Urgent Breast-Related Consults Seen by Acute Care Surgery at a Safety Net Hospital

Background Classically, urgent breast consults are seen by Breast Surgery or Surgical Oncology (BS/SO). At our safety net hospital, Acute Care Surgery (ACS) performs all urgent surgical consultations, including initial assessment of breast consults with coordinated BS/SO follow-up. The objective was to determine safety of ACS initial assessment of acute breast pathology. Methods All urgent breast-related consultations were included (2016-2019). Demographics, consult indications, and investigations/interventions were captured. Outcomes were compared between patients assessed by ACS versus both ACS and BS/SO at presentation. Results 234 patients met study criteria, with median age 39 years. Patients were primarily Hispanic (82%) women (96%). Most were not seen by BS/SO at presentation (69%), although BS/SO assessment was more frequent among patients ultimately diagnosed with cancer (8% vs 1%, P = .012). No patient had delay >90 days to core biopsy from presentation. Outcomes including time to cancer diagnosis (14 vs 8 days, P = .143) and outpatient BS/SO assessment (16 vs 13 days, P = .528); loss to follow-up (25% vs 21%, P = .414); and ED recidivism (24% vs 18%, P = .274) were comparable between patients seen by ACS versus ACS/BS/SO at index presentation. Conclusion Urgent breast consults at our safety net hospital typically underwent initial assessment by ACS with outpatient evaluation by BS/SO. Time to follow-up and cancer diagnosis, loss to follow-up, and ED recidivism were similar after index presentation assessment by ACS versus ACS and BS/SO. In a resource-limited environment, urgent breast consults can be safely managed in the acute setting by ACS with coordinated outpatient BS/SO follow-up.

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Acute Care Surgery in the Safety Net Hospital: Maintaining Referrals and Optimizing Outcomes

Scandinavian Journal of Surgery ◽

10.1177/145749691009900204 ◽

2010 ◽

Vol 99 (2) ◽

pp. 68-72 ◽

Cited By ~ 3

Author(s):

W. L. Biffl ◽

P. S. Mehler ◽

E. E. Moore

Keyword(s):

Acute Care ◽

Safety Net ◽

Acute Care Surgery ◽

Safety Net Hospital ◽

Care Surgery

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Acute care surgery: The safety net hospital model

Surgery ◽

10.1016/j.surg.2007.01.004 ◽

2007 ◽

Vol 141 (3) ◽

pp. 297-298 ◽

Cited By ~ 10

Author(s):

Ernest E. Moore

Keyword(s):

Acute Care ◽

Safety Net ◽

Acute Care Surgery ◽

Safety Net Hospital ◽

Care Surgery

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Acute Care Surgery in the Times of COVID-19 Pandemic: Our Experience at a Large Safety Net Hospital

Panamerican Journal of Trauma, Critical Care & Emergency Surgery ◽

10.5005/jp-journals-10030-1284 ◽

2020 ◽

Vol 9 (2) ◽

pp. 142-146

Author(s):

Nicholas Namias ◽

Gerd D Pust ◽

Antonio Marttos ◽

Gabriel Ruiz ◽

Shrey Modi ◽

...

Keyword(s):

Acute Care ◽

Safety Net ◽

Acute Care Surgery ◽

Safety Net Hospital ◽

The Times ◽

Care Surgery

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P074: Improving urology care in the emergency department through implementation of an Acute Care Urology model

CJEM ◽

10.1017/cem.2019.265 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S90

Author(s):

A. Kirubarajan ◽

R. Buckley ◽

S. Khan ◽

R. Richard ◽

V. Stefanova ◽

...

Keyword(s):

Emergency Department ◽

Acute Care ◽

Outpatient Care ◽

Renal Colic ◽

Interdisciplinary Collaboration ◽

Wait Time ◽

Acute Care Surgery ◽

Post Intervention ◽

Care Surgery

Introduction: Renal colic is one of the most common presentations to the emergency department (ED), and often requires complex interdisciplinary collaboration between emergency physicians and urology surgeons. Previous literature has shown that adoption of interdisciplinary rapid referral clinics can improve both timeliness of care and patient outcomes. However, these Acute Care Surgery models have not yet been commonly adopted for urology care in the ED. Methods: In July 2016, we adopted the intervention of an Acute Care Urology (ACU) model through the creation of a rapid referral clinic dedicated to ED patient referrals, the addition of an ACU surgeon, and enhanced use of daytime OR blocks. We conducted a manual chart review of 579 patients presenting to the ED with a complaint of renal colic. Patient data was collected in two separate time periods to analyze trends before implementation of the ACU model (pre-intervention, September - November 2015), to examine the model's impact (post-intervention, September - November 2016). Secondary methods of evaluation included a survey of 20 ED physicians to capture subjective feedback through Likert scale data. Results: Of the evaluated 579 patients with a complaint of renal colic,194 patients were discharged from ED with an diagnosis of obstructing kidney stone and were referred to urology for outpatient care. The ED-to-clinic time was significantly lower for those in the ACU model (p <0.001). The mean time to clinic was 15.76 days (SD = 15.47, range 1-93) pre-intervention versus 4.17 days (SD = 2.33, range = 1-12) post-intervention. Furthermore, the ACU clinic allowed significantly more patients to be referred for outpatient care (p = 0.0004). There was also higher likelihood that patients would successfully obtain an appointment following referral (p = 0.0055). Decreasing trends were shown in mean ED wait time, in addition to time from assessment to procedure. Results of the qualitative survey were overwhelmingly positive. All 20 surveyed ED physicians were more confident that outpatients would be seen in a timely manner (85% strongly agree, 15% agree). Qualitative feedback included the belief that follow-up is more accessible, that ED physicians are less likely to page the on-call urologist, and that they are able to discharge patients sooner. Conclusion: The ACU model for patients with renal colic may be beneficial in reducing ED-to-clinic time, ensuring proper follow-up after ED diagnosis, and improving patient care within the ED.

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Surgeons in surge — the versatility of the acute care surgeon: outcomes of COVID-19 ICU patients in a community hospital where all ICU patients are managed by surgical intensivists

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000557 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000557

Author(s):

Rachel Leah Choron ◽

Christopher A Butts ◽

Christopher Bargoud ◽

Nicole Krumrei ◽

Amanda L Teichman ◽

...

Keyword(s):

Critically Ill ◽

Acute Care ◽

Critically Ill Patients ◽

Community Hospital ◽

Invasive Mechanical Ventilation ◽

Case Series ◽

Acute Care Surgery ◽

Icu Patients ◽

Care Surgery

BackgroundReported characteristics and outcomes of critically ill patients with COVID-19 admitted to the intensive care unit (ICU) are widely disparate with varying mortality rates. No literature describes outcomes in ICU patients with COVID-19 managed by an acute care surgery (ACS) division. Our ACS division manages all ICU patients at a community hospital in New Jersey. When that hospital was overwhelmed and in crisis secondary to COVID-19, we sought to describe outcomes for all patients with COVID-19 admitted to our closed ICU managed by the ACS division.MethodsThis was a prospective case series of the first 120 consecutive patients with COVID-19 admitted on March 14 to May 10, 2020. Final follow-up was May 27, 2020. Patients discharged from the ICU or who died were included. Patients still admitted to the ICU at final follow-up were excluded.ResultsOne hundred and twenty patients were included (median age 64 years (range 25–89), 66.7% men). The most common comorbidities were hypertension (75; 62.5%), obesity (61; 50.8%), and diabetes (50; 41.7%). One hundred and thirteen (94%) developed acute respiratory distress syndrome, 89 (74.2%) had shock, and 76 (63.3%) experienced acute kidney injury. One hundred (83.3%) required invasive mechanical ventilation (IMV). Median ICU length of stay (LOS) was 8.5 days (IQR 9), hospital LOS was 14.5 days (IQR 13). Mortality for all ICU patients with COVID-19 was 53.3% and 62% for IMV patients.ConclusionsThis is the first report of patients with COVID-19 admitted to a community hospital ICU managed by an ACS division who also provided all surge care. Mortality of critically ill patients with COVID-19 admitted to an overwhelmed hospital in crisis may not be as high as initially thought based on prior reports. While COVID-19 is a non-surgical disease, ACS divisions have the capability of successfully caring for both surgical and medical critically ill patients, thus providing versatility in times of crisis.Level of evidenceLevel V.

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Outcomes of an acute care surgery model: a 10‐year follow‐up study

ANZ Journal of Surgery ◽

10.1111/ans.15655 ◽

2020 ◽

Vol 90 (3) ◽

pp. 257-261 ◽

Cited By ~ 1

Author(s):

Cigdem Kaya ◽

Phillip F. Yang ◽

Shing W. Wong ◽

Philip G. Truskett

Keyword(s):

Acute Care ◽

Acute Care Surgery ◽

Follow Up Study ◽

Care Surgery

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Management of traumatic subarachnoid hemorrhage by the trauma service: is repeat CT scanning and routine neurosurgical consultation necessary?

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000313 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000313 ◽

Cited By ~ 3

Author(s):

Stephen W Cooper ◽

Kimberly B Bethea ◽

Trevor J Skrobut ◽

Rod Gerardo ◽

Karen Herzing ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Acute Care ◽

Ct Scanning ◽

Acute Care Surgery ◽

Mild Tbi ◽

Ct Findings ◽

Trauma Service ◽

New Findings ◽

Care Surgery

Subarachnoid hemorrhage (SAH) results frequently from traumatic brain injury (TBI). The standard management for these patients includes brief admission by the acute care surgery (trauma) service with neurological checks, neurosurgical consultation and repeat head CT within 24 hours to identify any progression or resolution. Recent studies have questioned the need for repeat CT imaging and specialty consultation in mild TBI. We reviewed patients with mild TBI specifically with isolated SAH to determine progression of the pathology and need for neurosurgical involvement. All patients with SAH secondary to mild TBI (Glasgow Coma Score (GCS) of 13–15) who presented over a 5-year period (January 2010 to December 2014) to a level I trauma center were identified from the trauma registry. Demographic data, initial CT findings, neurosurgical consultation, follow-up CT findings, Injury Severity Score (ISS), admission GCS and length of stay (LOS) were all obtained from the patient’s charts. Patients with other traumatic brain lesions on the initial CT were excluded. There were 299 patients (male, 48.5%), mean age 60.9 and mean ISS 8. Average time between the first and second CT was 11.3 hours. In all, 267 (89.2%) patients had either no change or an improvement/resolution on follow-up CT scan. Only 26 patients (8.7%) had either worsening or new findings on CT. Eight patients did not have a second scan completed (2.6%). All patients had neurosurgical consultation. Patients with mild TBI with isolated SAH generally have low morbidity, short LOS and negligible mortality. Less than 10% of this population had worsening of their head injury on repeat CT scanning. Given the low acuity of these patients with SAH and tendency towards resolution without intervention, acute care surgeons can manage this specific group of patients with TBI without routine neurosurgical consultation. Repeat CT scanning continues to have utility as it may identify new lesions, deterioration or need for further management.

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Surgical outcome evaluation of perforated gastric cancer: from the aspects of both acute care surgery and surgical oncology

Scandinavian Journal of Gastroenterology ◽

10.1080/00365521.2017.1369562 ◽

2017 ◽

Vol 52 (12) ◽

pp. 1371-1376 ◽

Cited By ~ 3

Author(s):

Shang-Yu Wang ◽

Chih-Ho Hsu ◽

Chien-Hung Liao ◽

Chih-Yuan Fu ◽

Chun-Hsiang Ouyang ◽

...

Keyword(s):

Gastric Cancer ◽

Acute Care ◽

Surgical Outcome ◽

Surgical Oncology ◽

Outcome Evaluation ◽

Acute Care Surgery ◽

Care Surgery

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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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