Category: Case Studies

Case Studies, Quality of Care, Surgical Hospitalist Results

Expanding Surgical Care at Rural Hospitals

In the event of a traumatic medical emergency, millions of Americans—especially in rural areas, home for more than 14% of Americans –don’t have access to a qualified surgeon. When an accident does occur, they have to travel miles and hours to find the care they need, putting their health at risk. Often ambulances will pass right by a community hospital to get patients to a qualified trauma care facility. It’s a loss for patients, families, hospitals and the community.

Why is there such a shortage of surgeons in rural America? There are many reasons. The American College of Surgeons notes that more than half of surgeons practicing in rural areas are nearing retirement. In addition, substantial numbers of new general surgeons choose to specialize, and because of the small number of patients in rural areas, there is not enough demand to support these specialty practices. Surgeons often choose to work in or near urban areas, where there are a wealth of professional opportunities for them and amenities, schools and resources for their families. Medical students who might consider rural surgery attend university-based surgical residencies in urban environments. Without exposure to and mentorship from rural practitioners, they often choose to stay in urban facilities.

This situation creates many challenges for hospitals and communities. Frequently elective surgeries are scheduled out of the area, while community residents often choose to simply travel to other locales for health care. Even in emergencies, patients are often diverted 50 miles or more to other facilities.

Sutter Amador Hospital, like many others in rural areas, faced the challenges of 1) recruiting top-notch surgeons, 2) serving and retaining patients in its demographic and 3) achieving long-term clinical and efficiency outcomes.

While providing a range of much needed and high-quality health care services to its patients, the hospital sought to find a way to give its patients and community access to high quality, 24/7/365 acute care surgery services. To that end, hospital leaders began an intensive effort to address their need for qualified surgeons.

They had a strong and successful model to follow. In 2007, their affiliate hospital in the Sutter system, Sutter Medical Center, Sacramento (SMCS) launched a surgicalist program with Surgical Affiliates. A five-year study of the program published in the Journal of American College of Surgeons showed it had generated significant improvements, including:

  • Length of stay for general surgery cases decreased by as much as 12% – from 6.5 days to 5.7 days.
  • Complications were reduced 43% – from 21% to 12%.
  • Readmissions decreased slightly. However, the key fact is that while length of stay decreased significantly, the readmission rate did not increase.
  • Hospital costs decreased 31%, from $12,009 to $8,306, indicating potential savings of $2 million or more in a single year for a facility of this type and size.

With this example of how the surgicalist program, also referred to as a surgical hospitalist program, had transformed hospital performance and addressed the surgeon shortage, Sutter Amador and Surgical Affiliates made a commitment to replicate this success with 24/7 surgical teams and a collaborative and programmatic approach that would consistently improve both patient outcomes and hospital efficiency metrics.

Three years into the program, Sutter Amador is already seeing significant outcome improvements and results.

  • Inpatient, outpatient and total cases increased 250%
  • Volumes of laparoscopic procedures doubled and tripled
  • Average length of stay (ALOS) decreased
  • Hospital Case Mix Index (CMI) increased .0853%

The increase in volumes and improved metrics generated a positive ROI for the program. Additional benefits include the ability to ensure 24/7/365 call coverage; a cap on skyrocketing payments to surgeons and locum tenens companies, thus ensuring greater predictability of expenses; and improvements in the overall responsiveness and timeliness of care. All that and patient satisfaction increased as well.

The success Sutter Amador Hospital has achieved is an outstanding example of how to bring quality surgical care to rural areas. It proves that the surgicalist model works in a rural hospital environment by delivering acute care surgery based on evidence-based guidelines. The result of the model is improved quality of care, patient safety and hospital performance.

If you’re interested in learning more, please request our case study entitled “Off the Beaten Track: A Road Map for Expanding Surgical Care at Rural Hospitals” at

i Rural Health Info:
ii New England Journal of Medicine, “Physician Shortages in the Specialties Taking a Toll, March 2011 (
iii The Journal of American College of Surgeons, “Sustainability and Success of the Acute Care Surgery Model in the Nontrauma Setting,” July 2014, Volume 219, Issue 1, Pages 90–98

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.”

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