Department of Surgery, Wake Forest University, Winston-Salem, NC 27157, USA.
J Am Coll Surg. 2012 Apr;214(4):531-5; discussion 536-8. doi: 10.1016/j.jamcollsurg.2011.12.045. Epub 2012 Mar 6.
The creation of an acute care surgery service provides a rich operative experience for acute care surgeons. Elective surgeons typically have concerns about whether their practice volume will be restored with elective cases. Acute care surgery has financial implications for both groups. The aim of this project is to examine the impact in terms of work relative value units (wRVUs), collections, and cases in both groups with creation of an acute care surgery service at our institution.
Work RVUs, collections, and case volume were examined from departmental records for 2 groups before and after acute care surgery service creation. The service began on September 1, 2008. Before this time, emergency surgical consults went to the general surgeon on call. After this date, all emergency consults were seen by acute care surgeons.
The number of operations performed by the acute care surgery group increased significantly when the mean of the 2 years after institution of acute care surgery were compared with the mean of the 2 years preceding the service creation (1,639 vs 790/year; p = 0.007). There was no change in total operations done by the elective surgery group (2,763 vs 2,496/year: p = 0.13). Elective caseload, however, did increase by 23% in the elective surgery group. In the acute care surgery group, wRVUs increased by 140% and elective surgery group wRVUs decreased by 8%. Collections increased in both groups (acute care surgery 129%, elective surgery 7%) and the combined collections of the groups increased by $2,138,00 in the year after service creation.
Acute care surgery service creation took emergency business from the elective surgery group, but this was almost immediately replaced with elective cases. This resulted in higher collections for both groups and a resultant significant increase in collections in aggregate.
创建急性护理外科服务为急性护理外科医生提供了丰富的手术经验。择期手术医生通常担心他们的手术量是否会随着择期手术而恢复。急性护理外科对两组都有财务影响。本项目的目的是检查在我院创建急性护理外科服务后，两组在工作相对价值单位（wRVU）、收入和病例方面的影响。
在创建急性护理外科服务前后，从科室记录中检查了两组的工作 RVU、收入和病例量。该服务于 2008 年 9 月 1 日开始。在此之前，紧急手术咨询由值班普外科医生处理。在此日期之后，所有紧急咨询都由急性护理外科医生处理。
当将急性护理外科服务创建后 2 年的平均值与服务创建前 2 年的平均值进行比较时，急性护理外科组的手术数量显著增加（1639 与 790/年；p=0.007）。择期手术组的总手术量没有变化（2763 与 2496/年；p=0.13）。然而，择期手术组的择期病例数增加了 23%。在急性护理外科组，wRVU 增加了 140%，而择期手术组的 wRVU 减少了 8%。两组的收入都有所增加（急性护理外科组增加了 129%，择期手术组增加了 7%），服务创建后一年，两组的总收入增加了 213.8 万美元。
创建急性护理外科服务从择期手术组手中抢走了急诊业务，但这几乎立即被择期手术取代。这导致两组的收入都有所增加，总收益也显著增加。
