Healthcare News & Insights

New model improves emergency surgery

Making emergency surgery safer may be tough, especially since much of it happens under serious time contstraints. But one hospital has created a successful model others can follow with great results.

464190543Researchers implemented a new acute care surgery model at two hospitals in Sacramento, CA: Sutter General Hospital and Sutter Memorial Hospital.

Over a five-year period, the research team studied how the model affected patient care and the rates of complications post surgery.

One of the head researchers, Dr. Lynette Scherer, discussed the findings in an interview with Hospitals & Health Networks, a publication from the American Hospital Association.

Staffing shift

With the new model, the hospitals changed the way they staffed the emergency department with surgeons.

Previously, emergency surgeries were performed by elective surgeons who were on-call at the hospital. Unless it was a life-or-death situation, the surgeons would typically do their elective surgeries first and then start performing emergency surgeries.

This system was revamped under the new model. Here, the hospitals had a few full-time-equivalent surgeons who were trained for trauma critical care. Each surgeon was assigned to a 24-hour in-house shift at one of the facilities, and their sole job was to handle emergency surgeries. The surgeon on duty was expected to respond to any potential surgeries in the ED within a half hour.

Along with the surgeon, a nonphysician practitioner (NPP), either a nurse practitioner or a physician’s assistant, went on rounds with the rest of the surgical team. The NPP and the surgeon would handle all emergency surgery patients that day.

While the surgeon on duty rotated each day, the same NPP would work several days in a row to ensure continuity of care for patients in the middle of a hospital stay.

More consistent care

To ensure continuity during the handoff process when the new surgeon came on call, the NPP on staff would create a detailed checklist each day that contained all the key features of each patient’s care. That way, the surgeon on duty for the day could easily pick up where the last one left off.

And the two hospitals instituted a set of evidence-based standards all emergency surgeons were required to follow when performing certain surgeries and directing patients’ post-surgical care. This also strengthened continuity of care while reducing waste and unnecessary treatment, such as giving patients antibiotics for a longer time period than required.

Positive results

When comparing the performance of the new model to the hospital’s traditional acute surgery procedures, the results were promising. Patients’ length of stay went down by 12%, and the number of complications from surgery decreased by close to 43%. Additionally, the model helped the hospital reduce its costs by 31%, which added up to around $2 million in savings each year.

So it may be worthwhile to take a look at your hospital’s current emergency surgery process, and talk to your surgeons and clinical staff to see if a change of this nature is feasible.

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