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The importance of on-call surgeons for the management of emergency care cases is undeniable; however, the sole dependence upon the on-call approach in today’s care setting is quickly becoming unreliable. Increased on-call burdens, irregular and hectic workloads, and decreased work-life balance have contributed to the surgeon shortages observed in many hospitals today. A Surgicalist approach is the answer to this growing crisis.

The Top 5 Reasons to Launch a Surgicalist Program

Currently, there is a slow but steadily rising trend emerging in hospitals across the country, one that utilizes a Surgicalist strategy for improving hospital outcomes and lowering staff turnover. Surgicalists manage emergency surgeries exclusively, reducing the need for relying solely on on-call surgeons to cover planned interventions.

Perhaps the most beneficial reasons for implementing a Surgicalist strategy includes reducing the on-call burden for surgeons, improving the achievement of greater annual financial goals, introducing new surgical skill sets, and improving patient-related outcomes.

Reason #1: Improved Surgeon Retention

Finding consistent medical care for acute care surgery patients is a growing challenge that seems to be gaining momentum. A nationwide surgeon shortage, as well as surgeons’ evolving priorities, have reduced the number of on-call doctors available for emergency surgical needs. Many surgeons, for example, are seeking a greater work-life balance and are opting for private practice.

A Surgicalist program may be the answer to the quickly deteriorating viability of surgical call rotation. Surgicalists eliminate the burden of unmanageable workloads, allowing hospital surgeons to focus on more private and elective surgical procedures. Potentially, employing a Surgicalist team may help reduce staff turnover while improving the quality of care offered to patients.

Reason #2: Diversify Skills

When employing a staff of Surgicalists who specialize in emergency care, you bring forth a greater range of skill and technique to the surgery floor. A traditional management approach of emergency cases involves patients receiving surgeons who are on call, yet this doesn’t mean the surgeon has a skill set that is sophisticated or experienced enough to handle every emergency patient. Surgicalists, however, are dedicated to emergency care cases. “If you crash your car, you don’t get to pick who your surgeon’s going to be,” says Lynette Scherer, MD, FACS, Chief Medical Officer of Surgical Affiliates. “We think that if you’re going to go to a trauma center, you really should get the best there is.”

Reason #3: Financial Benefit

Although hospitals do make an initial investment when implementing a Surgicalist program, the long-term cost benefit can be substantial. Simply, with more surgeons on staff to handle both elective and emergency interventions, hospitals experience a lower patient transfer rate. Retaining patients equates to more surgeries, which ultimately results in more jobs and a greater net financial benefit. Additionally, there is an elimination (or drastic reduction) in call coverage stipends, resulting in greater cost savings.

Reason #4: Improve Patient Outcomes

Under a Surgicalist program, patients often experience shorter wait times, shorter length of hospital stay, and fewer treatment-related complications. Typically, improved patient outcomes are a benefit associated with early or immediate intervention, compared with an intervention that depends upon an on-call surgeon’s own schedule and availability. Surgicalists, in comparison, are available 24/7, with no competition between elective and emergency cases.

Reason #5: Gain (or Improve) Community Trust

When a hospital can handle more patients and improve the level of care they provide for emergency cases, they begin to strengthen the trust their community has for them. In turn, this may result in a greater number of patients arriving at the center to receive much-needed care, regardless of the type of treatment they receive.

“Our community knows that they can count on us–we’re there in an emergency,” says Gary J. Passama, President and Chief Executive Officer of North Bay Healthcare System, a hospital that has recently implemented a Surgicalist program. “The team collaborating with our hospital staff,” he adds, “has improved patient care with the consistent use of surgical-best practices, continuity of care, and communications with patients, families, and the patient’s primary care team.”

Considering a Surgicalist Program?

Of hospitals that feature a traditional approach to emergency cases, only about 2% have Surgicalist programs in place. Part of the reason why these programs are so rare involves the lack of awareness and education around Surgicalist teams. To learn more about the Surgicalist approach and how you can use it to gain a competitive advantage over traditional hospital systems, contact us for a free program analysis consultation today.

There is a growing trend among practicing surgeons to seek a greater work-life balance, and many surgeons are moving away from private practice to avoid the strenuous and stressful regimen of constantly being on-call. This, along with uncompensated care, declining reimbursement, and liability issues, is contributing to an unprecedented shortage of on-call surgeons performing emergency care. Unsurprisingly, hospitals are in need of a comprehensive strategy that will help them keep up with ever-increasing patient demands.

Currently, there is a significant need for innovative plans of action that will help not only manage emergency surgical care and potentially improve patient outcomes but will also facilitate greater improvements within the hospital system overall. A surgicalist model addresses these needs, providing 24/7 dedicated local emergency surgeons for immediate emergency general surgery and trauma care, or even orthopedic surgery. The implementation of such an approach is aimed toward making a difference every day in the lives of patients.

The Role of a Surgicalist in Future Care

Although a traditional hospitalist model can be viable in certain care settings, the adoption of a surgicalist strategy can provide specific advantages in patient care and hospital-specific outcomes, as evidenced by numerous hospital case studies throughout the United States. Shorter wait times reduced the length of stay (LOS), fewer complications, and lower rates of patient transfers represent some of the reasons why a surgicalist model will advance emergency care now and in the future.

Improved Patient Care

The quality of patient care in emergency surgery continues to be a big priority for hospitals across the country. A 5-year study with Sutter Medical Center, Sacramento, showed noticeable benefits related to the surgicalist model for improving patient outcomes. After partnering with Surgical Affiliates and incorporating the surgicalist program in their center, overall patient complications were down by 43% and LOS decreased from 6.5 to 5.7 days.

Surgicalist programs may also increase the number of trauma surgeries performed annually, thereby increasing practice experience among surgeons. Greater experience often translates into more knowledgeable surgeons and a higher quality of care. At NorthBay Medical Center in Fairfield, California, for example, trauma surgeries increased by 3.5% in 2014 compared with 2012.

Greater Employee Retention

Compared with a traditional model of care, the surgicalist strategy reduces the need for surgeons to juggle both on-call and elective practices. When surgeons have a greater work-life balance and a clearer focus on what’s required of them (i.e., surgeries that they were trained to do), their quality of life improves. At Memorial Hospital Los Banos in central California, the implementation of a surgicalist program resulted in a significant improvement in its employee turnover rate, likely mirroring the greater workflow efficiency and higher physician satisfaction accomplished by their new surgicalist program.

Hospital Cost Savings

A surgicalist model may also help reduce costs as well as contribute to a hospital’s overall fiscal goals. For example, a surgicalist program may reduce rates of patient transfers to other facilities, which can help drive greater financial benefits to the hospital. At NorthBay Medical Center, the expanded trauma efforts by the surgicalist program were associated with an 81% reduction in transfers in 2014 compared with 2012.

Hospitals Stay Ahead of the Curve with a Surgicalist Program

The movement toward round-the-clock emergency care with highly trained surgicalists represents the changing landscape of healthcare. Millions of patients who require trauma or emergency general surgical care—particularly those admitted to rural area hospitals—have limited access to a qualified surgeon. The adoption and application of a surgicalist program help hospitals stay ahead of their competition, leading the way toward improving patient care in the emergency setting and making a difference in the lives of patients every day.

Surgical Affiliates and the Surgicalist Approach

Surgical Affiliates Management Group is committed to making a positive difference every day in the lives of patients seeking emergency surgical care. They are the first and only organization with proven results demonstrating their ability to lower hospital costs, decrease rates of readmissions, and improve the care of patients. To learn more about Surgical Affiliates and their efforts toward providing permanent surgicalist programs in hospitals around the country, read about the Surgical Affiliates System of Care^©.

Too often, patients with broken bones or other injuries that require the services of an orthopedic surgeon arrive at the ED only to discover these specialists aren’t available. The patient must wait for treatment, or sometimes be transferred to a facility out of their local area. The result is delayed treatment, inconvenience for both patients and families, a greater risk of complications and potentially a loss of revenue for the hospital when patients are transferred.

As a result of these challenges, orthopedic surgeons who function as acute orthopedic surgeons or orthopedic hospitalists are one of the latest trends in hospital medicine. Many surgeons find that being part of a comprehensive program that provides round-the-clock coverage and cares for patients is preferable to the demands of private practice and/or the inconvenience of taking a call at the hospital. Being part of a highly qualified team of surgeons and advanced practitioners, who are embedded in the hospital 24/7 to ensure continuity of care, means that surgeons can enjoy a manageable work schedule, a professionally exciting career, and competitive compensation.

For hospitals, the benefits are also compelling: the continuity and standardization that improves patient care and reduces complications, plus a team of highly qualified surgeons who are aligned with their goals to reduce unnecessary readmissions, achieve high patient satisfaction and reduce medical errors.

Pamela Mehta, MD, Surgical Affiliates Chief of Orthopedic Surgery, believes that “The goal for every patient should be access to high-quality surgical services no matter what time of day or night it’s needed. Applying acute care surgery standards to the orthopedic model can improve performance and resolve ongoing issues of reducing complications, improving outcomes, lowering costs, increasing efficiency and enhancing patient satisfaction.”

The acute orthopedic surgery program is a long-term, sustainable approach to meeting orthopedic surgery needs in a community and ensuring consistent coverage for patients needing both emergency and general orthopedic surgery. The program can be implemented as both a stand-alone and as a complement to acute care surgery and trauma programs.

What’s behind the growth of the acute orthopedic surgeon?

In short, it’s the same forces that are fueling the growth of acute care surgery or surgicalist specialty in general:

• Increasing reluctance of surgeons to be on-call for emergency surgeries

• The growing shortage of ED physicians and surgeons (including orthopedic surgeons)
• Increasing ED patient loads and an uptick in ED cases among the newly insured
• The failure of the old model of on-call surgeons and specialists to keep up with the demand of higher quality and efficiency metrics; instead the old system can result in delays in patients getting the treatment they need, difficulties in providing standardized care, and lead to complications as well as a lack of efficiency in hospital operations

What factors go into a successful program?

An acute care surgery program, including those with acute orthopedic surgeons, must be much more than having surgeons based in the hospital. The acute orthopedic surgery program must be built upon leadership from expert surgeons and executives, outstanding surgical teams that follow evidence-based guidelines in care delivery and collaboration with the hospital staff to consistently improve patient care and safety.

When this model is in place, patients, hospitals, and local orthopedic surgeons can reap the benefits of:

• Better access for patients to this specialized care. Orthopedic surgeons are available any time of the day or night 24/7
• Lower average length of stay for patients and as a result, lower treatment costs
• Community orthopedic surgeons freed up from taking ED surgical calls or in-hospital consults, enabling them to increase the efficiency and volume of their private practice and elective surgery case loads
• Orthopedic surgeons have an attractive alternative to the long hours and demands of a private practice
• Increased market share and revenue for hospitals
• Meeting the requirement for hospitals seeking higher level designation trauma centers, including Level I and Level II, to have trauma surgeons available that are trained in orthopedic surgery

Orthopedic surgeons who are interested in learning more, click here: Acute Orthopedic Surgery Programs. Hospitals interested in acute orthopedic surgery programs, click here: Surgical Hospitalist Programs.

As hospitals continue to deal with pay-for-performance, accountable care and population health management, it’s vitally important for them to consider how emergency surgery services are delivered and how it impacts their success.

One new resource on this topic is an article I recently wrote for the inaugural issue of Management in Healthcare, a new peer-reviewed journal. The article examines how, by implementing the service model developed for trauma and applied to emergency surgeries, it is possible for hospital’s most at-risk patient groups to receive standardized care according to best practices and practice management guidelines 24/7.

The result: high-quality care and better performance outcomes for the hospital. Plus, continuous quality improvement initiatives that touch multiple hospital departments, raising the bar on performance throughout the facility.

This new model for acute care surgery, also referred to as surgicalist programs, can help hospitals achieve results, as well as enhance their competitive position. Metrics show that a well-structured surgical hospitalist program can improve patient outcomes and improve costs. For example, a July 2014 paper in the Journal of the American College of Surgeons highlighted how a surgical hospitalist program produced sustainable results, including a 31% reduction in hospital costs and complications declined by 43%.

Read the article here.

In this, my last blog in a series about the Acute Care Surgery model, let’s review the benefits for general surgeons.

For surgeons who may not want to start a private practice or who may be looking for alternatives to that career path, an acute care surgery service represents a viable choice. It’s certainly challenging and gratifying on a professional level, and as we collaborate as a team, our skills and efficiency just get better and better. We see improved outcomes in our patients and greater satisfaction with patients and families because their care is handled from start to finish by a dedicated team who is there when patients need them.

The quality of life benefits are also very attractive: comparable income to the private practice model with a predictable work pattern, manageable shifts that allow the surgeon to plan his or life and the freedom to know your patients are receiving excellent care, even in your absence, has had appeal to many.

For example, the surgeon who is thinking of retirement may re-consider when he or she can alleviate the stress of a busy private practice and have control over a schedule. The young physician seeking the camaraderie and team-based care of residency can continue to get the support he or she needs.

Keeping these professionals active is very important in dealing with the impact of the current shortage of surgeons. Even mid-career surgeons who want to have more regularity in their schedules for growing families or other pursuits can have both a satisfying career and the quality of life they want. The acute care surgery model offers the attractions of predictable schedules with the challenge of meeting constantly changing patient needs.

Finally, there is the excitement of being part of something new and revolutionary. The acute care surgeon is a pioneer. Every day we are forging a new path—delivering an innovative solution that transforms the lives of our patients and keeps us engaged in our profession. Because we work in teams, there is always back-up and qualified professionals there for any patient need. We’re able to standardize care, which is a major reason why outcomes improve. Patients are delighted to have this attention, communication, and security knowing that they are being overseen 24/7.

The unspoken revolution currently taking place in American surgery is addressing the surgical shortfall while offering the promise of improving patient care and safety, and the potential to increase our own satisfaction as dedicated surgeons. The acute care surgery model is defining the next decade in emergency surgery care and we’re here to see it through.

In my last blog, I talked about the Acute Care Surgery space, highlighting where it is headed, specifically as we seek to attract new surgeons to the profession.

But in an era of surgical shortages, where millions of Americans don’t have ready access to a good surgeon, getting new physicians to join the profession is just Step 1. Step 2 is finding ways to encourage existing surgeons to stay in practice, to avoid burnout and the move to other specialties that may offer greater professional rewards and a more manageable quality of life.

Let’s start by looking at how acute care surgeons help hospitals, patients and private practice surgeons improve their practices.

The acute care surgery model offers a solution to ensure 24/7 availability in the hospital, while providing benefits to all surgeons, and most importantly, to the patients. Focusing solely upon emergency surgical care in the hospital, we care for patients who need emergency general surgery. We are available to immediately respond to any emergency surgery need from the ED. And because we are there, a community surgeon doesn’t have to get a call requiring them to come in at 2 a.m. to care for a car crash victim.

We provide all patient care including consults, covering a full-service follow-up clinic to manage those patients requiring care post discharge and perform all surgical procedures during our shift.

In some acute care surgery programs, the surgeons (all board-certified in general surgery, with many holding additional certificates, such as surgical critical care) take 24-hour shifts with the next day off. They are available to handle in-house emergencies and guarantee a response to the ED within 30 minutes when needed. In addition to surgeons, a nurse practitioner (NP) and/or physician assistant (PA) is often part of the team, rounding with the surgeons each day, coordinating care for patients and communicating with the family. They are key members of the team and play an important role in patient communication, treatment and ensure effective hand-off of the patient back to his or her primary physician.

We are a true team, experienced in the latest surgical techniques and procedures. One area of focus is the use of guidelines to ensure we provide optimal care before, during and after surgery.

When an entire surgical team is incentivized to agree and commit to evidence-based practice management guidelines, variations in care are significantly reduced. Standardizing care has repeatedly been proven to improve efficiencies and outcomes, as well as lower costs. For example:

• Reduced ED turnaround times.
• Operations are performed on a timelier basis.
• Shortened LOS, with decreased complications.

While there are many benefits to an acute care surgery model, as it is still relatively new, there are concerns and important issues to discuss with our colleagues and partners. One of the concerns is the possible erosion of private practices in the community.

However, as numerous published works have shown, this doesn’t have to be the case. In fact, an article in the Journal of the American College of Surgeonsⁱ demonstrated that despite the introduction of a busy Acute Care Surgery team, the volume of cases for private practice surgeons remained the same.

In some instances, relief from ED call has allowed some private practice surgeons to increase their surgical volume; as well as enjoy a more stable office and personal life. In short, the presence of an Acute Care Surgery team enables them to perform more elective surgery cases and can help improve their overall quality of life.

My last blog of this series will address additional advantages this model brings to surgeons.

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ⁱ Journal of the American College of Surgeons. “Acute Care Surgery: Impact on Practice and Economics of Elective Surgeons.” Preston R. Miller, M.D., FACS, et al. April 2002. (http://www.journalacs.org/article/S1072-7515(12)00073-7/abstract)

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Whether it’s a collision or an emergency appendectomy, acute care surgeons, take care of the sickest patients in the hospital. We are hospital-based surgeons who, as part of a dedicated and collaborative team, provide care to patients during their most critical times of need, 24/7.

Because we are highly trained and are at the ready when patients need us most, we help to save lives and improve outcomes.

Acute care surgery is an evolving specialty encompassing the components of trauma, critical care, and emergency general surgery. The specialty addresses one of the biggest transformations happening in the ever-changing environment of surgery. It is taking on new responsibilities for emergency surgical care, and increasing the ability to care for these patients as new techniques are developed, in the face of advancing technology. Acute care surgeons are pioneering a new approach to in-patient surgery.

The Surgical Shortage versus the Demands of Inpatient Surgery Today

Why is this transformation necessary? Patients’ emergency care can be compromised by physician shortages in the surgical suite and increased volumes in the ED, a situation that has been escalating over the last several years. In fact, more than 10 years ago, a Robert Wood Johnson Foundation (RWJF) survey found that two-thirds of EDs do not have enough surgical call coverage to meet the demand for emergency surgical care.ⁱ This ongoing problem has only grown worse. A subsequent study by RWJF of on-call specialty care found that three-quarters of EDs had inadequate surgical call coverage.ⁱⁱ

Now, with millions of Americans obtaining health coverage for the first time, hospitals across the nation are reporting that even more patients are presenting to their emergency departments, in part because these newly insured patients have trouble finding primary care physicians.ⁱⁱⁱ Taking care of these patients is exacerbated by the growing shortage of surgeons. Estimates are that there will be a shortage of 46,100 surgeons and medical specialists by 2020.^iv

Clearly, the old, traditional method of surgeons in private practice taking a call, just will not work today. There aren’t enough surgeons. Those in private practice often want to focus on their practices which are intensive enough without the “nuisance of being on call.”^v Furthermore, the demands of patient care today require responses in minutes, not hours. As the acuity of patients who are hospitalized rises, so too is their need for responsive, immediately-available teams to provide acute care surgery. Finally, within the hospital environment, all departments are required to step up their timeliness and performance in delivering care according to best practices.

A New Acute Care Surgery Model

The acute care surgery model initially arose in the academic environment as a solution to manage these patients with physiologic needs similar to trauma patients for whom access to 24/7 care could make a difference in their outcome.^{vi, vii, viii, ix, x, xi} With time, with the creation of Acute Care Surgery Fellowships and the American College of Surgeons’ (ACS) vision to bring together surgeons, resources and the infrastructure to provide 24/7 care for surgical emergencies, a new model emerged that is gaining acceptance across the nation. Implementing the acute care surgery model has proven very beneficial to patients with emergency surgery needs, reducing adverse outcomes and increasing overall positive results, improvements that are attributed to the focused care of these patients.^xii

As noted, the evolving specialty of acute care surgery encompasses trauma, critical care, and emergency general surgery. Arising to satisfy the need for emergency call coverage, acute care surgeons help speed up, standardize and improve patient care overall from the ED. The rise of on-site hospital surgeons, often acute care surgeons and frequently referred to as surgicalists, is helping mitigate the problems created from the increasingly limited number of surgeons who provide this care in the community.

Recognizing the growing national need for acute care surgeons, there are now 18 fully accredited AAST Acute Care Surgery fellowship programs focusing on this track. Acute care surgery now offers surgeons coming out of residency a new career path, one that acknowledges and rewards their skills and commitment. In an era of surgeon shortages, we must find ways to attract the best and brightest to this profession; this is an important step toward that goal.

Stay tuned for my next blog on this topic which addresses the advantages this model brings to hospitals and patients.

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ⁱ American College of Emergency Physicians. “On-call Specialist Coverage in U.S. Emergency Departments, ACEP Survey of Emergency Department Directors.” September 2004. (http://www.acep.org/workarea/DownloadAsset.aspx?id=8974)
ⁱⁱ Robert Wood Johnson Foundation. “Severe Shortage of Surgical Specialists Plagues Nation’s Emergency Departments.” Mitesh Rao, M.D., M.H.S., et al. February 10, 2011. (http://www.rwjf.org/en/library/articles-and-news/2011/02/severe-shortage-of-surgical-specialists-plagues-nations-emergenc.html)
ⁱⁱⁱ California HealthLine. “Many Newly Insured Individuals Struggle to Find Primary Care Docs.” December 8, 2014. (http://www.californiahealthline.org/articles/2014/12/8/many-newly-insured-individuals-struggle-to-find-primary-care-docs)
^iv Bonnie Darves. “Physician Shortages in the Specialties Taking a Toll.” The New England Journal of Medicine Career Center. March 2011. (http://www.nejmcareercenter.org/article/physician-shortages-in-the-specialties-taking-a-toll/)
^v Deborah Gesensway. “Surgicalists: Why Aren’t They in Your Hospital?” Today’s Hospitalist. January 2015. (http://www.todayshospitalist.com/index.php?b=articles_read&cnt=1977)
^vi Derlet RW, Richards JR. “Overcrowding in the nation’s emergency departments: complex causes and disturbing effects.” Annals of Emergency Medicine. 2000; 35:63–68.
^vii Lewin Group. “Emergency Department Overload: A Growing Crisis. The Results of the AHA Survey of Emergency Department (ED) and Hospital.” 2002.
^viii Asplin BR, Magid DJ, Rhodes KV, et al. “A conceptual model of emergency department crowding.” Annals of Emergency Medicine. 2003; 42:173–180.
^ix Scherer LA, Battistella FD. Trauma and emergency surgery: an evolutionary direction for trauma surgeons.” Journal of Trauma. 2004; 56:7–12.
^x Kim PK, Dabrowski GP, Reilly PM, et al. “Redefining the future of trauma surgery as a comprehensive trauma and emergency general surgery service.” Journal of the American College of Surgeons. 2004; 199:96 –101.
^xi Capacity. Available at: http://www.hospitalconnect.com/aha/press_roominfo/content/EdoCrisisSlides.pdf. Accessed Online May 5, 2006.
^xii “Sustainability and Success of the Acute Care Surgery Model in the Nontrauma Setting.”Journal of the American College of Surgeons. Volume 219, Issue 1, Pages 90–98. (http://www.journalacs.org/article/S1072-7515(14)00220-8/fulltext)

Millions of Americans don’t have access to a qualified surgeon in the event of a trauma-related medical emergency—a problem that is especially acute in rural areas. Recently, Anne Platt, FACHE and CEO of Sutter Amador Hospital, and I made a presentation at the American College of Healthcare Executives’ 2016 Congress on Healthcare Leadership on this topic.

Thousands of hospitals nationwide face the twin challenges of recruitment and retention of qualified surgeons for acute and trauma care. While the issue is especially prevalent in rural areas, it affects urban and suburban hospitals as well. Plus, the issue of recruiting surgeons is compounded by aging surgeons (average age is now over 50), while fewer graduates are entering critical care residencies.

The implications of the looming surgical shortage do not bode well for hospitals or patients.

Over-burdened surgeons are increasingly pushing back. Hospitals are constantly struggling to recruit, retain and maintain surgeons and their Trauma Center status. And, patient care can potentially suffer.

Like other hospitals in rural areas, Sutter Amador Hospital faced the increasingly difficult issues of recruiting and retaining enough surgeons to serve the needs of its community. The hospital’s goal was to find a viable solution to ensure that both its patients and the surrounding community had access to high quality, 24/7 acute care surgery services. It also wanted a long-term solution to help it avoid losing market share while ensuring that the solution aligned with its mission, goals, and culture.

Ultimately, the hospital opted to partner with Surgical Affiliates and adopted our surgicalist hospital model to solve its problems and address its needs. With this long-term solution, which is reproducible in other hospitals, the focus is on the creation of a team approach, coordinated and supported with processes, systems and skilled advanced practitioners (nurse practitioners and physician assistants). Surgeons are always available—24/7—for consults and acute care surgeries, while advanced practitioners support the surgical team by managing the clinic, follow-up care, and care coordination.

A comprehensive surgical hospitalist program benefits rural hospitals, especially for solving the challenges of recruiting surgeons and improving quality of patient care. Plus, the model can work for hospitals in urban environments, providing consistent surgical call coverage and improving patient safety and outcomes, while boosting results throughout the hospital.

From 2012 to 2014 Sutter Amador has:

• Increased all general surgery cases from 129 to 266
• Decreased Average Length of Stay from 6.45 to 5.26
• Increased Case Mix Index from 2.0 to 2.34

As a result, the hospital has generated a positive ROI. By applying the acute care surgery model, which applies disciplines in trauma surgery to general surgery, hospitals can better achieve consistent, evidence-based care and improved clinical outcomes.

With increasing demand, aging of surgeons and the challenges of recruitment in many markets, the nation’s hospitals will continue to struggle to find solutions for acute and trauma surgical care. A very viable solution is to partner with outside organizations such as Surgical Affiliates to build surgicalist programs. Our model delivers a programmatic approach to general emergency surgery providing access to high-quality emergency surgical care 24/7.

>Our Acute Care Surgery Model (also referred to as surgical hospitalist or surgicalist programs) delivers a programmatic approach to general emergency surgery providing access to high-quality emergency surgical care 24/7. By applying the acute care surgery model, which applies disciplines in trauma surgery to general surgery, we are able to achieve consistent, evidence-based care and improved clinical outcomes for our patients. Our comprehensive Acute Care Surgery program delivers a dedicated team of surgeons led by a medical director whose sole practice is treating emergency surgery patients. This model addresses widespread emergency department challenges and improves efficiencies throughout the hospital but more importantly improves patient outcomes.

We found that after implementing our Acute Care Surgery Model, complications were dramatically decreased. Results of a five-year study published in the Journal of the American College of Surgeons showed:

• Complications decreased 43%
• Length of stay decreased 12%
• Hospital costs decreased 31%
• Readmission rates were down—while LOS significantly decreased, readmissions did not increase
• Overall hospital CMI improved
• Annual savings was $2 million

Additionally, this model produced shorter hospital lengths of stay and lower costs.

• Appendectomies—an average 27.8% decrease in total hospital costs; average LOS decreased 36.7%; the number of appendectomies increased 15.8%
• Laparotomies—outcomes from in-hospital morbidity declined 49%
• Cholecystectomies— in-hospital morbidity declined 83%; an average 14% decrease in total hospital costs; the readmission rate decreased 69.6%; number of cholecystectomies increased 29.8%

Another study reported that the national average cost for cholecystectomies per case is $15,650¹, yet after the Acute Care Surgery model was applied at the facility referenced above, its cost per case for the same procedure was $8,432, representing a 46% savings.

These results, which have proven sustainable and can be implemented in all types of hospitals, are an outcome of improving the timeliness of care, implementing patient care guidelines and protocols to reduce variation. For more information, visit our Hospitalist Program Calculator or Surgical Hospitalist Program page.

¹ Stey A, Brook R, Needleman J, et al. Hospital Costs by Inpatient. J Am Coll Sug 2015:220:207-217