Abstract
IntroductionAcute care surgical services provide timely comprehensive emergency general surgical care while optimizing the use of limited resources. At our institution, 50% of the daily dedicated operating room (OR) time allocated to the Acute Care Emergency Surgery Service (ACCESS) came from previous elective general surgery OR time. We assessed the impact of this change in resource allocation on wait-times for elective general surgery cancer cases.MethodsWe retrospectively reviewed adult patients who underwent elective cancer surgeries in the pre-ACCESS (September 2009 to June 2010) and post-ACCESS (September 2010 to June 2011) eras. Wait-times, calculated as the time between booking and actual dates of surgery, were compared within assigned priority classifications. Categorical and continuous variables were compared using chi-square and Mann–Whitney U tests respectively.ResultsA total of 732 cases (367 pre-ACCESS and 365 post-ACCESS) were identified, with no difference in median wait-times (25 versus 23 days) between the eras. However, significantly fewer cases exceeded wait-time targets in the post-ACCESS era (p <0.0001). There was a significant change (p = 0.027) in the composition of cancer cases, with fewer breast cancer operations (22% versus 28%), and more colorectal (41% versus 32%) and hepatobiliary cancer cases (5% versus 2%) in the post-ACCESS era.ConclusionThese results suggest that shifting OR resources towards emergency surgery does not affect the timeliness of surgical cancer care. This study may encourage more centres to adopt acute care surgical services alongside their elective or subspecialty practices.
Highlights
Acute care surgical services provide timely comprehensive emergency general surgical care while optimizing the use of limited resources
We identified a total of 732 patients who underwent cancer surgery by the general surgeons at Victoria Hospital (VH) across the two study periods (Table 2)
There were 365 elective cancer surgeries performed in the post-Acute Care Emergency Surgery Service (ACCESS), compared to 367 cases performed in the pre-ACCESS period
Summary
Acute care surgical services provide timely comprehensive emergency general surgical care while optimizing the use of limited resources. Acute care surgery (ACS) is a distinct surgical care model that provides dedicated comprehensive care for general surgical emergencies such as acute appendicitis, cholecystitis, bowel obstruction, perineal sepsis, and perforated viscus [1,2,3] This model has proven to be an innovative and cost-effective strategy of delivering emergency surgical care to patients [1,3], resulting in significantly shorter wait-times for urgent and emergent. At the London Health Sciences Centre (LHSC) - Victoria Hospital, the Acute Care and Emergency Surgery Service (ACCESS) was established in July 2010 when the growing need for organized emergency general surgery coverage was recognized by the Division of General Surgery, the Emergency Department, and hospital leadership In this model, a single staff surgeon suspends their elective practice while covering ACCESS for one week at a time (Monday to Monday), and their previously-allocated elective OR time for the week (15 hours) is subsumed into the daily dedicated ACCESS OR time. The team is assigned a full complement of housestaff
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