Advertisement

Acute Care Surgical Services: Return to Traditional Surgery as Backbone of the Modern Hospital

  • James M. FeeneyEmail author
  • Rifat Latifi
Chapter

Abstract

The acute care surgery (ACS), a distinctly different model for the provision of care to acutely injured or ill patients with surgical diseases, has shown great promise in streamlining care, reducing costs, and improving outcomes. This model arose initially from dissatisfaction within the trauma and surgical critical care community, culminating in a transformation of trauma surgery to increasingly nonoperative scope of management, and in the relegation of operative care to other “consultant” specialties. While the model may be seen as innovative, it is, in fact, simply a return to traditional surgeons performing traditional surgery, with added intensive care expertise. As such, this model has been quite successful. Still, more needs to be done to maintain the interest of young surgeons to join the ranks.

Keywords

Acute care surgery Emergency surgery Critical care Trauma Intensive care unit Education Financing 

References

  1. 1.
    Institute of Medicine (of the National Academies). The future of emergency care. Fact Sheet June 2006. Acute Care Surgery: Trauma, Critical Care, and Emergency Surgery.Google Scholar
  2. 2.
    Acute Care Surgery: Trauma, Critical Care, and Emergency Surgery. The committee to develop the reorganized specialty of trauma, surgical critical care, and emergency surgery. J Trauma Acute Care Surg. 2005;58(3):614–6.  https://doi.org/10.1097/01.TA.0000159347.03278.E1.CrossRefGoogle Scholar
  3. 3.
    Spain DA, Miller FB. Education and training of the future trauma surgeon in acute care surgery: trauma, critical care, and emergency surgery.  https://doi.org/10.1016/j.amjsurg.2005.05.014.CrossRefGoogle Scholar
  4. 4.
    Moore EE. Trauma surgery: is it time for a facelift? Ann Surg. 2004;240:563–4.CrossRefGoogle Scholar
  5. 5.
    Britt LD. Trauma: still the cornerstone of acute care surgery specialty. J Am Coll Surg. 2017;226:211–22.CrossRefGoogle Scholar
  6. 6.
    Green SM. Trauma surgery: discipline in crisis. Ann Emerg Med. 2009;53:198–207.CrossRefGoogle Scholar
  7. 7.
    Cubas RF, Gómez NR, Rodriguez S, Wanis M, Sivanandam A, Garberoglio CA. Outcomes in the management of appendicitis and cholecystitis in the setting of a new acute care surgery service model: impact on timing and cost.  https://doi.org/10.1016/j.jamcollsurg.2012.06.415. Get rights and content.CrossRefGoogle Scholar
  8. 8.
    Lau B, DiFronzo LA. An acute care surgery model improves timeliness of care and reduces hospital stay for patients with acute cholecystitis. Am Surg. 2011;77(10):1318–1321(4).PubMedGoogle Scholar
  9. 9.
    O’Mara MS, Scherer L, Wisner D, Owens LJ. Sustainability and success of the acute care surgery model in the nontrauma setting. J Am Coll Surg. 2014;219(1):98–100.  https://doi.org/10.1016/j.jamcollsurg.2014.02.022. Get rights and content.CrossRefGoogle Scholar
  10. 10.
    Ekeh AP, Monson B, Wozniak CJ, Armstrong M, McCarthy MC. Management of acute appendicitis by an acute care surgery service: is operative intervention timely?  https://doi.org/10.1016/j.jamcollsurg.2008.01.016.CrossRefGoogle Scholar
  11. 11.
    Earley AS, Pryor JP, Kim PK, Hedrick JH, Kurichi JE, Minogue AC, Sonnad SS, Reilly PM, Schwab CW. An acute care surgery model improves outcomes in patients with appendicitis. Ann Surg. 2006;244:498.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Murphy PB, DeGirolamo K, Van Zyl TJ, Allen L, Haut E, Leeper WR, Leslie K, Parry N, Hameed M, Vogt KN. Impact of the acute care surgery model on disease- and patient-specific outcomes in appendicitis and biliary disease: a meta-analysis.  https://doi.org/10.1016/j.jamcollsurg.2017.08.026.CrossRefGoogle Scholar
  13. 13.
    Khalil M, Pandit V, Rhee P, Kulvatunyou N, Orouji T, Tang A, O’Keeffe T, Gries L, Vercruysse G, Friese RS, Joseph B. Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery: a nationwide analysis. J Trauma Acute Care Surg. 2015;79:60–4.CrossRefGoogle Scholar
  14. 14.
    Hameed SM, Brenneman FD, Ball CG, Pagliarello J, Razek T, Parry N, Widder S, Minor S, Buczkowski A, MacPherson C, Johner A, Jenkin D, Wood L, McLoughlin K, Anderson I, Davey D, Zabolotny B, Saadia R, Bracken J, Nathens A, Ahmed N, Panton O, Warnock GL. General surgery 2.0: the emergence of acute care surgery in Canada. Can J Surg. 2010;53:79.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Qureshi A, Smith A, Wright F, Brenneman F, Rizoli S, Hsieh T, Tien HC. The impact of an acute care emergency surgical service on timely surgical decision-making and emergency department overcrowding.  https://doi.org/10.1016/j.jamcollsurg.2011.04.020.CrossRefGoogle Scholar
  16. 16.
    Privette AR, Evans AE, Moyer JC, Nelson MF, Knudson M, Mackersie RC, Callcut RA, Cohen MJ. Beyond emergency surgery: redefining acute care surgery.  https://doi.org/10.1016/j.jss.2014.11.012.CrossRefGoogle Scholar
  17. 17.
    Britt RC, Weireter LJ, Britt LD. Initial implementation of an acute care surgery model: implications for timeliness of care. J Am Coll Surg. 2009;209:421–4.CrossRefGoogle Scholar
  18. 18.
    Sheldon GF. Trauma manpower in the decade of aftershock. Bull Am Coll Surg. 1992;77:6e12.Google Scholar
  19. 19.
    Mattox KL. TraumaLine 2000: a history of change and a vision for the future. Bull Am Coll Surg. 2000;85:24e34.Google Scholar
  20. 20.
    Dente CJ, Duane TM, Jurkovich GJ, Britt LD, Meredith JW, Fildes JJ. How much and what type: analysis of the first year of the acute care surgery operative case log. J Trauma Acute Care Surg. 2014;76(2):329–39.  https://doi.org/10.1097/TA.0000000000000114. David A. Spain.CrossRefPubMedGoogle Scholar
  21. 21.
    Davis KA, Dente CJ, Burlew CC, Jurkovich GJ, Reilly PM, Toschlog EA, Cioffi WG. Refining the operative curriculum of the acute care surgery fellowship. J Trauma Acute Care Surg. 2015;78(1):192–6.  https://doi.org/10.1097/TA.0000000000000477.CrossRefPubMedGoogle Scholar
  22. 22.
    Burlew CC, Davis KA, Fildes JJ, Esposito TJ, Dente CJ, Jurkovich GJ. Acute care surgery fellowship graduates’ practice patterns: the additional training is an asset. J Trauma Acute Care Surg. 2017;82(1):208–10.  https://doi.org/10.1097/TA.0000000000001309.CrossRefPubMedGoogle Scholar
  23. 23.
    Barnes SL, Cooper CJ, Coughenour JP, MacIntyre AD, Kessel JW. Impact of acute care surgery to departmental productivity. J Trauma Acute Care Surg. 2011;71(4):1027–34.  https://doi.org/10.1097/TA.0b013e3182307146.CrossRefGoogle Scholar
  24. 24.
    Procter L, Bernard AC, Korosec RL, Chipko PL, Kearney PA Jr, Zwischenberger JB. An acute care surgery service generates a positive contribution margin in an appropriately staffed hospital.  https://doi.org/10.1016/j.jamcollsurg.2012.09.020.CrossRefGoogle Scholar
  25. 25.
    Miller PR, Wildman EA, Chang MC, Meredith JW. Acute care surgery: impact on practice and economics of elective surgeons. J Am Coll Surg. 2012;214(4):536–8.  https://doi.org/10.1016/j.jamcollsurg.2011.12.045.CrossRefGoogle Scholar
  26. 26.
    Lissauer ME, Schulze R, May A, Esposito T, Duane TM. Update on the status and future of acute care surgery: 10 years later. J Trauma Acute Care Surg. 2014;76(6):1462–6.  https://doi.org/10.1097/TA.0000000000000226.CrossRefPubMedGoogle Scholar
  27. 27.
    Taheri PA, Maggio PM, Dougherty J, Neil C, Fetyko S, Harkins DR, Butz DA. Trauma center downstream revenue: the impact of incremental patients within a health system. J Trauma Acute Care Surg. 2007;62(3):615–21.  https://doi.org/10.1097/TA.0b013e31802ee532.CrossRefGoogle Scholar
  28. 28.
    Sweeting RS, Carter JE, Meyer AA, Rich PB. The price of acute care surgery. J Trauma Acute Care Surg. 2013;74(5):1239–45.CrossRefGoogle Scholar
  29. 29.
    Santry HP, Madore JC, Collins CE, Ayturk MD, Velmahos GC, Britt LD, Kiefe CI. Variations in the implementation of acute care surgery: results from a national survey of university-affiliated hospitals. J Trauma Acute Care Surg. 2015;78:60–8.  https://doi.org/10.1097/TA.0000000000000492.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Kaplan LJ, Frankel H, Davis KA, Barie PS. Pitfalls of implementing acute care surgery. J Trauma Acute Care Surg. 2007;62(5):1264–71.  https://doi.org/10.1097/TA.0b013e318053dfd8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryWestchester Medical CenterValhallaUSA
  2. 2.New York Medical College, School of Medicine, Department of Surgery and Westchester Medical CenterValhallaUSA

Personalised recommendations