Barnes Stephen L, Cooper Christopher J, Coughenour Jeffrey P, MacIntyre Allan D, Kessel James W
Division of Acute Care Surgery, Department of Surgery, University of Missouri, Columbia, Missouri 65203, USA.
J Trauma. 2011 Oct;71(4):1027-32; discussion 1033-4. doi: 10.1097/TA.0b013e3182307146.
The face of trauma surgery is rapidly evolving with a paradigm shift toward acute care surgery (ACS). The formal development of ACS has been viewed by some general surgeons as a threat to their practice. We sought to evaluate the impact of a new division of ACS to both departmental productivity and provider satisfaction at a University Level I Trauma Center.
Two-year retrospective analysis of annual work relative value unit (wRVU) productivity, operative volume, and FTEs before and after establishment of an ACS division at a University Level I trauma center. Provider satisfaction was measured using a 10-point scale. Analysis completed using Microsoft Excel with a p value less than 0.05 significant.
The change to an ACS model resulted in a 94% increase in total wRVU production (78% evaluation and management, 122% operative; p<0.05) for ACS, whereas general surgery wRVU production increased 8% (-15% evaluation and management, 14% operative; p<0.05). Operative productivity was substantial after transition to ACS, with 129% and 44% increases (p<0.05) in operative and elective case load, respectively. Decline in overall general surgery operative volume was attributed to reduction in emergent cases. Establishment of the ACS model necessitated one additional FTE. Job satisfaction substantially improved with the ACS model while allowing general surgery a more focused practice.
The ACS practice model significantly enhances provider productivity and job satisfaction when compared with trauma alone. Fears of a productivity impact to the nontrauma general surgeon were not realized.
创伤外科正迅速发展，向急性护理外科（ACS）模式转变。一些普通外科医生认为ACS的正式发展对他们的业务构成威胁。我们试图评估在一所一级大学创伤中心新设立的ACS部门对科室生产力和医疗服务提供者满意度的影响。
对一所一级大学创伤中心设立ACS部门前后的年度工作相对价值单位（wRVU）生产力、手术量和全时当量（FTE）进行为期两年的回顾性分析。使用10分制衡量医疗服务提供者的满意度。使用Microsoft Excel进行分析，p值小于0.05具有统计学意义。
转变为ACS模式后，ACS的总wRVU产出增加了94%（评估和管理增加78%，手术增加122%；p<0.05），而普通外科的wRVU产出增加了8%（评估和管理减少15%，手术增加14%；p<0.05）。转变为ACS模式后手术生产力大幅提高，手术病例量和择期病例量分别增加了129%和44%（p<0.05）。普通外科手术总量的下降归因于急诊病例的减少。ACS模式的建立需要额外增加一个全时当量。ACS模式使工作满意度大幅提高，同时使普通外科的业务更加专注。
与单纯创伤模式相比，ACS实践模式显著提高了医疗服务提供者的生产力和工作满意度。对非创伤普通外科医生生产力产生影响的担忧并未成为现实。
