Achieving hospital/physician alignment and standardised care for emergency surgery: The new model for acute care surgery

Abstract

Hospitals today must find ways to build hospital/physician alignment throughout the facility in order to achieve the goal of quality care, standardised according to best practices. The pressures of pay for performance, accountable care and population health management demand that hospitals optimise their clinical services and efficiency in every service line. The area of emergency surgery is no exception. A hospital that is able to improve patient outcomes, reduce complications and effectively manage length of stay for its emergency surgeries is better positioned to capture more of its patient demographic. The hospital's most at-risk patient group receives standardised care according to best practices and practice management guidelines 24/7, ensuring high-quality care and better performance outcomes for the hospital. At the same time, continuous quality improvement initiatives touch multiple hospital departments, raising the bar on performance throughout the facility. As a result of this quest for improvement, a new model for acute care surgery has been developed, consisting of the application of the clinical standards that have been so successful in upgrading trauma care, applied to other acute care surgery settings; surgical hospitalists organised into teams of surgeons based in the hospital 24/7; expansion of these surgery teams to cover trauma, orthopaedics and acute care surgeries; development of site-specific best practices standards; and collaboration with all departments in the hospital to raise the bar on performance and efficiency. Recent research shows the results that these new programmes are achieving in hospitals ranging from the academic medical centre to the community hospital. Metrics document improved patient outcomes, reductions in complications, reduced length of stay, appropriate Case Mix Index due to better documentation and decreased cost per case. Better coordination of care and communication with patients and families from these programmes also positively influences patient satisfaction. There are now 18 fully accredited American Association for the Surgery of Trauma fellowship programmes focusing on the acute care surgery track, a major step forwards to formalise the specialty of acute care surgery in the profession of medicine. This paper examines the challenges to achieving standardised care for emergency surgeries, describes the new model, examines the research on its results and outlines how these results will impact the overall hospital performance.