DeGirolamo Kristin, Murphy Patrick B, D'Souza Karan, Zhang Jacques X, Parry Neil, Haut Elliott, Leeper W Robert, Leslie Ken, Vogt Kelly N, Hameed S Morad
Am Surg. 2017 Dec 1;83(12):1438-1446.
In recent years, significant workload, high acuity, and complexity of emergency general surgery conditions have led hospitals to replace the traditional on-call model with dedicated acute care surgery (ACS) service models. A systematic search of Ovid, EMBASE, and MEDLINE was undertaken to examine the impact of ACS services on health-care delivery processes and cost, education, and provider satisfaction. From 1827 papers, reviewers identified 22 studies that met inclusion criteria and subsequently used The Evidence-Based Practice for Improving Quality method and Newcastle-Ottawa Scale to score quality and level of evidence. Most studies found an increase in daytime operating, improved patient transit from emergency department to operating room to home, and decreased length of stay. Higher and more diverse case volumes improved resident education and operative experience. ACS services enhanced the educational experience of residents on subspecialty services by offloading emergency work from those services. Finally, surgeons generally felt that ACS services improved job satisfaction, productivity, and billing. The ACS model has demonstrated improvement in timeliness of care, diversified case mix, decreased costs, improved trainee learning, and increased surgeon job satisfaction.
近年来，急诊普通外科手术的工作量大、病情严重程度高且复杂，促使医院用专门的急性护理手术（ACS）服务模式取代传统的随叫随到模式。我们对Ovid、EMBASE和MEDLINE进行了系统检索，以研究ACS服务对医疗服务提供流程、成本、教育及医护人员满意度的影响。评审人员从1827篇论文中筛选出22项符合纳入标准的研究，随后使用循证实践改进质量方法和纽卡斯尔-渥太华量表对证据质量和水平进行评分。大多数研究发现日间手术量增加，患者从急诊科到手术室再到家的转运情况得到改善，住院时间缩短。更高且更多样化的病例数量提升了住院医师的教育水平和手术经验。ACS服务通过减轻专科服务中的急诊工作负担，增强了住院医师在专科服务方面的教育体验。最后，外科医生普遍认为ACS服务提高了工作满意度、工作效率和计费水平。ACS模式已在护理及时性、病例组合多样化、成本降低、学员学习效果改善以及外科医生工作满意度提高等方面有所体现。
