Surgicalists: The Cutting Edge

ACHE Conference, Acute Care Surgery, Quality of Care, Surgical Hospitalist Program

News from ACHE: Rural Communities Environments No Longer Need to Be Off the Beaten Track for Surgical Care

Amador_PhotoMillions of Americans don’t have access to a qualified surgeon in the event of a trauma related medical emergency—a problem that is especially acute in rural areas. Recently, Anne Platt, FACHE and CEO of Sutter Amador Hospital, and I made a presentation at the American College of Healthcare Executives’ 2016 Congress on Healthcare Leadership on this topic.

Thousands of hospitals nationwide face the twin challenges of recruitment and retention of qualified surgeons for acute and trauma care. While the issue is especially prevalent in rural areas, it affects urban and suburban hospitals as well. Plus, the issue of recruiting surgeons is compounded by aging surgeons (average age is now over 50), while fewer graduates are entering critical care residencies.

The implications of the looming surgical shortage do not bode well for hospitals or patients.

Over-burdened surgeons are increasingly pushing back. Hospitals are constantly struggling to recruit, retain and maintain surgeons and their Trauma Center status. And, patient care can potentially suffer.

Like other hospitals in rural areas, Sutter Amador Hospital, faced the increasingly difficult issues of recruiting and retaining enough surgeons to serve the needs of its community. The hospital’s goal was to find a viable solution to ensure that both its patients and the surrounding community had access to high quality, 24/7 acute care surgery services. It also wanted a long-term solution to help it avoid losing market share, while ensuring that the solution aligned with its mission, goals and culture.

Ultimately, the hospital opted to partner with Surgical Affiliates and adopted our surgicalist model to solve its problems and address its needs. With this long-term solution, which is reproducible in other hospitals, the focus is on the creation of a team approach, coordinated and supported with processes, systems and skilled advanced practitioners (nurse practitioners and physician assistants). Surgeons are always available—24/7—for consults and acute care surgeries, while advanced practitioners support the surgical team by managing clinic, follow-up care and care coordination.

A comprehensive surgical hospitalist program benefits rural hospitals, especially for solving the challenges of recruiting surgeons and improving quality of care. Plus, the model can work for hospitals in urban environments, providing consistent surgical call coverage and improving patient safety and outcomes, while boosting results throughout the hospital.

From 2012 to 2014 Sutter Amador has:

  • Increased all general surgery cases from 129 to 266
  • Decreased Average Length of Stay from 6.45 to 5.26
  • Increased Case Mix Index from 2.0 to 2.34

As a result, the hospital has generated a positive ROI. By applying the acute care surgery model, which applies disciplines in trauma surgery to general surgery, hospitals can better achieve consistent, evidence-based care and improved clinical outcomes.

With increasing demand, aging of surgeons and the challenges of recruitment in many markets, the nation’s hospitals will continue to struggle to find solutions for acute and trauma surgical care. A very viable solution is to partner with outside organizations such as Surgical Affiliates to build surgicalist programs. Our model delivers a programmatic approach to general emergency surgery providing access to high quality emergency surgical care 24/7.

Acute Care Surgery, Quality of Care, Surgical Hospitalist Results

Data Shows the Acute Care Surgery Model Improves General Emergency Surgery Outcomes

samg_docs-patientOur Acute Care Surgery Model (also referred to as surgical hospitalist or surgicalist programs) delivers a programmatic approach to general emergency surgery providing access to high quality emergency surgical care 24/7. By applying the acute care surgery model, which applies disciplines in trauma surgery to general surgery, we are able to achieve consistent, evidence-based care and improved clinical outcomes for our patients. Our comprehensive Acute Care Surgery program delivers a dedicated team of surgeons led by a medical director whose sole practice is treating emergency surgery patients. This model improves efficiencies throughout the hospital but more importantly improves patient outcomes.

We found that after implementing our Acute Care Surgery Model, complications were dramatically decreased. Results of a five-year study published in the Journal of the American College of Surgeons showed:

  • Complications decreased 43%
  • Length of stay decreased 12%
  • Hospital costs decreased 31%
  • Readmission rates were down—while LOS significantly decreased, readmissions did not increase
  • Overall hospital CMI improved
  • Annual savings was $2 million

Additionally, this model produced shorter lengths of stay and lower costs.

  • Appendectomies—an average 27.8% decrease in total hospital costs; average LOS decreased 36.7%; the number of appendectomies increased 15.8%
  • Laparotomies—outcomes from in-hospital morbidity declined 49%
  • Cholecystectomies— in-hospital morbidity declined 83%; an average 14% decrease in total hospital costs; the readmission rate decreased 69.6%; number of cholecystectomies increased 29.8%

Another study reported that the national average cost for cholecystectomies per case is $15,6501, yet after the Acute Care Surgery model was applied at the facility referenced above, its cost per case for the same procedure was $8,432, representing a 46% savings.

These results, which have proven sustainable and can be implemented in all types of hospitals, are an outcome of improving timeliness of care, implementing patient care guidelines and protocols to reduce variation. For more information, visit our Our Program page.

1 Stey A, Brook R, Needleman J, et al. Hospital Costs by Inpatient. J Am Coll Sug 2015:220:207-217

Careers, Surgical Hospitalist Program

A Formula for Work-Life Balance: Surgical Hospitalist

Dr Mitchell and Sundance McGuirre RNHospitals are searching for a workable system for 24/7 ED emergency surgery coverage. Unfortunately for the hospitals, there’s a shortage of surgeons. This, combined with many surgeons’ frustration with ED call coverage and their desire to have more regular hours, is exacerbating the problem. It’s often a major source of conflict between hospital administrators and surgeons, which can potentially negatively impact quality of care.

That’s one of the reasons Surgical Affiliates was founded: to be the solution for this problem. Our surgicalist model delivers proven, high-quality, 24/7 coverage for patients needing emergency surgeries, while offering healthcare professionals (surgeons, NPs and PAs) an option they never thought was possible: having a challenging and rewarding career AND time for personal priorities. In addition to general surgery, our program encompasses specialties such as trauma, and orthopedic surgery.

Here are a few reasons to consider becoming a member of the Surgical Affiliates team:

  • You can be part of a new and satisfying field as a surgicalist.
  • You can be in a practice unlike any you’ve known, with the professional satisfaction of doing what you were trained to do.
  • You can focus on your patients while all of the management services are handled for you.
  • You can have dependable and regular schedules that afford you the time and benefits to attain work-life balance.
  • You can enjoy your free time with the security of knowing that your patients are receiving the highest quality of care from your practice partners who are as committed to quality patient care as you are.

The career and lifestyle afforded by our model is what enables us to bring teams of high quality and talented healthcare personnel to our partner hospitals. When we look for healthcare professionals to join our team, in addition to the usual criteria of board certifications, etc., we seek out people who are passionate about their job and the patients’ well-being, who have a record of achieving high patient satisfaction scores, who are involved in their community and who thrive on working in a team-oriented environment. We look for top people because we want the doctors in our partner hospitals to say they “want their family members to be treated by our doctors.”

For surgeons especially, Surgical Affiliates’ model offers more options. For example, the surgeon who may be thinking of retiring may re-consider with the option of a more flexible schedule on the surgical hospitalist team, or a private practice without the stress of taking ED call. Younger surgeons may thrive on the challenge of doing emergency surgeries while not worrying about patient insurance or billing, and enjoying the lengthier blocks of free time for family or other pursuits.

We are always looking for:

  • General surgeons
  • Trauma surgeons
  • Orthopedic surgeons
  • Nurse practitioners
  • Physician assistants

Why not join us and be part of a team that is transforming surgical care across the U.S.? Here’s a link so you can learn more: