2021 General Surgery Presentations

MSS06: THE IMPACT OF A DEDICATED ACUTE CARE SURGERY SERVICE ON TEAM EFFICIENCY AND RESIDENT EDUCATION AT A MILITARY LEVEL 1 TRAUMA HOSPITAL
Phillip M Kemp Bohan; Anne E O'Shea; Robert C Chick; Emily A Pospiech; Jason S Radowsky; Robert W Krell; Valerie G Sams; Brooke Army Medical Center

Objectives: Dedicated acute care surgery (ACS) teams manage emergency general surgical consults for a hospital system, offloading workload from the trauma and general surgical teams with elective cases and clinic responsibilities. Implementation of a new service can introduce inefficiency and impact resident education by redistributing case volume. At our institution, an ACS service was created in June 2020 and consisted of a dedicated staff, chief resident, midlevel resident, multiple interns, and a dedicated weekday operating room. The team fielded all ACS consults during daytime hours. Overnight consults were evaluated by the in-house trauma staff but admitted to the ACS service. Here, we evaluated the impact of the new ACS service at our military institution on patient throughput and resident experience.

Methods: We conducted a retrospective review of laparoscopic appendectomies (LA) and cholecystectomies (LC) performed for ACS diagnoses before (December 2019-March 2020) and after (July 2020-October 2020) creation of the ACS service. Outcome data (time from consult to operation, time from operation to discharge, and length of stay (LOS)), and resident experience (number of cases performed by the day ACS service and of cases passed off to the oncoming team) were recorded.

Results: 223 patients were included (pre-ACS: n=108; post-ACS: n=115); 112 underwent LA while 111 underwent LC. Among LAs and LCs there were no differences in median time from consult to operation (LA: 2.4 hours vs 2.4 hours, p=0.44; LC: 14.0 hours vs 19.3 hours, p=0.87), time from operation to discharge (LA: 16.1 hours vs 12.8 hours, p=0.07; LC: 19.9 hours vs 21.0 hours, p=0.19), and LOS (LA: 21.1 hours vs 18.6 hours, p=0.18; LC: 38.5 hours vs 43.6 hours, p=0.72) between pre- and post-ACS groups. On subgroup analysis of non-perforated appendicitis (n=47 pre-ACS; n=51 post-ACS), median time from operation to discharge became significantly shorter (15.4 hours vs 10.2 hours, p=0.02). There were no differences in proportion of cases performed by the day team (59% pre-ACS, 57% post-ACS; p=0.70) or passed to the oncoming team (39% pre-ACS, 44% post-ACS; p=0.41).

Conclusions: Implementation of an ACS service resulted in minimal disruption and reduced post-operative length of stay for patients undergoing LA for non-perforated appendicitis. This transition occurred in a time where nearly all hospital activity was affected by coronavirus hospital protocols. The ACS service preserved case volume for both the day and overnight call teams, maximizing resident education while reducing the burden on the trauma and elective surgical services.