
Patient Outcomes ◽  
Community Hospital ◽  
Hospital Efficiency ◽  
Hospital Charges ◽  
Acute Care Surgery ◽  
Health Evaluation ◽  
Care Surgery

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.

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

Surgery ◽  
2017 ◽  
Vol 161 (3) ◽  
pp. 876-883 ◽  
Author(s):  
Olga Kantor ◽  
Andrew B. Schneider ◽  
Marko Rojnica ◽  
Andrew J. Benjamin ◽  
Nancy Schindler ◽  
...  
Keyword(s):  
Patient Care ◽  
Acute Care ◽  
Resident Education ◽  
Acute Care Surgery ◽  
Care Surgery

Practice/regulation partnerships: The pathway to increased safety in nursing practice, health care systems, and patient care

Nurse Leader ◽  
2007 ◽  
Vol 5 (3) ◽  
pp. 50-54 ◽  
Author(s):  
Mary Beth Thomas ◽  
Debora Simmons ◽  
Krisanne Graves ◽  
Sharon K. Martin
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Nursing Practice ◽  
Health Care Systems ◽  
Care Systems ◽  
Practice Regulation

scholarly journals Why Are Digital Health Care Systems Still Poorly Designed, and Why Is Health Care Practice Not Asking for More? Three Paths Toward a Sustainable Digital Work Environment

10.2196/26694 ◽  
2021 ◽  
Vol 23 (6) ◽  
pp. e26694
Author(s):  
Johanna Persson ◽  
Christofer Rydenfält
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Work Environment ◽  
Digital Health ◽  
Health Care Systems ◽  
Digital Systems ◽  
User Context ◽  
Care Systems ◽  
Digital Work ◽  
And Task

Knowledge of how to design digital systems that are ergonomically sound, high in usability, and optimized for the user, context, and task has existed for some time. Despite this, there are still too many examples of new digital health care systems that are poorly designed and that could negatively affect both the work environment of health care staff and patient safety. This could be because of a gap between the theoretical knowledge of design and ergonomics and the practical implementation of this knowledge in procuring and developing digital health care systems. Furthermore, discussions of digitalization are often at a general level and risk neglecting the nature of direct interaction with the digital system. This is problematic since it is at this detailed level that work environment and patient safety issues materialize in practice. In this paper, we illustrate such issues with two scenarios concerned with contemporary electronic health care records, based on field studies in two health care settings. We argue that current methods and tools for designing and evaluating digital systems in health care must cater both to the holistic level and to the details of interaction and ergonomics. It must also be acknowledged that health care professionals are neither designers nor engineers, so expectations of them during the development of digital systems must be realistic. We suggest three paths toward a more sustainable digital work environment in health care: (1) better tools for evaluating the digital work environment in the field; (2) generic formulations of qualitative requirements related to usability and for adaptation to the user, context, and task, to be used in procurement; and (3) the introduction of digital ergonomics as an embracing concept capturing several of the ergonomic challenges (including physical, cognitive, and organizational aspects) involved in implementing and using digital systems.

scholarly journals Social Network Analysis of Patient Movement Across Health Care Entities in Orange County, Florida

2020 ◽  
Vol 135 (4) ◽  
pp. 452-460
Author(s):  
Danielle A. Rankin ◽  
Sarah D. Matthews
Keyword(s):  
Health Care ◽  
Social Network ◽  
Social Network Analysis ◽  
Network Analysis ◽  
Acute Care ◽  
Orange County ◽  
Health Care Systems ◽  
Acute Care Hospitals ◽  
Local Public Health ◽  
Care Systems

Objective Multidrug-resistant organisms (MDROs) are continually emerging and threatening health care systems. Little attention has been paid to the effect of patient transfers on MDRO dissemination among health care entities in health care systems. In this study, the Florida Department of Health in Orange County (DOH-Orange) developed a baseline social network analysis of patient movement across health care entities in Orange County, Florida, and regionally, within 6 surrounding counties in Central Florida. Materials and Methods DOH-Orange constructed 2 directed network sociograms—graphic visualizations that show the direction of relationships (ie, county and regional)—by using 2016 health insurance data from the Centers for Medicare & Medicaid Services, which include metrics that could be useful for local public health interventions, such as MDRO outbreaks. Results We found that both our county and regional networks were sparse and centralized. The county-level network showed that acute-care hospitals had the highest influence on controlling the flow of patients between health care entities that would otherwise not be connected. The regional-level network showed that post–acute-care hospitals and other facilities (behavioral hospitals and mental health/substance abuse facilities) served as the primary controls for flow of patients between health care entities. The most prominent health care entities in both networks were the same 2 acute-care hospitals. Practice Implications Social network analysis can help local public health officials respond to MDRO outbreak investigations by determining which health care facilities are the main contributors of dissemination of MDROs or are at high risk of receiving patients with MDROs. This information can help epidemiologists prioritize prevention efforts and develop county- or regional-specific interventions to control and halt MDRO transmission across a health care network.

scholarly journals Powerful Lessons from Cuban Medical Education Programs: Fostering the Social Contract in Athletic Training Programs

2019 ◽  
Vol 14 (4) ◽  
pp. 275-282
Author(s):  
Kimberly S. Peer ◽  
Chelsea L. Jacoby
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Patient Care ◽  
Educational Reform ◽  
Athletic Training ◽  
Training Programs ◽  
Health Care Systems ◽  
The United States ◽  
Education And Health ◽  
Care Systems

Context The Cuban medical education and health care systems provide powerful lessons to athletic training educators, clinicians, and researchers to guide educational reform initiatives and professional growth. Objective The purpose of this paper is to provide a brief overview of the Cuban medical education system to create parallels for comparison and growth strategies to implement within athletic training in the United States. Background Cubans have experienced tremendous limitations in resources for decades yet have substantive success in medical education and health care programs. As a guiding practice, Cubans focus on whole-patient care and have established far-reaching research networks to help substantiate their work. Synthesis Cuban medical education programs emphasize prevention, whole-patient care, and public health in a unique approach that reflects disablement models recently promoted in athletic training in the United States. Comprehensive access and data collection provide meaningful information for quality improvement of education and health care processes. Active community engagement, education, and interventions are tailored to meet the biopsychosocial needs of individuals and communities. Results Cuban medical education and health care systems provide valuable lessons for athletic training programs to consider in light of current educational reform initiatives. Strong collaborations and rich integration of disablement models in educational programs and clinical practice may provide meaningful outcomes for athletic training programs. Educational reform should be considered an opportunity to expand the athletic training profession by embracing the evolving role of the athletic trainer in the competitive health care arena. Recommendation(s) Through careful consideration of Cuban medical education and health care initiatives, athletic training programs can better meet the contract with society as health care professionals by integrating the Accreditation Council for Graduate Medical Education's core competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice now promoted in the Commission on Accreditation of Athletic Training Education's 2020 Standards for Accreditation of Professional Athletic Training Programs. Conclusion(s) Educational and health care outcomes drive change. Quality improvement efforts transcend both education and health care. Athletic training can learn valuable lessons from the Cubans about innovation, preventative medicine, patient-centered community outreach, underserved populations, research initiatives, and globalization. Not unlike Cuba, athletic training has a unique opportunity to embrace the challenges associated with change to create a better future for athletic training students and professionals.

Genomics, clinical research, and learning health care systems: Strategies to improve patient care

2016 ◽  
Vol 64 (3) ◽  
pp. 225-228 ◽  
Author(s):  
Janet K. Williams ◽  
Ann K. Cashion ◽  
Sam Shekar ◽  
Geoffrey S. Ginsburg
Keyword(s):  
Health Care ◽  
Clinical Research ◽  
Patient Care ◽  
Health Care Systems ◽  
Improve Patient Care ◽  
Care Systems ◽  
Improve Patient
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