The association between self-declared acute care surgery services and critical care resources: Results from a national survey.

Published on Jul 5, 2020in Journal of Critical Care3.425
路 DOI :10.1016/J.JCRC.2020.04.002
Ashley M. Tameron (OSU: Ohio State University), Kevin B. Ricci5
Estimated H-index: 5
(OSU: Ohio State University)
+ 10 AuthorsHeena P. Santry9
Estimated H-index: 9
(OSU: Ohio State University)
Abstract Purpose We examined differences in critical care structures and processes between hospitals with Acute Care Surgery (ACS) versus general surgeon on call (GSOC) models for emergency general surgery (EGS) care. Methods 2811 EGS-capable hospitals were surveyed to examine structures and processes including critical care domains and ACS implementation. Differences between ACS and GSOC hospitals were compared using appropriate tests of association and logistic regression models. Results 272/1497 hospitals eligible for analysis (18.2%) reported they use an ACS model. EGS patients at ACS hospitals were more likely to be admitted to a combined trauma/surgical ICU or a dedicated surgical ICU. GSOC hospitals had lower adjusted odds of having 24-h ICU coverage, in-house intensivists or respiratory therapists, and 4/6 critical-care protocols. Conclusions Critical care delivery is a key component of EGS care. While harnessing of critical care structures and processes varies across hospitals that have implemented ACS, overall ACS models of care appear to have more robust critical care practices.
馃摉 Papers frequently viewed together
#1Angela M. Ingraham (UW: University of Wisconsin-Madison)H-Index: 4
#2M. Didem Ayturk (UMMS: University of Massachusetts Medical School)H-Index: 9
Last. Heena P. Santry (OSU: Ohio State University)H-Index: 9
view all 4 authors...
Objective: To examine national adherence to emergency general surgery (EGS) best practices. Background: There is a national crisis in access to high-quality care for general surgery emergencies. Acute care surgery (ACS), a specialty leveraging strengths of trauma systems, may ameliorate this crisis. A critical component of trauma care is adherence to clinical guidelines. We previously established best practices for EGS using RAND Appropriateness Methodology and pilot data. Method: A hybrid (post...
#1Kathleen B. To (UM: University of Michigan)H-Index: 9
#2Neil KamdarH-Index: 18
Last. Marianne WynkoopH-Index: 1
view all 114 authors...
Background Annually, more than 2 million patients are admitted with emergency general surgery (EGS) conditions. Emergency general surgery cases comprise 11% of all general surgery operations, yet account for 47% of mortalities and 28% of complications. Using the statewide general surgery Michigan Surgical Quality Collaborative (MSQC) data, we previously confirmed that wide variations in EGS outcomes were unrelated to case volume/complexity. We assessed whether patient care model (PCM) affected E...
#1Faisal Masud (Houston Methodist Hospital)H-Index: 19
#2Tina Yaqing Cai Lam (A&M: Texas A&M University)H-Index: 1
Last. Sahar Fatima (Houston Methodist Hospital)H-Index: 2
view all 3 authors...
: Over the past few decades, an increasing number of studies have shown that intensivist-staffed intensive care units (ICUs) lead to overall economic benefits and improved patient outcomes, including shorter length of stay and lower rates of complications and mortality. This body of evidence has convinced advocacy groups to adopt this staffing model as a standard of care in the ICU so that more hospitals are offering around-the-clock intensivist coverage. Even so, opponents have pointed to high ...
#1Jasmine A. Khubchandani (UMMS: University of Massachusetts Medical School)H-Index: 5
#2Angela M. Ingraham (UW: University of Wisconsin-Madison)H-Index: 4
Last. Heena P. Santry (UMMS: University of Massachusetts Medical School)H-Index: 16
view all 6 authors...
Importance Owing to lack of adequate emergency care infrastructure and decline in general surgery workforce, the United States faces a crisis in access to emergency general surgery (EGS) care. Acute care surgery (ACS), an organized system of trauma, general surgery, and critical care, is a proposed solution; however, ACS diffusion remains poorly understood. Objective To investigate geographic diffusion of ACS models of care and characterize the communities in which ACS implementation is lagging....
#1Fiona Lecky (University of Sheffield)H-Index: 61
#2Wanda Russell (University of Manchester)H-Index: 10
Last. Jane ShewanH-Index: 5
view all 18 authors...
Objective Reconfiguration of trauma services, with direct transport of patients with traumatic brain injury (TBI) to specialist neuroscience centres (SNCs)鈥攂ypassing non-specialist acute hospitals (NSAHs), could improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) may worsen outcomes when compared with selective secondary transfer from nearest NSAH to SNC. We conducted a pilot cluster randomised controlled trial to determine the feasibility and plausibili...
#1Shikhar Agarwal (Geisinger Medical Center)H-Index: 32
#2Karan Sud (Mount Sinai St. Luke's and Mount Sinai Roosevelt)H-Index: 12
Last. Samir R. Kapadia (Cleveland Clinic)H-Index: 101
view all 6 authors...
We aimed to evaluate the secular trends in demographics, risk factors, and clinical characteristics of patients presenting with acute myocardial infarction (AMI) or acute ischemic stroke (AIS), using a large nationally representative data set of in-hospital admissions. We used the 2003 to 2013 Nationwide Inpatient Sample. All admissions with primary diagnosis of AMI or AIS were included. Across 2003 to 2013, a total of 1,360,660 patients with AMI and 937,425 patients with AIS were included in th...
#1Seth A. Seabury (SC: University of Southern California)H-Index: 26
#2Katalin Bognar (Precision Health Economics)H-Index: 6
Last. Darren Tayama (Genentech)H-Index: 13
view all 6 authors...
Abstract Background and purpose There is widespread geographic variation in healthcare quality, but we often lack clear strategies for improving quality in underserved areas. This study characterized geographic disparities in stroke care quality to assess whether improved access to neurological services has the potential to bridge the care quality gap, particularly in terms of alteplase (rt-PA) administration. Methods This was a retrospective study using quality performance data from the 2015 Ho...
#1Rachel Kohn (UPenn: University of Pennsylvania)H-Index: 13
#2Vanessa MaddenH-Index: 6
Last. Meeta Prasad KerlinH-Index: 16
view all 7 authors...
Rationale: Several intensive care unit (ICU) organizational practices have been associated with improved patient outcomes. However, the uptake of these evidence-based practices is unknown.Objectives: To assess diffusion of ICU organizational practices across the state of Pennsylvania.Methods: We conducted two web-based, cross-sectional surveys of ICU organizational practices in Pennsylvania acute care hospitals, in 2005 (chief nursing officer respondents) and 2014 (ICU nurse manager respondents)...
#1Jean Louis Vincent (ULB: Universit茅 libre de Bruxelles)H-Index: 187
#1Joaquim M. Havens (Brigham and Women's Hospital)H-Index: 21
#2Olubode A. Olufajo (Brigham and Women's Hospital)H-Index: 17
Last. Ali Salim (Brigham and Women's Hospital)H-Index: 78
view all 6 authors...
Importance Hospital readmission rates following surgery are increasingly being used as a marker of quality of care and are used in pay-for-performance metrics. To our knowledge, comprehensive data on readmissions to the initial hospital or a different hospital after emergency general surgery (EGS) procedures do not exist. Objective To define readmission rates and identify risk factors for readmission after common EGS procedures. Design, Setting, and Participants Patients undergoing EGS, as defin...
Cited By0
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.