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As hospitals nationwide face the ongoing challenge of managing costs while achieving improved quality outcomes, those best positioned for success in this competitive healthcare environment will give increased focus to patient safety, quality, and cost in providing value-based care. The Surgical Affiliates Surgical Hospitalist Program provides hospitals with a powerful acute care surgery model with published, peer-reviewed quality outcomes that raises the level of hospital performance and achieves cost savings that are proven and sustained.

Generating a Program of Savings Based on Documented, Peer-Reviewed Quality Outcomes

Although hospitals make an initial investment when implementing a surgical hospitalist program, the return on investment (ROI) can be substantial and typically offsets the cost of the program. We’re pleased to offer the Acute Care Surgery Program Impact Calculator, an easy-to-use tool designed to allow hospitals to quickly determine the potential ROI impact that can be achieved by implementing our acute care or trauma surgical hospitalist programs. Based on a few specific data points entered by the user, the Acute Care Surgery (ACS) Program Impact Calculator utilizes documented, peer-reviewed quality outcome data to immediately generate an estimated program of savings in three key metrics – emergency surgical case volume, length of stay (LOS), and case mix index (CMI).

Specifically, the ACS Program Impact Calculator generates a concise, one-page summary that provides an overall projection of the cost savings your hospital could achieve by implementing our surgical hospitalist programs. Also, the report provides a comparison of current and expected data points for emergency surgical case volume, length of stay (LOS), and case mix index (CMI) as well as a projected ROI impact figure for each of the three metrics. The projected savings generated with the implementation of our surgical hospitalist programs are achieved while maintaining superior quality metrics, including Center for Medicare and Medicaid Services (CMS) performance in the 92^nd percentile for quality of care at a mean cost. The data and calculations utilized on the ACS Program Impact Calculator are based on industry standards, past Surgical Affiliates case study results, and published information.

Achieving a Robust ROI with Improvements in Key Metrics

The robust ROI achieved with our surgical hospitalist programs is derived from improvements in three key cost-related metrics, namely emergency surgical case volume, length of stay (LOS), and case mix index (CMI). While the expected improvements in these areas are well documented and significant, the financial impact often extends far beyond these in providing hospitals a competitive advantage in improved performance and efficiencies throughout the organization.

Emergency Surgical Case Volume

In providing hospitals with a dedicated team of board-certified surgical partners providing 24/7 emergency general surgery care, our surgical hospitalist programs experienced an increase in surgical volume. With a highly qualified team in place to provide emergency surgical support, operations are performed more quickly and are no longer deferred until elective cases or clinic patients are completed. Also, the accessible, high quality trauma and acute care surgery programs we establish enable hospitals to create a culture of “yes,” typically increasing the number of patients transferred into the hospital for emergency surgeries and reducing the need for local patients to be transferred to other facilities to receive treatment for serious conditions requiring prompt surgery.

Length of Stay

Decreased length of stay is a key improvement directly related to the availability of 24/7 acute surgical care that is the cornerstone of our surgical hospitalist programs. Because emergency patients undergo surgery without delays, throughput within the hospital is typically improved and the availability of beds increases. Inherent in the improved length of stay metric is increased quality of care, as eliminating surgical delays reduces complication rates and improves outcomes for patients.  Improvement in the length of stay metric is well documented in peer-reviewed data from a five-year study of a Surgical Affiliates Surgical Hospitalist program with Sutter Memorial Medical Center published in the Journal of the American College of Surgeons (JACS).

Case Mix Index (CMI)

A core benefit of our surgical hospitalist programs is that we provide highly qualified surgeons who manage patients as a team in accordance with evidence-based guidelines, reducing variations in care and helping to standardize best practices across our programs. This standardization of care, in concert with the requirement that our surgeons provide documentation that supports the resources patients require, typically leads to significant improvement in CMI. Most of our programs achieve an improved CMI to 2.09, which is demonstrated in the peer-reviewed JACS study and also represents the average CMI of our current surgical hospitalist programs.

If you have questions about the results generated by the Acute Care Surgery Program Impact Calculator, or you’d like to learn more about our acute care surgery model and how it can help your hospital achieve improved quality outcomes and sustained cost savings, contact us today for a free program analysis consultation.

Learn about how today’s leading hospitals are working with Surgical Affiliates to implement 24/7 emergency surgical care. As well as how these hospitals address the fears many local surgeons have about the program’s impact on the surgical volume and team structure.

To overcome the challenges inherent in standard surgical care models, hospitals require systematic approaches that offer effective solutions to reduce transfers out of the hospital, improve current standards of care, and increase the number of surgery cases performed without sacrificing care quality.

While a surgical hospitalist program is designed to address these issues, there are several legitimate fears and misconceptions regarding these programs that are often raised by hospital medical staff. When unaddressed, these fears may perpetuate the repetitive care cycle that’s inefficient, costly, and associated with a higher risk of post-surgical complications.

The issue is, how do hospitals keep local surgeons happy under a surgical hospitalist program like the one offered from Surgical Affiliates? Also, how do hospitals prevent surgeons from threatening to take their services elsewhere when another group of acute care and emergency/trauma surgeons comes in?

Addressing the Fears of a Surgical Program

Despite the benefits of the Surgical Affiliates approach, there are some legitimate fears associated with this type of program that often prevents adoption.

When a third-party surgical team comes in to cover acute care and emergency surgery services, many hospitals fear that local on-call surgeons will find their position within the center threatened, resulting in surgeons taking their services to another hospital. The local on-call surgeons often own private practices and typically receive a stipend for emergency coverage, which helps to supplement their income. The fear of losing this stipend can provoke anxiety among local surgeons. Of course, one of the main goals is to ensure these professionals are satisfied, as they are typically prime sources of revenue for the hospital.

It’s appropriate to be concerned that an outside program will produce resentment among medical staff and result in a loss of business from the current cadre of local providers. However, the data does not support the notion that surgicalist programs decrease business — in fact, these programs help satisfy local surgeons and increase surgery caseload.

Keep reading to learn how Surgical Affiliates accomplishes this in hospitals across the nation.

How a Surgical Program Increases Business for Local Surgeons

One of the issues many hospitals have concerning a program like Surgical Affiliates is that surgeons may feel their position will become minimized following adoption. Fortunately, this surgical solution works with local surgeons and provides them options related to how and when they wish to practice, essentially resulting in zero loss in the number of cases they can perform in any given shift.

In general, hospitals participating in a surgicalist model feature an equal mix of surgeons – some surgeons want to focus on elective cases, some want the option of elective and/or emergency cases, and some want to focus purely on emergency care. Under the program, these options are available for all currently employed surgeons at the facility. And, if surgeons don’t want to take a call, they don’t have to. This can help them focus more on the elective cases that they enjoy — however, emergency cases are still theirs for the taking if they require or want the extra income.

A Surgical Program Provides Cost-Effective Care Despite Initial Investment

Another barrier to program engagement includes the initial costs associated with implementing a “‘round-the-clock acute emergency care surgical program.” Despite these fears, all hospitals under the program see a return on investment (ROI), due to Surgical Affiliate’s expertise in creating efficiencies and the program’s ability to manage surgical opportunities that may have otherwise been transferred to outside centers.

Additionally, with a greater number of on-site surgeons available for emergency surgical services, even rural hospitals become a reliable source of care in the community. This improved community-wide trust increases the number of cases that come into the hospital, thereby affecting the hospital’s bottom line.

Surgical Affiliates: Case Studies

In a retrospective 5-year study of the Surgical Affiliates strategy implemented in Sutter General Hospital in Sacramento, California, none of the surgeons in the hospital experienced a loss of business and all performed just as many operations during the 5-year period as they performed prior to program adoption. During these 5 years, complications, length of hospital stay, readmissions, and hospital costs significantly decreased for emergency cases, following the implementation of the acute care surgical model.¹

In fact, in every hospital that adopts the Surgical Affiliates program, emergency surgical volume steadily increases and the operative volume for local surgeons does not decline, despite all emergency operations being performed by the Surgical Affiliates team. NorthBay Medical Center in Fairfield, California, for instance, observed a 3.2% increase in the number of operations performed during a 2-year period. The center also observed an improvement in operating margins from a 3-year period of -2.1% in 2011 to .2% in 2012, and 6.3% in 2013.²

Learn More About Surgical Affiliates’ Surgical Program

Hospitals should present these findings to surgeons or other hospital personnel who may feel nervous about potential program adoption. Knowing the real-world data regarding how the program works and understanding how to communicate these findings to hospital staff may prevent surgeons from taking their elective surgical services elsewhere.

To learn more about the program offered by Surgical Affiliates and how it’s been successful for driving down hospital costs, reducing transfers and complication rates, and retaining and satisfying local surgeons, read through our case studies and take a look at our recent media stories demonstrating its effectiveness in today’s clinical setting.

References:

1. 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):90-98.

2. NorthBay Medical Center: Case Study. Surgical Affiliates data on file.

In this interview of the Behind the Knife Podcast, Lynette Scherer MD, FACS, Chief Medical Officer (CMO) of Surgical Affiliates, provides her take on important considerations for trauma surgeons, including early intervention, medication management, and communication among the surgical team. This podcast interview was conducted following Dr. Scherer’s talk, titled “Broken Bones – What the Trauma Surgeon Needs to Know,” presented at the 2018 Trauma, Critical Care & Acute Care Surgery (TCCACS) event held April 9-11, in Las Vegas, NV. Listen to the full interview at Behind the Knife.

“I love making a difference.” These 5 simple words are what Lynette Scherer MD, FACS, uses when asked about what makes her excited when it comes to trauma and acute care surgery.

Patients presenting the emergency room with traumatic injuries are often extremely sick and have a high mortality risk. Surgeons possessing many years of experience in trauma and general surgery substantially improve the chance of survival. This experience and skill set has driven the success of Dr. Scherer’s own practice as well as her contribution as Chief Medical Officer of Surgical Affiliates. “I think the breadth of what we do is great,” Dr. Scherer added, “and I feel like I make a difference when I go to work every day.”

Orthopedic Injury Management: Key Considerations from Dr. Scherer

Orthopedic injuries require a management approach that focuses on early intervention while maintaining quality care. Medication management is an important consideration in this setting, particularly among those with open fractures. According to Dr. Scherer, trauma surgeons need to pay close attention to delivering antibiotic treatment to patients with open fractures within a 60-minute window of hospital admission. “I realize that in some rural settings, the patient might not get to the hospital within 60 minutes, but the focus is on delivering antibiotics as soon as possible,” said Dr. Scherer. “In fact, doing this is just as important as your secondary survey.” Additionally, Dr. Scherer recommends having a goal of early termination of antibiotic therapy to ensure a positive outcome. “The other thing we have in our control is how long the patient is receiving antibiotics,” added Dr. Scherer. “The focus should be on getting these antibiotics turned off within 24-72 hours.”

The Importance of Early Intervention

Similar to most emergency surgeries, early intervention is key for improving prognosis in trauma patients, regardless of injury type. For femur fractures, however, certain challenges exist in many hospital settings that prevent timely surgical management. “I think it’s pretty well accepted on getting femur fractures fixed early,” Dr. Scherer explained, “but as we see fewer and fewer orthopedic surgeons who are willing or able to cover trauma surgeries, we’re starting to see a little bit of a push back on how quickly those femur fractures can be stabilized.” Early stabilization, according to Dr. Scherer, is key for favorable outcomes in these patients. Hospitals with a specialized 24-hour surgery team may be in a better position to ensure early intervention in these patients.

Timely Delivery to the OR

For individuals presenting to the hospital with an orthopedic injury, conventional wisdom states that these patients must be delivered to the operating room (OR) early, or at least within 6 hours of arrival. However, this isn’t always the case, particularly for low-risk injuries. “We now have pretty solid evidence, especially for the lower grade injuries, that these surgeries can be performed within 24 hours,” Dr. Scherer commented, “except for patients with grossly contaminated wounds. In that case, these wounds should be washed out as soon as possible.” Most often, a washout for contaminated wounds that count for the trauma registry “is the one that happens in the OR where devitalized tissue is debrided and the wound is completely washed out.”

Other Considerations for the Trauma Surgeon

In cases where a trauma patient has a head injury and has also developed venous thromboembolism (VTE), Dr. Scherer again advocates for early management, specifically in regard to VTE prophylaxis. “We like to start [VTE prophylaxis] within 24-48 hours after stable CT,” commented Dr. Scherer, “depending upon what kind of bleeding they had.” Communication within a neurosurgery team is also critical for appropriate management of these and other trauma patients. “I think communication with the neurosurgeons is critical, and sometimes it has to be over and over and over to get a group consensus,” Dr. Scherer explained, “and invariably there’s a discussion about patients with more complicated wounds.”

The emphasis on early presentation and treatment highlights the importance of having a robust, fully capable team of experienced and specialized trauma surgeons available to take on cases, regardless of the time of day. Surgical Affiliates works with existing hospital systems to support current surgical teams and improve standards of care by offering a 24-hour trauma and acute care service, facilitating earlier intervention and reduced transfers. To learn more about the program read through our real-world case studies here.

The pain associated with shattered bone, a sports injury, or a fractured hip can be frightening. Especially for those patients who find that treatment at their local hospital means waiting until an orthopedic surgeon can arrive. This delayed treatment is all too common across America and can substantially impact community trust while adversely impacting the overall financial status of the hospital system.

The Benefits of an Orthopedic Surgery Program

An orthopedic emergency that requires immediate surgical attention is usually the result of some type of trauma, either related to physical activity and recreation, violence, or an accident that occurs during normal activity. Types of injuries that require an orthopedic surgeon include:

• Hip fractures
• Dislocated bones
• Open (compound) fractures
• Acute compartment syndrome (extremity trauma)

Some of these injuries can be life threatening if not managed immediately. Unfortunately, some hospitals have few resources and orthopedic services on hand, resulting in delayed treatment and complications in these emergency situations.

Today, the demand for Orthopedic surgeons to provide hospital services is growing, yet issues to ensure continuity of care has proven challenging. The utilization of surgery programs, such as an Acute Orthopedic Surgery program, may provide a direct solution to this issue by introducing surgeons who are devoted to 24/7 orthopedic care.

An orthopedic surgery program means relying less on locum tenens and on-call physicians and more on reliable, stable surgeons who are available to handle patients at any time of the day or night. “I guarantee you we wouldn’t have orthopedic services if it wasn’t for Surgical Affiliates–there’s not a doubt in my mind,” said Doug Archer, Sutter Health Memorial Hospital administrator in Los Banos, California. In fact, approximately 60,000 people in the area would be without orthopedic services “and they would still be driving to Salinas” if it wasn’t for implementing an emergency orthopedic surgical team at Sutter Health Memorial.

In an orthopedic surgical program, also known as a surgicalist program, surgeons become embedded in the hospital culture and are essential for ensuring efficient patient management while reducing transfers out of the facility. Adding a specialized surgical program adds new dimensions to the hospital setting by increasing the number of patients treated in-house, reducing costs, increasing revenue, and building community value and trust.

Better Care and More Patients Treated In-House

Having an orthopedic surgery program in place reduces transfers out of the facility and provides a dedicated team of orthopedic surgeons that are able to treat patients in-house as opposed to sending to a neighboring hospital that is better equipped to handle orthopedic emergencies. Specialized services also help facilitate lower average length of stay for patients, which supports the value-based care model resulting in more efficient patient management.

Growth of Hospital Staff

According to Doug Archer, many physicians who would come to work in the surgery setting at Los Banos would be gone within 2 years of hiring, in part due to the rural setting. “Continuity of care became an issue,” said Archer. Since adding a specialized team of 24/7 emergency surgeons, Memorial Hospital has been able to secure a specialty program with surgeons that stay. “They [orthopedic surgeons] have been able to develop relationships with the other hospital staff,” added Archer, “and they’ve been able to establish themselves even though they don’t live in the community. Primary care physicians are a lot more comfortable referring to someone they know rather than the orthopedist on call, which helps the community a ton. It gives us the ability to really provide a robust and complete specialty service versus piecing it together with locum tenens.”

Surgical Affiliates Acute Orthopedic Surgery Program

With the Surgical Affiliates orthopedic surgery program, hospitals can rely on a long-term approach to achieving its orthopedic surgical goals, regardless of the community setting. For rural hospitals, the program may also be helpful when recruitment and retention become challenging.

Contact Surgical Affiliates today to learn more and start improving the quality of healthcare at both the patient and practitioner level.

In the United States, approximately 1.7 million patients per year sustain a traumatic brain injury.^1,2 Estimates from the CDC suggest that roughly 52,000 deaths are attributable to traumatic brain injury nationwide.³ Some of these patients require immediate neurosurgical intervention to survive, such as when a patient requires removal of an enlarging hematoma from around the brain.

In 2013, approximately 2.8 million visits to the emergency department were associated with brain injury.⁴ Today, experienced neurosurgeons who are willing to provide emergency care are in limited supply. It is particularly hard to find those who meet and fulfill the stringent requirements for the American College of Surgeons trauma verification. Many neurosurgeons find professional satisfaction by delivering care in an elective setting, further limiting the number of available neurosurgeons to care for emergencies. Subsequently, there is a growing need for surgeons who will readily take on emergency neurosurgical cases. A surgical hospitalist program may provide the optimal solution when neurosurgeons don’t heed the emergency call.

Why Neurosurgeons Don’t Answer an Emergency Call

The workload of most surgeons has become increasingly difficult to maintain. On-call burdens and the pressure to produce more elective volume have contributed to the declining availability of surgeons for emergency care, and this is especially true for neurosurgeons. Many of today’s neurosurgeons have chosen to focus on providing high-level elective care that focuses on specialty cases. Emergency care is disruptive to this sort of an elective practice and often times emergency patients don’t have the means to provide payment for such services. The disruption of the elective practice and the inability to be paid for services to reduce the likelihood that neurosurgeons will happily embrace the emergency call burden.

According to Lynette Scherer, MD, FACS, Chief Medical Officer of Surgical Affiliates, the need in helping emergency neurosurgery patients has quadrupled in recent years because there has been a significant shortage of neurosurgeons who are willing to take emergency cases. Additionally, since many neurosurgeons perform elective cases, hospitals aren’t pressuring these highly specialized physicians to take cases they don’t want. “Neurosurgeons can really command a presence at the hospital because their cases are so valuable to the hospital and the care they provide is so critical,” said Dr. Scherer, “and the hospital often won’t force them to take the emergency call as long as they are doing their elective cases.”

Impact on Patients Requiring Emergency Neurosurgery

The lack of hospital neurosurgeons to provide care for emergency cases can result in delayed patient care and the worsening of patient outcomes. Additionally, when a neurosurgeon doesn’t answer an emergency call, hospital efficiency will subsequently be impacted since staff will need to take the time to find someone that will help the patient.

Hospitals in rural communities are especially affected by neurosurgeons who refuse to take on emergency neurosurgical cases. “If a patient shows up in a small rural center looking for help,” commented Dr. Scherer, “that hospital may be calling for hours trying to locate a neurosurgeon.” Hospitals in major metropolitan areas, although better connected and more likely to find a surgeon to help in an emergency case, are also impacted by the shortage of willing emergency neurosurgeons. Many patients have to be transferred to a center that will take them, which delays treatment for potentially life-threatening issues.

The Surgicalist Approach for Emergency Neurosurgery Cases

The surgicalist program with Surgical Affiliates offers a one-of-a-kind initiative for the field of neurosurgery. This program provides neurosurgeons who are willing and ready to take on an emergency neurosurgical procedure. At Surgical Affiliates, there is a 24/7 neurosurgery team available for emergency cases, such as cases involving epidural hematomas, traumatic brain injury, acute or infectious spinal cord processes, or stroke-related care. Hospitals who can’t find a neurosurgeon to answer an emergency case can simply partner with Surgical Affiliates who will provide a team of neurosurgeons available for immediate care.

Learn How a Surgicalist Program Can Improve Neurosurgical Care

Currently, Surgical Affiliates is the first organization to offer a surgicalist program for neurosurgery and is seen as the leader in facilitating greater and more immediate care for patients presenting with life-threatening neurosurgical problems.  If you wish to learn more about the surgicalist approach and how you can use it to improve the level of care your emergency neurosurgery patients can receive, contact us today for a free program analysis consultation.

References

1. Faul M, Xu L, Wald MM, et al. Traumatic brain injury in the United States: national estimates of prevalence and incidence, 2002–2006. Injury Prevention. 2010;16: A268.
2. Annual Number of TBIs. Centers for Disease Control and Prevention. https://www.cdc.gov/traumaticbraininjury/pdf/tbi_blue_book_annualnumber.pdf. Accessed December 8, 2017.
3. Get the Stats on Traumatic Brain Injury in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/traumaticbraininjury/pdf/bluebook_factsheet-a.pdf. Accessed November 8, 2017.
4. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths — the United States, 2007 and 2013. MMWR Surveill Summ. 2017;66(No. SS-9):1–16.

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.