当前急症外科医生劳动力状况：实地视角。
The current State of the acute care surgery workforce: A boots on the ground perspective.
机构信息
Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
出版信息
Am J Surg. 2018 Dec;216(6):1076-1081. doi: 10.1016/j.amjsurg.2018.08.023. Epub 2018 Sep 8.
BACKGROUND
Acute care surgery (ACS) was proposed to address a general surgery workforce crisis; however, the ACS workforce composition is unknown. A national survey was conducted to determine the differences in the emergency general surgery (EGS) workforce between ACS and non-ACS hospitals.
METHODS
The American Hospital Association (AHA) Annual Survey of Hospitals database was queried to identify acute care general hospitals. A hybrid mail/electronic survey was sent to 2811 acute care hospitals that met the inclusion criteria of hospitals that care for adult patients (≥18 years old) with an emergency room (ER), ≥ 1 operating room (OR), and 24-h ER access. Hospitals were queried on whether they utilized an ACS model. The workforce composition among ACS and non-ACS hospitals was evaluated using X tests, t tests, and Wilcoxon rank-sum tests.
RESULTS
Survey response was 60% (N = 1690). ACS hospitals had a higher proportion of emergency surgeons who were female (20% vs. 14%, p < 0.0001), newly-trained (17% vs 10%, p < 0.0001), critical care trained (78% vs. 31%, p < 0.0001), and who had an additional degree (35% vs. 13%, p < 0.0001). More ACS hospitals had 24/7 in-house OR nursing staff (72% vs. 15%, p < 0.0001) and ancillary staff.
CONCLUSIONS
ACS and non-ACS hospitals differ in their surgical workforce. It is clear that ACS hospitals have more human capital, which suggests that ACS hospitals may require more dedicated resources compared to non-ACS hospitals.
背景
急性护理外科（ACS）的提出是为了应对普通外科医生劳动力危机；然而，ACS 劳动力的构成情况尚不清楚。进行了一项全国性调查，以确定 ACS 和非 ACS 医院之间的急诊普通外科（EGS）劳动力之间的差异。
方法
查询美国医院协会（AHA）年度医院调查数据库，以确定急性护理综合医院。向符合纳入标准的 2811 家急性护理医院发送了混合邮件/电子调查，这些医院收治成年患者（≥18 岁），有急诊室（ER）、≥1 个手术室（OR）和 24 小时 ER 通道。调查医院是否采用 ACS 模式。使用 X 检验、t 检验和 Wilcoxon 秩和检验评估 ACS 和非 ACS 医院之间的劳动力构成。
结果
调查回应率为 60%（N=1690）。ACS 医院中女性急诊外科医生的比例更高（20%比 14%，p<0.0001），新培训（17%比 10%，p<0.0001）、重症监护培训（78%比 31%，p<0.0001）和拥有额外学位（35%比 13%，p<0.0001）的比例更高。更多的 ACS 医院拥有 24/7 内部 OR 护理人员（72%比 15%，p<0.0001）和辅助人员。
结论
ACS 和非 ACS 医院的外科劳动力存在差异。很明显，ACS 医院拥有更多的人力资本，这表明与非 ACS 医院相比，ACS 医院可能需要更多的专用资源。
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