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In an ad hoc committee of the American Association for the Surgery of Trauma AAST published a proposal for restructuring the role of the trauma surgeon, renaming the field acute care surgery. ACS would encompass elective and emergency general surgery, trauma surgery, and surgery critical care. This new paradigm would use shift-based hour coverage schedules. The goal of the program would be to provide the ACS physician with operative experience in general trauma, an elective surgery practice and some subspecialty procedures associated with trauma. The ACS program would be flexible enough to tailor the practice to the needs and desires of the institution and acute care surgeon ACSu.
Since , there has been a rapid increase in the demand for the ACSu throughout the United States in both academic and private practice. This includes surgeons trained in surgical critical care and trauma and surgical hospitalists, who are general surgeons that provide emergency general surgery care.
Introduction
The ACS model provides hospitals with an in-house surgeon around the clock. Inconvenient and disruptive ER calls to general surgeons are diverted thus allowing elective cases to proceed unhindered during the day. There is increased reimbursement to the hospital and the ACSu, and better patient care. Post-implementation studies at these institutions noted increased satisfaction of the surgery residents, fellows, and trauma surgeons. Academic institutions have found that implementation of the EGS and the hiring of acute care surgeons provide much needed relief for generalists, increased operating room efficiency, and decreased patient wait time.
physician assistant residency.
Community hospitals have also integrated ACS successfully. For example, one acute care surgeon trained in surgery critical care covers all emergent cases during the day and the limited critical care needs for a seven-surgeon group. This surgeon also covers any undesignated consults. The surgeon group rotates night and weekend call. The Emergency Department at this hospital has been pleased to have a surgeon immediately available to see consultations and the patients have been happy for the decreased waiting time for evaluation and operations.
This acute care surgeon enjoys the wide variety within the practice and the partners enjoy having much less disruption to their daily schedules and elective cases.
Acute Care Surgery at EVMS
AAST-approved programs are required to include certain elements within their curriculum and complete an evaluation and inspection process by AAST; they must also already have a well-established surgery critical care program. This has not been the case at institutions implementing these programs. Orthopedic and neurosurgeons have expressed concerns about expanding the scope of practice of ACS and have been reluctant to participate in teaching their specialty-specific procedures. The idea of a more lifestyle conscious surgical specialty appeals to many medical students, especially women interested in surgery.
An ongoing thread has developed on www. With greater than 20 institutions awaiting AAST certifications and many institutions developing sections within their departments, it is evident clear ACS enhances surgical care and trauma and is academically robust. Many private hospitals have developed emergency general surgery teams staffed by ACSu. Surgical journals have multiple advertisements for acute care surgery positions throughout the United States. The ACS movement initiated in the late s, and defined in by the AAST, has provided a unique opportunity to redefine and enhance the role of the general surgeon within the health care system.
ACS is likely to become an integral part general surgery and may increase the number of trained general surgeons and trauma surgeons.
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Author information Copyright and License information Disclaimer. Copyright by the Missouri State Medical Association. This article has been cited by other articles in PMC.
Abstract These are uncertain times for general surgery residents. Introduction When I first became interested in surgery, I was lucky enough to attend the Clinical Congress. Why is Trauma Care Losing Favor? Open in a separate window. A Possible Solution to Improve Trauma Care Hospitals want surgeons to provide trauma coverage and injured patients need trauma surgeons. This includes surgeons trained in surgical critical care and trauma and surgical hospitalists, who are general surgeons that provide emergency general surgery care.
The ACS model provides hospitals with an in-house surgeon around the clock. Inconvenient and disruptive ER calls to general surgeons are diverted thus allowing elective cases to proceed unhindered during the day. There is increased reimbursement to the hospital and the ACSu, and better patient care.
The acute care surgeons and the elective general surgeons they work with are happier and practice more efficiently.
Mo Med - Sept Oct 2010
Post-implementation studies at these institutions noted increased satisfaction of the surgery residents, fellows, and trauma surgeons. Academic institutions have found that implementation of the EGS and the hiring of acute care surgeons provide much needed relief for generalists, increased operating room efficiency, and decreased patient wait time.
Community hospitals have also integrated ACS successfully. For example, one acute care surgeon trained in surgery critical care covers all emergent cases during the day and the limited critical care needs for a seven-surgeon group. This surgeon also covers any undesignated consults.
The surgeon group rotates night and weekend call. The Emergency Department at this hospital has been pleased to have a surgeon immediately available to see consultations and the patients have been happy for the decreased waiting time for evaluation and operations. This acute care surgeon enjoys the wide variety within the practice and the partners enjoy having much less disruption to their daily schedules and elective cases. AASTapproved programs are required to include certain elements within their curriculum and complete an evaluation and inspection process by AAST; they must also already have a well-established surgery critical care program.
Acute Care Surgery: Redefining the General Surgeon
This has not been the case at institutions implementing these programs. Orthopedic and neurosurgeons have expressed concerns about expanding the scope of practice of ACS and have been reluctant to participate in teaching their specialty-specific procedures. The idea of a more lifestyle conscious surgical specialty appeals to many medical students, especially women interested in surgery. An Ongoing thread has developed on www. With greater than 20 institutions awaiting AAST certifications and many institutions developing sections within their departments, it is evident clear ACS enhances surgical care and trauma and is academically robust.
Many private hospitals have developed emergency general surgery teams staffed by ACSu. Surgical journals have multiple advertisements for acute care surgery positions throughout the United States. ACS is likely to become an integral part general surgery and may increase the number of trained general surgeons and trauma surgeons.
Principles and Practice Accessed April 30, Effects of an organized critical care service on outcomes and resource utilization: Criti Care Med February 27 2: A new solution for emergency surgical care? Published by Mo Med. This page can be found at http: