It’s early in the morning and a loved one suddenly awakes with a sharp abdominal pain, accompanied by nausea and a low grade fever. Not wanting to take any chances, you rush her to the emergency room of a local hospital. Here, the ER physician may diagnose the condition, but if emergency surgery is required it may take several hours before a surgeon arrives at the hospital to perform it.
That’s not the case at Jersey City Medical Center and an increasing number of other hospitals, where a board certified general surgeon is at the hospital 24/7 to handle such emergencies. Known as Acute Care Surgery, it’s a relatively new surgical specialty that can be defined as the urgent assessment and treatment of non-trauma general surgical emergencies. This may include treating such common conditions as appendicitis, diverticulitis, bowel obstruction, perforated ulcers, gall bladder infections, and postoperative complications.
Acute Care Surgery is staffed with general surgeons, who are also trained in trauma and emergency general surgery and critical care, and routinely take care of the sickest patients in the hospital.
An Acute Care Surgery patient may be one who is:
- Transferred from an outside hospital with a complicated surgical need requiring specialized surgical care
- An admission from the Emergency Department with an acute surgical need night or day
- A hospitalized patient who may additionally require acute surgical intervention.
“This is a growing area of care that’s beginning now to catch on at many regional medical centers and major teaching hospitals,” said Dr. Sherwin Schrag, an acute care surgeon at Jersey City Medical Center. “It’s a model that is still not commonly practiced at most hospitals for the simple reason that there are relatively few general surgeons. Many primary care physicians may not even be aware of it. For patients, however, having a surgeon at the hospital to perform an emergency surgery can make a huge difference in the eventual patient outcome.”
Recent studies concur with Dr. Schrag. Research conducted by the American College of Surgeons, a scientific and educational organization of surgeons, found that the use of Acute Care Surgery can lead to significant reductions in various key patient measures. This includes length of hospital stay, surgical decision-making time, and “time to stretcher” (which is a measure of overall emergency department overcrowding, a major problem in many American hospitals).
According to the study’s authors, “In the past five years, there has been a groundswell of support for establishment of these services for a variety of reasons, such as the growing difficulty of treating acute surgical conditions and a decrease in operative trauma surgical cases.”
The study further found that Acute Care Surgery services was associated with a 15 percent reduction in surgical decision time and a 20 percent decrease in the average “time to stretcher” time for all ED patients. Focusing on an isolated group of appendicitis cases, it was found that these services shaved surgical decision time by 30 percent for these patients.
“Studies have also found that the Acute Care Surgery model results in significant decreases in time from consultation to operating room; complication rate; and rupture rate,” said Dr. Schrag, who is double board certified. “When you’re talking about the care of a loved one, these are all important criteria. The bottom line is that you don’t want a family member or friend sitting in a hospital bed at 3 in the morning waiting in discomfort for a surgeon to show up hours later.”