Surgicalists: The Cutting Edge

Case Studies, Quality of Care, Surgical Hospitalist Results

Driving Hospital Success with a Level II Trauma Center

Trauma photo for MSJ BlogHospitals with trauma centers have a demonstrated commitment to providing the absolute best care possible. They do this by meeting the requirements established by the government and other authorized entities. Many take the additional step of voluntarily allowing experts from the American College of Surgeons (ACS) to conduct an on-site review of the hospital to assess and verify the required, relevant program features, including items such as hospital policy, resources and patient care.

Designed to help hospitals improve their trauma care, ACS verification is, as you can imagine, a complicated process. Many hospitals view the process as an overwhelming task and opt not to go forward. However, we have personally seen that the benefits to patients, the community and the hospital make the process a worthwhile endeavor.

In fact, we just developed a case study about the hospital-wide improvements in operational and financial benefits achieved by Mercy San Juan Medical Center when it undertook the mission to develop a trauma center. Once the hospital made the decision to develop a trauma center to improve the care to its community, hospital administration partnered with us (Surgical Affiliates) to develop a Level II trauma center, which we developed from the ground up based on ACS guidelines so that no recommendations for improvement could be made by the certification team from the American College of Surgeons.

Since its opening, the Level II trauma center at Mercy San Juan Medical Center has proven to be a driver of success for the hospital. Over time, it has consistently increased volume growing from treating 750 trauma patients in 2001 to 1,991 patients in 2014. Additionally, due to our culture of yes, we increased the number of patient transfers in to the hospital per year; from 55 in 2011, to 254 in 2014. We found the “transfer in” population and the ability of getting out-of-network and capitated patients repatriated to their “home” systems when their conditions stabilized improved the hospital payer mix.

What’s more, the presence of the trauma center led to the creation of an environment that allowed for open and honest peer review with a commitment to closing loops and changing behavior. It also created a “halo effect” throughout the hospital, resulting in improved performance across multiple departments. For example, faster turn-around times for lab work, the institution of a massive transfusion protocol so that blood transfusions were available within 120 seconds of the patient’s arrival, rapid MRI and CT scan availability, and a myriad of other enhancements.

Our collaboration with the hospital also sparked the idea for a revolutionary approach to acute surgical care: the Surgical Affiliates’ System of Care©, which adapts and modifies trauma care standards to the emergency general surgery model or acute care surgery. Those standards include: board certified surgeons, an interdisciplinary approach, team cohesiveness, specific and measured responsiveness, a standardized approach to care by all providers, and peer review of all cases to identify performance improvement opportunities.

As a result of its trauma program collaboration with Surgical Affiliates, Mercy San Juan implemented a surgical hospitalist program with us to enhance its acute care surgery services. The hospital is now seeing the results in shorter lengths of stay, fewer complications and the ability to capture a larger demographic.

The Mercy San Juan Level II trauma center is an outstanding example of hospital/physician collaboration. If you’re interested in learning more, please read our new case study. You can request a copy by visiting and clicking on the box entitled “Transformational Hospital/Physician Collaboration Prepares to Strike Twice.”

Quality of Care, Surgical Hospitalist Results

SMCS Named a Top 100 Hospital, Further Validating Surgical Hospitalist Program Results

Facility_SHSSR_SMCS_SGH_2009_2Recently, for the fifth time, Sutter Medical Center, Sacramento (SMCS) was named one of the Top 100 Hospitals in the U.S. by Truven Analytics. It was recognized, along with the other hospitals selected, for consistently delivering outstanding quality of care, satisfaction and community value at a reasonable cost.

For the first time, SMCS also earned the Top 100 Hospitals Everest® Award—one of only 17 hospitals in the nation and the only hospital in California to simultaneously set the national benchmark for both “balanced excellence in a single year” and “greatest improvement over five consecutive years.”

Truven selected the hospitals based upon an independent analysis of public data. The criteria used included both financial benchmarks (hospital profitability, as well as Medicare per beneficiary spending) and clinical measures; for example, 30-day readmission and mortality rates metrics.

Surgical Affiliates Management Group’s surgicalist program was one component that helped SMCS achieve this major recognition. Our collaborative surgical hospitalist program boosted performance throughout the hospital, improved patient care and reduced costs, as documented in a five-year study undertaken by SMCS and Surgical Affiliates, which was published in the prestigious peer-reviewed Journal of the American College of Surgeons. The study validated that surgical hospitalist programs improve key hospital performance metrics. For SMCS this included:

  • Decreasing length of stay by 12%
  • Reducing complications by 43%
  • Lowering costs by 31%—a total of $2 million in a single year

According to Jean Chenoweth, senior vice president at Truven Health Analytics, if all Medicare inpatients received the same level of care as those treated in the award-winning facilities:

  • More than 164,000 additional lives could be saved.
  • Approximately 82,000 additional patients could be complication free.
  • More than $6 billion could be saved.
  • The average patient stay would decrease by nearly half a day.
  • And if the same standards were applied to all inpatients, the impact would be even greater.

We’re delighted that Sutter Medical Center, Sacramento has once again been honored as one of the nation’s top hospitals. If you are interested in learning more about how our partnership with SMCS helped accomplish these results, please read our most recent case study “The Verdict Is In: Surgical Hospitalist Programs Deliver Improved Results throughout the Hospital.” To request a copy, please visit

Case Studies, Quality of Care, Surgical Hospitalist Results

Is Access to Specialists a Key to Improving Hospital Margins?

NBMC_photoHospitals across the U.S. are struggling financially. However, one of our partner hospitals, NorthBay Medical Center, is bucking this national trend, and increasing its margins and operating success – a fact that was lauded in Modern Healthcare1 last year. The key, as cited in the article, is the hospital’s ability to keep its patients from leaving the county for specialty services, such as cardiovascular surgery. The result: its operating margins climbed from negative 2.1 percent in 2011 to 6.3 percent in 2013.

One compelling example of the success of the hospital’s strategy is its partnership with us, which has produced results that raised hospital results in improved care, decreased length of stay, and lower costs.

Our collaborative partnership with NorthBay Medical Center is recognized by hospital leadership. Gary Passama, president and chief executive officer of NorthBay Healthcare System, expressed to me that “now his community knows that they can count on us [the hospital] because Surgical Affiliates is there to handle any emergency.” I appreciated hearing this because it reinforced the strength of our partnership and common goal to providing the community with access to high-quality emergency surgical care and knowing that the community could turn to the NorthBay Healthcare System for any medical emergency.

Our team approach enables us to collaborate with a hospital’s staff to improve patient care by implementing a consistent use of surgical best practices, continuity of care, and communications with patients, families, and the patient’s primary care team.

In addition, because hospital executives knew that NorthBay Medical Center would remain the county’s busiest trauma center, we were asked to collaborate with them to expand the hospital’s trauma center to achieve a Level 2 designation verified by the American College of Surgeons. By obtaining this verification, NorthBay is able to assure its community that when they look to the hospital for care, including trauma care, that they’ll be treated with the highest standards.

NorthBay has definitely raised the bar in identifying and implementing strategies that have been proven to provide the best access to the high-quality care in its community and these same strategies could benefit any hospital faced with the same situation.

If you’re interested in learning more, please read our new case study. You can request a copy by visiting Our Results Page and clicking on the box entitled “NorthBay Hospital Continues to Buck the Trend with Outstanding Results from Surgical Hospitalist Program.”

1 Kutscher, B. Hospital margins slump due to squeeze from volume, rates, investments, Modern Healthcare, June 23, 2014