As hospitals continue to deal with pay-for-performance, accountable care and population health management, it’s vitally important for them to consider how emergency surgery services are delivered and how it impacts their success.
One new resource on this topic is an article I recently wrote for the inaugural issue of Management in Healthcare, a new peer-reviewed journal. The article examines how, by implementing the service model developed for trauma and applied to emergency surgeries, it is possible for hospital’s most at-risk patient groups to receive standardized care according to best practices and practice management guidelines 24/7.
The result: high-quality care and better performance outcomes for the hospital. Plus, continuous quality improvement initiatives that touch multiple hospital departments, raising the bar on performance throughout the facility.
This new model for acute care surgery, also referred to as surgicalist programs, can help hospitals achieve results, as well as enhance their competitive position. Metrics show that a well-structured surgical hospitalist program can improve patient outcomes and improve costs. For example, a July 2014 paper in the Journal of the American College of Surgeons highlighted how a surgical hospitalist program produced sustainable results, including a 31% reduction in hospital costs and complications declined by 43%.
In this, my last blog in a series about the Acute Care Surgery model, let’s review the benefits for general surgeons.
For surgeons who may not want to start a private practice or who may be looking for alternatives to that career path, an acute care surgery service represents a viable choice. It’s certainly challenging and gratifying on a professional level, and as we collaborate as a team, our skills and efficiency just get better and better. We see improved outcomes in our patients and greater satisfaction with patients and families because their care is handled from start to finish by a dedicated team who is there when patients need them.
The quality of life benefits are also very attractive: comparable income to the private practice model with a predictable work pattern, manageable shifts that allow the surgeon to plan his or life and the freedom to know your patients are receiving excellent care, even in your absence, has had appeal to many.
For example, the surgeon who is thinking of retirement may re-consider when he or she can alleviate the stress of a busy private practice and have control over a schedule. The young physician seeking the camaraderie and team-based care of residency can continue to get the support he or she needs.
Keeping these professionals active is very important in dealing with the impact of the current shortage of surgeons. Even mid-career surgeons who want to have more regularity in their schedules for growing families or other pursuits can have both a satisfying career and the quality of life they want. The acute care surgery model offers the attractions of predictable schedules with the challenge of meeting constantly changing patient needs.
Finally, there is the excitement of being part of something new and revolutionary. The acute care surgeon is a pioneer. Every day we are forging a new path—delivering an innovative solution that transforms the lives of our patients and keeps us engaged in our profession. Because we work in teams, there is always back-up and qualified professionals there for any patient need. We’re able to standardize care, which is a major reason why outcomes improve. Patients are delighted to have this attention, communication and security knowing that they are being overseen 24/7.
The unspoken revolution currently taking place in American surgery is addressing the surgical shortfall while offering the promise of improving patient care and safety, and the potential to increase our own satisfaction as dedicated surgeons. The acute care surgery model is defining the next decade in emergency surgery care and we’re here to see it through.
In my last blog, I talked about the Acute Care Surgery space, highlighting where it is headed, specifically as we seek to attract new surgeons to the profession.
But in an era of surgical shortages, where millions of Americans don’t have ready access to a good surgeon, getting new physicians to join the profession is just Step 1. Step 2 is finding ways to encourage existing surgeons to stay in practice, to avoid burnout and the move to other specialties that may offer greater professional rewards and a more manageable quality of life.
Let’s start by looking at how acute care surgeons help hospitals, patients and private practice surgeons improve their practices.
The acute care surgery model offers a solution to ensure 24/7 availability in the hospital, while providing benefits to all surgeons, and most importantly, to the patients. Focusing solely upon emergency surgical care in the hospital, we care for patients who need emergency general surgery. We are available to immediately respond to any emergency surgery need from the ED. And because we are there, a community surgeon doesn’t have to get a call requiring them to come in at 2 a.m. to care for a car crash victim.
We provide all patient care including consults, covering a full service follow-up clinic to manage those patients requiring care post discharge and perform all surgical procedures during our shift.
In some acute care surgery programs, the surgeons (all board-certified in general surgery, with many holding additional certificates, such as surgical critical care) take 24-hour shifts with the next day off. They are available to handle in-house emergencies and guarantee a response to the ED within 30 minutes when needed. In addition to surgeons, a nurse practitioner (NP) and/or physician assistant (PA) is often part of the team, rounding with the surgeons each day, coordinating care for patients and communicating with the family. They are key members of the team and play an important role in patient communication, treatment and ensure effective hand-off of the patient back to his or her primary physician.
We are a true team, experienced in the latest surgical techniques and procedures. One area of focus is the use of guidelines to ensure we provide optimal care before, during and after a surgery.
When an entire surgical team is incentivized to agree and commit to evidence-based practice management guidelines, variations in care are significantly reduced. Standardizing care has repeatedly been proven to improve efficiencies and outcomes, as well as lower costs. For example:
While there are many benefits to an acute care surgery model, as it is still relatively new, there are concerns and important issues to discuss with our colleagues and partners. One of the concerns is the possible erosion of private practices in the community.
However, as numerous published works have shown, this doesn’t have to be the case. In fact, an article in the Journal of the American College of Surgeonsi demonstrated that despite introduction of a busy Acute Care Surgery team, the volume of cases for private practice surgeons remained the same.
In some instances, relief from ED call has allowed some private practice surgeons to increase their surgical volume; as well as enjoy a more stable office and personal life. In short, the presence of an Acute Care Surgery team enables them to perform more elective surgery cases and can help improve their overall quality of life.
My last blog of this series will address additional advantages this model brings to surgeons.
i Journal of the American College of Surgeons. “Acute Care Surgery: Impact on Practice and Economics of Elective Surgeons.” Preston R. Miller, M.D., FACS, et al. April 2002. (http://www.journalacs.org/article/S1072-7515(12)00073-7/abstract)