Introduction: Despite three million adults in the United States (US) being admitted annually for emergency general surgery (EGS) conditions, which disproportionately affect vulnerable populations, we lack an understanding of the barriers to round-the-clock EGS care. Our objective was to measure gaps in round-the-clock EGS care.
Methods: From August 2015 to December 2015, we surveyed all US-based, adult acute care general hospitals that have an emergency room and ≥1 operating room and provide EGS care, utilizing paper and electronic methods. Surgeons or chief medical officers were queried regarding EGS practices.
Results: Of 2,811 hospitals, 1,634 (58.1%) responded; 279 (17.1%) were unable to always provide round-the-clock EGS care. Rural location, smaller bed size, and non-teaching status were associated with lack of round-the-clock care. Inconsistent surgeon coverage was the primary reason for lacking round-the-clock EGS care (n=162; 58.1%). However, lack of a tiered system for booking emergency cases, no anesthesia availability overnight, and no stipend for EGS call were also associated with the inability to provide round-the-clock EGS care.
Discussion: We found significant gaps in access to EGS care, often attributable to workforce deficiencies.
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| http://dx.doi.org/10.1097/as9.0000000000000043 | DOI Listing |
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Gaps in Emergency General Surgery Coverage in the United States.
Ann Surg Open
March 2021
Department of Surgery, The Ohio State University, 395 W 12 Avenue, Columbus, OH.
Introduction: Despite three million adults in the United States (US) being admitted annually for emergency general surgery (EGS) conditions, which disproportionately affect vulnerable populations, we lack an understanding of the barriers to round-the-clock EGS care. Our objective was to measure gaps in round-the-clock EGS care.
Methods: From August 2015 to December 2015, we surveyed all US-based, adult acute care general hospitals that have an emergency room and ≥1 operating room and provide EGS care, utilizing paper and electronic methods.
In-house intensivist presence does not affect mortality in select emergency general surgery patients.
J Trauma Acute Care Surg
October 2021
From the Department of Surgery-Trauma (A.P.R.), University Hospitals, Cleveland; Department of Surgery (S.A.S., A.Z.P., A.D., H.E.B., V.K.H.), Ohio State University Wexner Medical Center; Department of Surgery (K.B.R.), Johns Hopkins Medical School, Baltimore, MD; Department of Surgery (W.M.O.), University of Alabama, Birmingham, AL; Consulting Studio (H.P.S.), NBBJ Design LLC, Columbus, OH; Department of Trauma Surgery (H.P.S.), Kettering Medical Center, Kettering, OH; Center for Surgical Health Assessment, Research and Policy (S.A.S., K.B.R., A.Z.P., A.D., H.E.B., V.K.H., H.P.S.), Ohio State University, Columbus, Ohio; Department of Dermatology (V.T.D.), University of Massachusetts Medical School, Worcester MA; Department of Surgery (A.M.I.), University of Wisconsin, Madison, Wisconsin; and Ohio State University College of Medicine (W.M.O.), Columbus, Ohio.
Background: This study aimed to assess the relationship between availability of round-the-clock (RTC) in-house intensivists and patient outcomes in people who underwent surgery for a life-threatening emergency general surgery (LT-EGS) disease such as necrotizing soft-tissue infection, ischemic enteritis, perforated viscus, and toxic colitis.
Methods: Data on hospital-level critical care structures and processes from a 2015 survey of 2,811 US hospitals were linked to patient-level data from 17 State Inpatient Databases. Patients who were admitted with a primary diagnosis code for an LT-EGS disease of interest and underwent surgery on date of admission were included in analyses.
Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a mixed-methods Donabedian approach.
BMC Med Res Methodol
October 2020
Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA, USA.
Background: Acute Care Surgery (ACS) was developed as a structured, team-based approach to providing round-the-clock emergency general surgery (EGS) care for adult patients needing treatment for diseases such as cholecystitis, gastrointestinal perforation, and necrotizing fasciitis. Lacking any prior evidence on optimizing outcomes for EGS patients, current implementation of ACS models has been idiosyncratic. We sought to use a Donabedian approach to elucidate potential EGS structures and processes that might be associated with improved outcomes as an initial step in designing the optimal model of ACS care for EGS patients.
View Article and Find Full Text PDFAssociation between operating room access and mortality for life-threatening general surgery emergencies.
J Trauma Acute Care Surg
July 2019
From the Department of Surgery (V.T.D.), University of Massachusetts Medical School, Worcester, Massachusetts; Department of Surgery (A.P.R., K.B.R., A.Z.P., A.D., H.E.B., S.A.S., H.P.S.), Ohio State University Wexner Medical Center, Columbus, Ohio; Center for Surgical Health Assessment (A.P.R., K.B.R., A.Z.P., A.D., H.E.B., S.A.S., H.P.S.), Research, and Policy (SHARP), Ohio State University, Columbus, Ohio; Department of Surgery (A.M.I.), University of Wisconsin, Madison, Wisconsin, and Department of Quantitative Health Sciences (M.D.A.), University of Massachusetts Medical School, Worcester, Massachusetts.
Article Synopsis
- The study analyzed the impact of operating room (OR) access on outcomes for patients with life-threatening emergency general surgery conditions in US hospitals.
- Out of 2,811 hospitals surveyed in 2015, 1,690 provided data linking OR access practices to patient outcomes, focusing on those who underwent surgery on the same day as admission.
- The results revealed that a lack of in-house emergency general surgery (EGS) surgeons and reliance on on-call nurses was linked to higher in-hospital mortality rates for patients with serious conditions.
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