Effects of acute care surgery
The Governors also sought to evaluate specific acute
care-related issues, such as the efficiency of care delivery, emergency room (ER) coverage, and costs since the
development of an acute care surgery program. Table 1,
this page, shows the overall responses to the effect of
these programs on health care delivery, and Table 2,
page 31, identifies the responses to the same questions
from acute care general surgeons as compared with all
other surgeons. For most of these issues, the percentage of positive answers was higher among the acute
care general surgeons than among all other surgeons.
The Governors also wanted to determine the positive effects of an acute care surgery service on patient
and provider well-being based on responses from acute
care surgeons as compared with all other surgeons (see
Table 3, page 31). Again, for most of these issues, acute
care surgeons were more likely than other surgeons to
answer in the affirmative.
The survey also sought to determine perceptions
of the intermediate or negative effects of an acute care
surgery service from the acute care surgeon perspective versus all other surgeons (see Table 4, page 32).
Since the development of acute care surgery services, 26 percent of the survey respondents reported a
decrease in the number of surgical cases done by general surgeons who were not involved in the acute care
surgery program (see Figure 4, page 32). In addition,
79 percent reported no significant change in income
(see Figure 5, page 32).
Tables 5 and 6 (see page 33) show income variability
based on the specialty of the respondent. For all types of
surgeons, most noted no significant change in income.
More general surgeons ( 17 percent) noted an increase
in their income than a decrease in earnings ( 9 percent).
We also asked the Governors to describe any negative developments that have emerged since their
hospital developed an acute care surgery service.
These responses can be combined into six categories,
which are listed below in order of the frequency of
the response:
•Fragmented care/poor continuity of care: 10 responses
•Negative effects on the call schedule: seven responses
•Decreased quality of care due to less experienced acute
care surgeons: six responses
•OR access issues due to acute care surgery cases needing to be scheduled urgently/emergently: four responses
• Conflicts/controversy bet ween acute care surgeons and
community surgeons: four responses
•Devaluation of the general surgeon: Two responses
TABLE 1. EFFECTS OF ACUTE CARE SURGERY PROGRAMS
ON HEALTH CARE DELIVERY (ALL SPECIALTIES)
Issue Yes No Don’t know
ER patients that need a general surgery consult are seen more quickly 59% 17% 24%
Inpatients that need a general surgery consult are seen more quickly 56 23 21
It has been easier for our hospital to provide ER general surgery coverage 57 27 16
Patients with nontraumatic general surgical emergencies
get to the operating room (OR) more quickly 48 27 25
The length of stay for patients with nontraumatic surgical emergencies has decreased 32 27 41
Care of patients with nontraumatic surgical emergencies has improved 55 21 24
Care of patients in the surgical intensive care unit (ICU) has improved 43 25 32
The cost of care for emergency surgical patients has decreased 14 23 63
General surgeons are happy that they no longer have to take ER general surgery call 48 24 28
Surgical specialists are happy that they no longer have to take ER general surgery call 44 28 28
General surgeons now have a more predictable lifestyle with less interruption
of scheduled surgery days and office days 58 19 23
Surgical specialists now have a more predictable lifestyle with less interruption
of scheduled surgery days and office days 49 28 23
Patients prefer the acute care surgery model over the traditional model 18 17 65
The nursing staff prefers the acute care surgery model over the traditional model 29 10 61
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