ABSTRACT
Having surgicalists on staff could benefit hospitals as value-based reimbursement becomes the industry standard. A dedicated team can help improve key metrics, such as a patient experience and quality of care.
Subject(s)
Emergency Service, Hospital , General Surgery , Medical Staff, Hospital , Models, Organizational , Leadership , Patient Satisfaction , Quality Assurance, Health CareABSTRACT
A surgical hospitalist program can address issues with surgical call coverage and help organizations prepare for value-based payment. Such a program can improve timeliness of care and reduce complications, length of stay, and costs. A surgical hospitalist program at one California hospital saved the organization an estimated $2 million a year.
Subject(s)
After-Hours Care , Efficiency, Organizational/economics , Hospitalists/economics , Surgeons , Diagnosis-Related Groups/statistics & numerical data , Humans , Postoperative Complications/epidemiology , United States/epidemiologyABSTRACT
BACKGROUND: The use of an acute care surgical model has been shown to improve patient care and efficiency. We propose that it is possible to apply this model to emergency general surgery patients at a nontrauma hospital. With this acute care surgery service, no change in the quality of care will occur, and improvements in quality, cost, and outcomes may be achieved and sustained. STUDY DESIGN: A retrospective review was performed of all emergency surgery operations performed at a tertiary referral community hospital without a trauma service. Data were collected from 1 year before and each year up to 4 years after the implementation of an acute care surgical (ACS) service. RESULTS: There were fewer overall complications with ACS (21% to 12%, p < 0.0001), and a shorter length of stay (6.5 days to 5.7 days, p = 0.0016). Hospital costs fell from $12,009 to $8,306 (p < 0.0001). Post-appendectomy complications decreased (13% to 3.7%, p < 0.0001), length of stay was shorter (3.0 to 2.3 days, p < 0.0001), and hospital costs decreased from $9,392 to $5,872 (p < 0.0001). Post-cholecystectomy complications decreased (21% to 9%, p = 0.012), length of stay was shorter (5.3 to 3.8 days, p = 0.0004), and hospital costs decreased from $12,526 to $9,348 (p < 0.0001). CONCLUSIONS: An acute care surgery service can be successfully implemented at a nontrauma hospital. The improvements seen in outcomes and finances are sustainable over time. This sort of coordinated, consistent care is successful and allows alignment of the goals of surgeons, hospitals, and patients.
Subject(s)
Critical Care/organization & administration , Hospital Costs/statistics & numerical data , Models, Organizational , Quality Improvement , Surgical Procedures, Operative , Tertiary Care Centers/organization & administration , California , Critical Care/economics , Critical Care/standards , Emergencies , Humans , Length of Stay/statistics & numerical data , Outcome and Process Assessment, Health Care , Postoperative Complications/economics , Postoperative Complications/epidemiology , Retrospective Studies , Surgical Procedures, Operative/economics , Surgical Procedures, Operative/standards , Tertiary Care Centers/economics , Tertiary Care Centers/standardsABSTRACT
BACKGROUND: In medical settings, motivational interviewing-based "brief intervention" (BI) counseling reduces alcohol-related risk-taking behavior and harm in high-risk populations. Individuals arrested for driving under the influence of alcohol (DUI) are another at-risk population. We sought to determine whether a BI administered shortly after a first DUI arrest might decrease problematic drinking behavior. METHODS: We conducted a single-center, parallel-group, double-blinded superiority randomized trial (NCT01270217), enrolling first-time DUI arrestees at a county jail from December 2010 through April 2011. Before their release, we randomized participants by computer-generated sequence to either a single BI or no discussion. We assessed 90-day change in Alcohol Use Disorders Identification Test (AUDIT) scores (range 0-40, higher values indicating more problematic drinking) as the primary outcome. RESULTS: We enrolled 200 subjects (100 to each arm), and 181 (90.5%, 86 control and 95 BI) completed the 90-day follow-up. Mean (SD) age was 30 (10) years, and 50% were men. Mean (SD) blood alcohol concentration upon arrest was 0.14% (0.04%). Mean (SD) baseline AUDIT scores were 8.8 (5.8) among control subjects and 7.7 (6.3) among BI subjects. At 90 days, AUDIT scores decreased by a mean (SD) 4.7 (5.1) units among control subjects and 3.4 (5.0) among BI subjects (difference, -1.3; 95% confidence interval [CI], -2.8 to +0.1). The likelihood of subsequent binge drinking [relative risk (RR) 1.6; 95% CI, 0.8-3.0; BI vs. control], abstinence (RR, 0.9; 95% CI, 0.4-2.1), alcohol-related injury to self or others (RR, 0.4; 95% CI, 0.1-2.4), and seeking treatment (RR, 1.2; 95% CI, 0.8-1.7) did not differ. CONCLUSION: A single BI counseling session shortly after first-time DUI arrest does not reduce 90-day self-reported drinking behavior or increase seeking treatment for drinking beyond that which occurs without such a discussion. LEVEL OF EVIDENCE: Therapeutic study, level III.
