In the United States, approximately 1.7 million patients per year sustain traumatic brain injury.1,2 Estimates from the CDC suggest that roughly 52,000 deaths are attributable to traumatic brain injury nationwide.3 Some of these patients require immediate neurosurgical intervention to survive, such as when a patient requires removal of an enlarging hematoma from around the brain.
In 2013, approximately 2.8 million visits to the emergency department were associated with brain injury.4 Today, experienced neurosurgeons who are willing to provide emergency care are in limited supply. It is particularly hard to find those who meet and fulfill the stringent requirements for American College of Surgeons trauma verification. Many neurosurgeons find professional satisfaction by delivering care in an elective setting, further limiting the number of available neurosurgeons to care for emergencies. Subsequently, there is a growing need for surgeons who will readily take on emergency neurosurgical cases. A surgical hospitalist program may provide the optimal solution when neurosurgeons don’t heed the emergency call.
The workload of most surgeons has become increasingly difficult to maintain. On-call burdens and the pressure to produce more elective volume have contributed to the declining availability of surgeons for emergency care, and this is especially true for neurosurgeons. Many of today’s neurosurgeons have chosen to focus on providing high level elective care that focuses on specialty cases. Emergency care is disruptive to this sort of an elective practice and often times emergency patients don’t have the means to provide payment for such services. The disruption of the elective practice and the inability to be paid for services reduce the likelihood that neurosurgeons will happily embrace the emergency call burden.
According to Lynette Scherer, MD, FACS, Chief Medical Officer of Surgical Affiliates, the need in helping emergency neurosurgery patients has quadrupled in recent years because there has been a significant shortage of neurosurgeons who are willing to take emergency cases. Additionally, since many neurosurgeons perform elective cases, hospitals aren’t pressuring these highly specialized physicians to take cases they don’t want. “Neurosurgeons can really command a presence at the hospital because their cases are so valuable to the hospital and the care they provide is so critical,” said Dr. Scherer, “and the hospital often won’t force them take the emergency call as long as they are doing their elective cases.”
The lack of hospital neurosurgeons to provide care for emergency cases can result in delayed patient care and the worsening of patient outcomes. Additionally, when a neurosurgeon doesn’t answer an emergency call, hospital efficiency will subsequently be impacted since staff will need to take the time to find someone that will help the patient.
Hospitals in rural communities are especially affected by neurosurgeons who refuse to take on emergency neurosurgical cases. “If a patient shows up in a small rural center looking for help,” commented Dr. Scherer, “that hospital may be calling for hours trying to locate a neurosurgeon.” Hospitals in major metropolitan areas, although better connected and more likely to find a surgeon to help in an emergency case, are also impacted by the shortage of willing emergency neurosurgeons. Many patients have to be transferred to a center that will take them, which delays treatment for potentially life-threatening issues.
The surgicalist program with Surgical Affiliates offers a one-of-a-kind initiative for the field of neurosurgery. This program provides neurosurgeons who are willing and ready to take on an emergency neurosurgical procedure. At Surgical Affiliates, there is a 24/7 neurosurgery team available for emergency cases, such as cases involving epidural hematomas, traumatic brain injury, acute or infectious spinal cord processes, or stroke-related care. Hospitals who can’t find a neurosurgeon to answer an emergency case can simply partner with Surgical Affiliates who will provide a team of neurosurgeons available for immediate care.
Currently, Surgical Affiliates is the first organization to offer a surgicalist program for neurosurgery and is seen as the leader in facilitating greater and more immediate care for patients presenting with life-threatening neurosurgical problems. If you wish to learn more about the surgicalist approach and how you can use it to improve the level of care your emergency neurosurgery patients can receive, contact us today for a free program analysis consultation.
The importance of on-call surgeons for management of emergency care cases is undeniable; however, the sole dependence upon the on-call approach in today’s care setting is quickly becoming unreliable. Increased on-call burdens, irregular and hectic workloads, and decreased work-life balance have contributed to the surgeon shortages observed in many hospitals today. A Surgicalist approach is the answer to this growing crisis.
Currently, there is a slow but steadily rising trend emerging in hospitals across the country, one that utilizes a Surgicalist strategy for improving hospital outcomes and lowering staff turnover. Surgicalists manage emergency surgeries exclusively, reducing the need for relying solely on on-call surgeons to cover planned interventions.
Perhaps the most beneficial reasons for implementing a Surgicalist strategy includes reducing the on-call burden for surgeons, improving the achievement of greater annual financial goals, introducing new surgical skill sets, and improving patient-related outcomes.
Finding consistent medical care for acute care surgery patients is a growing challenge that seems to be gaining momentum. A nationwide surgeon shortage as well as surgeons’ evolving priorities have reduced the number of on-call doctors available for emergency surgical needs. Many surgeons, for example, are seeking a greater work-life balance and are opting for private practice.
A Surgicalist program may be the answer to the quickly deteriorating viability of surgical call rotation. Surgicalists eliminate the burden of unmanageable workloads, allowing hospital surgeons to focus on more private and elective surgical procedures. Potentially, employing a Surgicalist team may help reduce staff turnover while improving the quality of care offered to patients.
When employing a staff of Surgicalists who specialize in emergency care, you bring forth a greater range of skill and technique to the surgery floor. A traditional management approach of emergency cases involves patients receiving surgeons who are on call, yet this doesn’t mean the surgeon has a skill set that is sophisticated or experienced enough to handle every emergency patient. Surgicalists, however, are dedicated to emergency care cases. “If you crash your car, you don’t get to pick who your surgeon’s going to be,” says Lynette Scherer, MD, FACS, Chief Medical Officer of Surgical Affiliates. “We think that if you’re going to go to a trauma center, you really should get the best there is.”
Although hospitals do make an initial investment when implementing a Surgicalist program, the long-term cost benefit can be substantial. Simply, with more surgeons on staff to handle both elective and emergency interventions, hospitals experience a lower patient transfer rate. Retaining patients equates to more surgeries, which ultimately results in more jobs and a greater net financial benefit. Additionally, there is an elimination (or drastic reduction) in call coverage stipends, resulting in greater cost savings.
Under a Surgicalist program, patients often experience shorter wait times, shorter length of hospital stay, and fewer treatment-related complications. Typically, improved patient outcomes are a benefit associated with early or immediate intervention, compared with intervention that depends upon an on-call surgeon’s own schedule and availability. Surgicalists, in comparison, are available 24/7, with no competition between elective and emergency cases.
When a hospital can handle more patients and improve the level of care they provide for emergency cases, they begin to strengthen the trust their community has for them. In turn, this may result in a greater number of patients arriving to the center to receive much-needed care, regardless of the type of treatment they receive.
“Our community knows that they can count on us–we’re there in any emergency,” says Gary J. Passama, President and Chief Executive Officer of North Bay Healthcare System, a hospital that has recently implemented a Surgicalist program. “The team collaborating with our hospital staff,” he adds, “has improved patient care with the consistent use of surgical-best practices, continuity of care, and communications with patients, families, and the patient’s primary care team.”
Of hospitals that feature a traditional approach to emergency cases, only about 2% have Surgicalist programs in place. Part of the reason why these programs are so rare involves the lack of awareness and education around Surgicalist teams. To learn more about the Surgicalist approach and how you can use it to gain a competitive advantage over traditional hospital systems, contact us for a free program analysis consultation today.
There is a growing trend among practicing surgeons to seek a greater work-life balance, and many surgeons are moving away from private practice to avoid the strenuous and stressful regimen of constantly being on-call. This, along with uncompensated care, declining reimbursement, and liability issues, are contributing to an unprecedented shortage of on-call surgeons performing emergency care. Unsurprisingly, hospitals are in need of a comprehensive strategy that will help them keep up with ever-increasing patient demands.
Currently, there is a significant need for innovative plans of action that will help not only manage emergency surgical care and potentially improve patient outcomes, but will also facilitate greater improvements within the hospital system overall. A surgicalist model addresses these needs, providing 24/7 dedicated local emergency surgeons for immediate emergency general surgery and trauma care, or even orthopedic surgery. The implementation of such an approach is aimed toward making a difference every day in the lives of patients.
Although a traditional hospitalist model can be viable in certain care settings, the adoption of a surgicalist strategy can provide specific advantages in patient care and hospital-specific outcomes, as evidenced by numerous hospital case studies throughout the United States. Shorter wait times, reduced length of stay (LOS), fewer complications, and lower rates of patient transfers represent some of the reasons why a surgicalist model will advance emergency care now and in the future.
The quality of patient care in emergency surgery continues to be a big priority for hospitals across the country. A 5-year study with Sutter Medical Center, Sacramento, showed noticeable benefits related to the surgicalist model for improving patient outcomes. After partnering with Surgical Affiliates and incorporating the surgicalist program in their center, overall patient complications were down by 43% and LOS decreased from 6.5 to 5.7 days.
Surgicalist programs may also increase the amount of trauma surgeries performed annually, thereby increasing practice experience among surgeons. Greater experience often translates into more knowledgeable surgeons and a higher quality of care. At NorthBay Medical Center in Fairfield, California, for example, trauma surgeries increased by 3.5% in 2014 compared with 2012.
Compared with a traditional model of care, the surgicalist strategy reduces the need for surgeons to juggle both on-call and elective practices. When surgeons have a greater work-life balance and a clearer focus on what’s required of them (i.e., surgeries that they were trained to do), their quality of life improves. At Memorial Hospital Los Banos in central California, the implementation of a surgicalist program resulted in a significant improvement in its employee turnover rate, likely mirroring the greater workflow efficiency and higher physician satisfaction accomplished by their new surgicalist program.
A surgicalist model may also help reduce costs as well as contribute to a hospital’s overall fiscal goals. For example, a surgicalist program may reduce rates of patient transfers to other facilities, which can help drive greater financial benefits to the hospital. At NorthBay Medical Center, the expanded trauma efforts by the surgicalist program was associated with an 81% reduction in transfers in 2014 compared with 2012.
The movement toward round-the-clock emergency care with highly trained surgicalists represents the changing landscape of healthcare. Millions of patients who require trauma or emergency general surgical care—particularly those admitted to rural area hospitals—have limited access to a qualified surgeon. The adoption and application of a surgicalist program helps hospitals stay ahead of their competition, leading the way toward improving patient care in the emergency setting and making a difference in the lives of patients every day.
Surgical Affiliates Management Group is committed to making a positive difference every day in the lives of patients seeking emergency surgical care. They are the first and only organization with proven results demonstrating their ability to lower hospital costs, decrease rates of readmissions, and improve the care of patients. To learn more about Surgical Affiliates and their efforts toward providing permanent surgicalist programs in hospitals around the country, read about the Surgical Affiliates System of Care©.