Abstract
There was a fast growth in the number and the formation of emergency department (ED) visits in China during the twenty-first century. As a result, engaging special medical model will be essential to decompressing the ED visits. To do this, it will be important to understand which specific aspects to focus interventions on for the greatest impact. To characterize the emergency surgery patients who were seen and discharged from ED. Retrospective cohort study of hospitalized emergency surgery patients currently under the care from specialists presenting to an urban, university affiliated hospital between 01 January 2018 and 1 January 2019. This study will highlight some of the controversies and challenges and key lessons learned. During the study period there were 231,229 ED visits; 4100 of these patients were admitted for Acute care surgery (ACS) service. Multivariate analysis identified age ≧ 65 (p = 0.023; odds ratio, OR = 2.66), ACS model (p = 0.000, OR = 0.18), ICU stay (p = 0.000, OR = 118.73) as factors associated with in-hospital mortality. There was a increase in length of stay between young and elderly postoperative patients when stratifying patients by age (11.67 ± 9.48 vs 13.95 ± 9.11 p < 0.05). ED overcrowding is not just an ED problem. ED overcrowding is a systems problem requiring a systematic facility-wide multidisciplinary response. Continuous and high-quality surveillance data across China are needed to estimate the acute care surgery model which used to deal with ED overcrowding.
Highlights
IntroductionEmergency general surgery (EGS) and trauma patients have always been an integral part of surgical care, the field of acute care surgery (ACS) as a surgical specialty is a relatively new concept
Abbreviations ACS Acute care surgery low-income and middleincome countries (LMICs) Low-income and middle-income countries emergency general surgery (EGS) Emergency general surgery AAST The American association for the surgery of trauma emergency department (ED) Emergency department International Classification of Diseases (ICD) International classification of diseases length of stay (LOS) Length of stay Fast Track Acute Care Surgery (FTACS) Fast track acute care surgery Enhanced Recovery after Surgery (ERAS) Enhanced recovery after surgery
There were ten specialties ED represented in our hospital: surgical emergency, medical emergency, stomatological emergency, gynecological emergency, obstetric emergency, dematological emergency, neurosurgical emergency, neurology emergency, Ophthalmic emergency and pediatric emergency
Summary
Emergency general surgery (EGS) and trauma patients have always been an integral part of surgical care, the field of acute care surgery (ACS) as a surgical specialty is a relatively new concept. Prior studies have demonstrated the ACS model can improve work flow and provide more effective delivery of care for patients with common urgent general surgery diagnoses without an increased rate of complications[2]. According to the “China Health Statistical Yearbook Compiled by the National Health and Family Planning Commission”, the number of emergency department (ED) visits in Chinese hospitals has increased significantly from 107,805,396 in 2012 to 166,489,807 in 2017 over a 6-year period (http://www.yearbookchina.com/) (Fig. 1). Due to high volumes of emergency surgery, a special ACS model was developed at a Third Grade Class A hospital in Harbin, Heilongjiang province, China. The aim of this study was to describe the structure of the ACS service in our hospital, the epidemiology of ACS and summarize experience to improve the efficiency of ACS service
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