Nontrauma Emergency Surgery: Optimal Case Mix for General Surgery and Acute Care Surgery Training

• DOI: 10.1097/ta.0b013e318232ced1
• Publication Date: 2011-11-10T10:08:07Z
• Authors: Jill R. Cherry-Bu...; Barbra S. Miller; Gerard M. Doherty; Melissa E. Brunsvold; Mark R. Hemmila; Pauline K. Park; Krishnan Raghaven...; Kristen C. Sihler; Wendy L. Wahl; Stewart C. Wang; Lena M. Napolitano
• Keywords: Case mix index; Exploratory laparotomy

To examine the case mix and patient characteristics outcomes of nontrauma emergency (NTE) service in an academic Division Acute Care Surgery.An NTE (attending, chief resident, postgraduate year-3 year-2 residents, two physician assistants) was created July 2005 for all urgent emergent inpatient department general surgery consults admissions. An database with prospective data collection admissions initiated from November 1, 2007. Prospective were collected by a dedicated trauma registrar Physiology Chronic Health Evaluation-intensive care unit (ICU) coordinator daily. ICU reviewed 2-year time period January 2008, through December 31, 2009. During same period, operative cases procedures examined compared mix.Thousand seven hundred eight patients admitted to during this (789 2008 910 2009). Surgical intervention required 70% service. Exploratory laparotomy or laparoscopy performed 449 patients, comprising 37% surgical procedures. In comparison, only 118 (5.9% admissions) major thoracotomy period. Acuity illness high, significant portion (13%) requiring admission. had higher admission Evaluation III scores [61.2 vs. 58.8 (2008); 58.2 55.8 (2009)], increased mortality [(9.71% 4.89% 6.78% 5.16% readmission rates (15.5% 7.4%) total (SICU) admissions.In era declining caseload trauma, provides ample opportunity complex decision making residency education, including advanced critical management. addition, creation optimal mix, abdominal operations, that can augment caseloads, maintain acute faculty skills, support training.