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Introduction: Emergency General Surgery (EGS) represent a wide spectrum of diseases with high complication and mortality rates. Race, insurance, and socioeconomic status have been associated with mortality in EGS patients. Acute care surgery (ACS) models have previously shown improved outcomes for EGS patients. We hypothesized that transition to an ACS model would increase access to care for underserved and higher risk EGS patients in a community hospital, without a change in mortality., Methods: This retrospective cohort study included adult EGS patients from 2017 to 2021 with current procedural terminology (CPT) codes of colectomy, small-bowel resection, peptic-ulcer surgery, appendectomy, or cholecystectomy. In July 2020, the hospital transitioned from a traditional model to an ACS model. Patients were analyzed for 42-month before (pre-ACS) and 18-month after (post-ACS) transition. Primary outcome was mortality; secondary outcomes were 30-day postoperative emergency department visits and readmission., Results: We analyzed 467 pre-ACS and 238 post-ACS patients. After transition, patients were more likely to be Black, older, self-pay, and have higher Elixhauser Comorbidity Index (ECI) scores. Rates of cholecystectomies increased and appendectomies decreased after transition. Adjusting for age, race, and ECI, there were no changes in 30-day all-cause mortality (0.9% versus 2.1%, P = 0.63), length of stay (2.7-days versus 3-days, P = 0.91) and rate of postop emergency department visits (7.5% versus 11.3%, P = 0.16). There was a significant increase in hospital readmission after the ACS transition (5.1 versus 10.5%, P = 0.001, odds ratio 5.3)., Conclusions: After implementation of an ACS model, we found an increase in EGS patients who were older, Black, underinsured, with higher ECI without change in mortality. Implementation of ACS models at community hospitals may increase access to quality care for underserved and higher risk patient populations., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The Emergency General Surgery (EGS) population is particularly at high risk for readmission. Currently, no system exists to predict which EGS patients are most at risk. We hypothesized that a subset of EGS patients could be identified with increased 30-day unplanned readmission. We also hypothesized that a majority of readmissions occur sooner than the conventional 2-week follow-up period., Methods: National Surgical Quality Improvement Program (NSQIP) nonelective general surgery patients were analyzed. Multivariable logistic regression identified factors with increased odds of unplanned readmission. AAST EGS Diagnosis Categories were used to categorize postop ICD-9 codes, and the top 10 CPT codes in each group were analyzed. Readmission rate, the reason for unplanned readmission, and time to readmission were analyzed., Results: A total of 383,726 patients were identified with a readmission rate of 8.1% within 30 d of their primary procedure. The top 50 CPT codes accounted for 84% of EGS readmissions. Increased readmission risk was demonstrated for underweight patients (OR = 1.15, P < 0.05). High-risk hospital characteristics were LOS >2 d, any inpatient pulmonary complications, and discharge to any facility or rehab (all P < 0.05). Surgical site infections cause nearly 25% of readmissions. Intestinal procedures are most frequently readmitted (22% of EGS readmissions), with colorectal procedures having the higher odds of readmission. Most readmissions occur <10 d after discharge., Conclusions: A high-risk subpopulation exists within EGS, and most readmissions occur sooner than a typical 2-week follow-up. Early interventions for high-risk EGS subpopulations may allow for early intervention and reduction of unnecessary healthcare utilization., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Emergency general surgery (EGS) admissions account for more than three million hospitalizations in the US annually; and interhospital transfers (IHTs) are costly. We aimed to better understand the population of transferred EGS patients and their subsequent care in a nationally representative sample., Methods: Using the 2002-2011 Nationwide Inpatient Sample, we identified patients aged ≥18 years with an EGS noncardiovascular principal diagnosis who were transferred from another hospital with urgent or emergent admission status. Patient demographics, hospitalization characteristics, rates of operation, and mortality were identified. Procedure codes were classified into surgery and procedures based on the HCUP Surgery Flag., Results: We identified an estimated 525,913 EGS admissions transferred from another acute care hospital. The mean age was 60 years, 51% were female, and >50% were Medicare patients. The rate of EGS IHTs increased while mortality decreased. Surgery was required for only 33% of transferred patients. The most common surgeries were laparoscopic cholecystectomy, lysis of adhesions, and wound debridement. The median length of stay was 4.4 days, 92% of patients were cared for in urban hospitals, and >50% in teaching hospitals., Conclusions: The percent of patients with an EGS diagnosis requiring IHT is increasing, which may reflect a trend toward regionalization of EGS. Transfers require significant resources and may delay care. More than half of the EGS patients did not require surgical intervention. Future studies to identify populations who benefit from IHT and ideal timing of transfer can establish opportunities for optimizing resource utilization and patient outcomes., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: Work rules have changed medical education. Knowledge previously acquired by experience must now be actively taught to avoid prolonging the training period. We report the feasibility of and clinical clerk opinions regarding a novel simulated floor management course to teach patient care concepts required on the surgical wards., Methods: We created a hospital ward with simulators exhibiting physical exam findings and active vital signs. Surgical clerks gathered data during "morning rounds," wrote notes, and provided care. An acute event allowed students to participate in active evaluation and treatment. Findings and plans were communicated to their "chief resident," a surgical attending. We distributed a survey to participants to determine attitudes and opinions about the course., Results: The course required five faculty, two medical educators, four surgical house staff, and 2.5 h to accommodate 40-50 students. Faculty and surgical house staff provided guidance and feedback on clinical skills. Fifty students completed the survey (56% response rate). Most clinical clerks thought that the simulated floor management course improved their understanding of medical management of surgical issues (66%) and their documentation skills (78%). Clinical clerks reported that attending involvement made the experience more valuable (89%) and was not intimidating (66%). Most expressed an interest in participating in more clinical scenarios (72%)., Conclusions: A simulation course for teaching patient care concepts is feasible and regarded positively by clinical clerk participants. Further development and use of such simulated patient care exercises may be an effective adjunct for training future house staff and hospital staff in patient care in a time of shifting work hour paradigms., (Copyright © 2012 Elsevier Inc. All rights reserved.)