Category: Acute Care Surgery

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

Acute Care Surgery, Quality of Care, Surgical Hospitalist Results

Acute Care Surgical Programs: Expanding Surgical Care

As hospitals continue to deal with pay-for-performance, accountable care and population health management, it’s vitally important for them to consider how emergency surgery services are delivered and how it impacts their success.

One new resource on this topic is an article I recently wrote for the inaugural issue of Management in Healthcare, a new peer-reviewed journal. The article examines how, by implementing the service model developed for trauma and applied to emergency surgeries, it is possible for hospital’s most at-risk patient groups to receive standardized care according to best practices and practice management guidelines 24/7.

The result: high-quality care and better performance outcomes for the hospital. Plus, continuous quality improvement initiatives that touch multiple hospital departments, raising the bar on performance throughout the facility.

This new model for acute care surgery, also referred to as surgicalist programs, can help hospitals achieve results, as well as enhance their competitive position. Metrics show that a well-structured surgical hospitalist program can improve patient outcomes and improve costs. For example, a July 2014 paper in the Journal of the American College of Surgeons highlighted how a surgical hospitalist program produced sustainable results, including a 31% reduction in hospital costs and complications declined by 43%.

Read the article here.

Acute Care Surgery, Quality of Care, Surgical Hospitalist Program, Surgical Hospitalist Results

Acute Care Surgery: A New Career Path

In this, my last blog in a series about the Acute Care Surgery model, let’s review the benefits for general surgeons.

For surgeons who may not want to start a private practice or who may be looking for alternatives to that career path, an acute care surgery service represents a viable choice. It’s certainly challenging and gratifying on a professional level, and as we collaborate as a team, our skills and efficiency just get better and better. We see improved outcomes in our patients and greater satisfaction with patients and families because their care is handled from start to finish by a dedicated team who is there when patients need them.

The quality of life benefits are also very attractive: comparable income to the private practice model with a predictable work pattern, manageable shifts that allow the surgeon to plan his or life and the freedom to know your patients are receiving excellent care, even in your absence, has had appeal to many.

For example, the surgeon who is thinking of retirement may re-consider when he or she can alleviate the stress of a busy private practice and have control over a schedule. The young physician seeking the camaraderie and team-based care of residency can continue to get the support he or she needs.

Keeping these professionals active is very important in dealing with the impact of the current shortage of surgeons. Even mid-career surgeons who want to have more regularity in their schedules for growing families or other pursuits can have both a satisfying career and the quality of life they want. The acute care surgery model offers the attractions of predictable schedules with the challenge of meeting constantly changing patient needs.

Finally, there is the excitement of being part of something new and revolutionary. The acute care surgeon is a pioneer. Every day we are forging a new path—delivering an innovative solution that transforms the lives of our patients and keeps us engaged in our profession. Because we work in teams, there is always back-up and qualified professionals there for any patient need. We’re able to standardize care, which is a major reason why outcomes improve. Patients are delighted to have this attention, communication and security knowing that they are being overseen 24/7.

The unspoken revolution currently taking place in American surgery is addressing the surgical shortfall while offering the promise of improving patient care and safety, and the potential to increase our own satisfaction as dedicated surgeons. The acute care surgery model is defining the next decade in emergency surgery care and we’re here to see it through.