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

Millions 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 hospital 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 the 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 patient 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.