Archive for May, 2018

Learn about how today’s leading hospitals are working with Surgical Affiliates to implement 24/7 emergency surgical care. As well as how these hospitals address the fears many local surgeons have about the program’s impact on the surgical volume and team structure.

To overcome the challenges inherent in standard surgical care models, hospitals require systematic approaches that offer effective solutions to reduce transfers out of the hospital, improve current standards of care, and increase the number of surgery cases performed without sacrificing care quality.

While a surgical hospitalist program is designed to address these issues, there are several legitimate fears and misconceptions regarding these programs that are often raised by hospital medical staff. When unaddressed, these fears may perpetuate the repetitive care cycle that’s inefficient, costly, and associated with a higher risk of post-surgical complications.

The issue is, how do hospitals keep local surgeons happy under a surgical hospitalist program like the one offered from Surgical Affiliates? Also, how do hospitals prevent surgeons from threatening to take their services elsewhere when another group of acute care and emergency/trauma surgeons comes in?

Addressing the Fears of a Surgical Program

Despite the benefits of the Surgical Affiliates approach, there are some legitimate fears associated with this type of program that often prevents adoption.

When a third-party surgical team comes in to cover acute care and emergency surgery services, many hospitals fear that local on-call surgeons will find their position within the center threatened, resulting in surgeons taking their services to another hospital. The local on-call surgeons often own private practices and typically receive a stipend for emergency coverage, which helps to supplement their income. The fear of losing this stipend can provoke anxiety among local surgeons. Of course, one of the main goals is to ensure these professionals are satisfied, as they are typically prime sources of revenue for the hospital.

It’s appropriate to be concerned that an outside program will produce resentment among medical staff and result in a loss of business from the current cadre of local providers. However, the data does not support the notion that surgicalist programs decrease business — in fact, these programs help satisfy local surgeons and increase surgery caseload.

Keep reading to learn how Surgical Affiliates accomplishes this in hospitals across the nation.

How a Surgical Program Increases Business for Local Surgeons

One of the issues many hospitals have concerning a program like Surgical Affiliates is that surgeons may feel their position will become minimized following adoption. Fortunately, this surgical solution works with local surgeons and provides them options related to how and when they wish to practice, essentially resulting in zero loss in the number of cases they can perform in any given shift.

In general, hospitals participating in a surgicalist model feature an equal mix of surgeons – some surgeons want to focus on elective cases, some want the option of elective and/or emergency cases, and some want to focus purely on emergency care. Under the program, these options are available for all currently employed surgeons at the facility. And, if surgeons don’t want to take a call, they don’t have to. This can help them focus more on the elective cases that they enjoy — however, emergency cases are still theirs for the taking if they require or want the extra income.

A Surgical Program Provides Cost-Effective Care Despite Initial Investment

Another barrier to program engagement includes the initial costs associated with implementing a “‘round-the-clock acute emergency care surgical program.” Despite these fears, all hospitals under the program see a return on investment (ROI), due to Surgical Affiliate’s expertise in creating efficiencies and the program’s ability to manage surgical opportunities that may have otherwise been transferred to outside centers.

Additionally, with a greater number of on-site surgeons available for emergency surgical services, even rural hospitals become a reliable source of care in the community. This improved community-wide trust increases the number of cases that come into the hospital, thereby affecting the hospital’s bottom line.

Surgical Affiliates: Case Studies

In a retrospective 5-year study of the Surgical Affiliates strategy implemented in Sutter General Hospital in Sacramento, California, none of the surgeons in the hospital experienced a loss of business and all performed just as many operations during the 5-year period as they performed prior to program adoption. During these 5 years, complications, length of hospital stay, readmissions, and hospital costs significantly decreased for emergency cases, following the implementation of the acute care surgical model.¹

In fact, in every hospital that adopts the Surgical Affiliates program, emergency surgical volume steadily increases and the operative volume for local surgeons does not decline, despite all emergency operations being performed by the Surgical Affiliates team. NorthBay Medical Center in Fairfield, California, for instance, observed a 3.2% increase in the number of operations performed during a 2-year period. The center also observed an improvement in operating margins from a 3-year period of -2.1% in 2011 to .2% in 2012, and 6.3% in 2013.²

Learn More About Surgical Affiliates’ Surgical Program

Hospitals should present these findings to surgeons or other hospital personnel who may feel nervous about potential program adoption. Knowing the real-world data regarding how the program works and understanding how to communicate these findings to hospital staff may prevent surgeons from taking their elective surgical services elsewhere.

To learn more about the program offered by Surgical Affiliates and how it’s been successful for driving down hospital costs, reducing transfers and complication rates, and retaining and satisfying local surgeons, read through our case studies and take a look at our recent media stories demonstrating its effectiveness in today’s clinical setting.

References:

1. O’Mara MS, Scherer L, Wisner D, Owens LJ. Sustainability and success of the acute care surgery model in the nontrauma setting. J Am Coll Surg. 2014;219(1):90-98.

2. NorthBay Medical Center: Case Study. Surgical Affiliates data on file.

In this interview of the Behind the Knife Podcast, Lynette Scherer MD, FACS, Chief Medical Officer (CMO) of Surgical Affiliates, provides her take on important considerations for trauma surgeons, including early intervention, medication management, and communication among the surgical team. This podcast interview was conducted following Dr. Scherer’s talk, titled “Broken Bones – What the Trauma Surgeon Needs to Know,” presented at the 2018 Trauma, Critical Care & Acute Care Surgery (TCCACS) event held April 9-11, in Las Vegas, NV. Listen to the full interview at Behind the Knife.

“I love making a difference.” These 5 simple words are what Lynette Scherer MD, FACS, uses when asked about what makes her excited when it comes to trauma and acute care surgery.

Patients presenting the emergency room with traumatic injuries are often extremely sick and have a high mortality risk. Surgeons possessing many years of experience in trauma and general surgery substantially improve the chance of survival. This experience and skill set has driven the success of Dr. Scherer’s own practice as well as her contribution as Chief Medical Officer of Surgical Affiliates. “I think the breadth of what we do is great,” Dr. Scherer added, “and I feel like I make a difference when I go to work every day.”

Orthopedic Injury Management: Key Considerations from Dr. Scherer

Orthopedic injuries require a management approach that focuses on early intervention while maintaining quality care. Medication management is an important consideration in this setting, particularly among those with open fractures. According to Dr. Scherer, trauma surgeons need to pay close attention to delivering antibiotic treatment to patients with open fractures within a 60-minute window of hospital admission. “I realize that in some rural settings, the patient might not get to the hospital within 60 minutes, but the focus is on delivering antibiotics as soon as possible,” said Dr. Scherer. “In fact, doing this is just as important as your secondary survey.” Additionally, Dr. Scherer recommends having a goal of early termination of antibiotic therapy to ensure a positive outcome. “The other thing we have in our control is how long the patient is receiving antibiotics,” added Dr. Scherer. “The focus should be on getting these antibiotics turned off within 24-72 hours.”

The Importance of Early Intervention

Similar to most emergency surgeries, early intervention is key for improving prognosis in trauma patients, regardless of injury type. For femur fractures, however, certain challenges exist in many hospital settings that prevent timely surgical management. “I think it’s pretty well accepted on getting femur fractures fixed early,” Dr. Scherer explained, “but as we see fewer and fewer orthopedic surgeons who are willing or able to cover trauma surgeries, we’re starting to see a little bit of a push back on how quickly those femur fractures can be stabilized.” Early stabilization, according to Dr. Scherer, is key for favorable outcomes in these patients. Hospitals with a specialized 24-hour surgery team may be in a better position to ensure early intervention in these patients.

Timely Delivery to the OR

For individuals presenting to the hospital with an orthopedic injury, conventional wisdom states that these patients must be delivered to the operating room (OR) early, or at least within 6 hours of arrival. However, this isn’t always the case, particularly for low-risk injuries. “We now have pretty solid evidence, especially for the lower grade injuries, that these surgeries can be performed within 24 hours,” Dr. Scherer commented, “except for patients with grossly contaminated wounds. In that case, these wounds should be washed out as soon as possible.” Most often, a washout for contaminated wounds that count for the trauma registry “is the one that happens in the OR where devitalized tissue is debrided and the wound is completely washed out.”

Other Considerations for the Trauma Surgeon

In cases where a trauma patient has a head injury and has also developed venous thromboembolism (VTE), Dr. Scherer again advocates for early management, specifically in regard to VTE prophylaxis. “We like to start [VTE prophylaxis] within 24-48 hours after stable CT,” commented Dr. Scherer, “depending upon what kind of bleeding they had.” Communication within a neurosurgery team is also critical for appropriate management of these and other trauma patients. “I think communication with the neurosurgeons is critical, and sometimes it has to be over and over and over to get a group consensus,” Dr. Scherer explained, “and invariably there’s a discussion about patients with more complicated wounds.”

The emphasis on early presentation and treatment highlights the importance of having a robust, fully capable team of experienced and specialized trauma surgeons available to take on cases, regardless of the time of day. Surgical Affiliates works with existing hospital systems to support current surgical teams and improve standards of care by offering a 24-hour trauma and acute care service, facilitating earlier intervention and reduced transfers. To learn more about the program read through our real-world case studies here.