Transforming Surgical and Interventional Care: Insights from the Robert Wood Johnson Foundation Clinical Scholars ProgramA qualitative analysis of acute care surgery in the United States: It's more than just “a competent surgeon with a sharp knife and a willing attitude”
Section snippets
Methods
We created a semistructured interview using the principle of reflexivity (reflecting upon the effect of clinical experience, literature review, and ongoing research on attitudes and preconceptions to decrease bias in both interviewing and analyses).34 Interview questions explored ACS implementation (eg, infrastructure, team organization, call coverage) and the evolution/future of ACS (see Appendix). The interview was piloted on senior acute care surgeons at centers familiar to the investigator
ACS model
All respondents described ACS as a specialty treating “time sensitive surgical disease,” including trauma, EGS, and SCC. Seventeen embraced the term “acute care surgery,” with 4 referring to “surgical hospitalists” or “in-house general surgeon.” However, one respondent disagreed stating, “we all went into this thing [surgery] ‘like I want to do the hairiest crap you can find me…people bleeding to death and dying and all that.’ I mean it couldn't be further from this hospitalist word of let me
Discussion
ACS has been theorized to improve productivity in an overburdened health care system, optimize outcomes, and increase the cost-effectiveness of EGS coverage.5, 6, 7, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 39, 40, 41, 42, 43 Our qualitative results from stakeholders at 18 hospitals with ACS programs show marked variability in the current implementation of ACS and suggest that, nearly a decade after the specialty first emerged, barriers may exist to realizing its benefits.
Greater quality
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Quality of Care for Gallstone Pancreatitis—the Impact of the Acute Care Surgery Model and Hospital-Level Operative Resources
2022, Journal of Gastrointestinal SurgeryRe-examining “Never Letting the Sun Rise or Set on a Bowel Obstruction” in the Era of Acute Care Surgery
2021, Journal of Gastrointestinal SurgeryWomen surgeons and the emergence of acute care surgery programs
2019, American Journal of SurgeryCitation Excerpt :ACS was initially proposed in 2005 as an innovative model of care to facilitate timely and high-quality EGS care along with trauma and surgical critical care.11–15 While clinical scope varies among present-day ACS models,16–18 most share a dedicated team-based approach to providing EGS coverage rather than conventional general surgeon on call models. The widespread professional satisfaction of surgeons in these team-based practices is unknown.
Variations in the Delivery of Emergency General Surgery Care in the Era of Acute Care Surgery
2019, Joint Commission Journal on Quality and Patient SafetyCitation Excerpt :We pilot tested early versions of the survey with surgeons who perform EGS. We included questionnaire items if they were deemed relevant in our prior research or if they were chosen as best practices by our expert panel.16,21–23 Given the absence of a standardized definition of ACS, those who responded that their hospital's approach to EGS was a dedicated clinical team whose scope encompasses EGS (± trauma, ± elective general surgery, ± burns) were classified as ACS hospitals.
The impact of an acute care surgery model on general surgery service productivity
2018, Perioperative Care and Operating Room Management
The research reported in this publication was in part supported by the University of Massachusetts Clinical Scholar Award (H.P.S.) through the National Center for Advancing Translational Sciences of the National Institutes of Health under award numbers UL1RR031982, 1KL2RR031981-01, and UL1TR000161. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
H.P.S. was a member of the RWJ Clinical Scholars Program, Chicago, IL, 2003–2005.